Caring for a child with congenital adrenal hyperplasia (CAH) often involves addressing unique challenges related to how well their body manages physical stress, weight gain, salt, and water balance. No special diet cures CAH, but the right food choices can help manage symptoms and support overall health.
This article explains how CAH affects the body and suggests six food groups to consider in your child’s diet. There’s no single “best” diet for young children with CAH, and research on this topic is limited. It’s important to talk with a nutritionist or dietitian to find the best plan for your child’s needs.
Congenital adrenal hyperplasia is a group of genetic conditions that affect how hormones are made in the adrenal glands. These glands produce cortisol, aldosterone, and androgens — hormones that help manage stress, regulate salt and water levels, and support growth and development.
In some types of CAH, the adrenal glands don’t make enough aldosterone, which is needed to keep the body’s salt and water in balance. Without enough aldosterone, the body can lose too much sodium, leading to dehydration and low blood pressure. This is called “salt-wasting” CAH. Children with salt-wasting CAH often need extra salt in their diet. A doctor can help decide how much is needed, as too much salt can be harmful.
Glucocorticoid medication, a type of steroid, is often used to manage CAH. However, using these medications for a long time can weaken bones by lowering bone density, raising the risk of osteoporosis. To help lower this risk, it’s important to get enough vitamin D and calcium.
A diet with essential nutrients can help support adrenal health, bone health, and overall growth. Here are six food categories that might help.
In salt-wasting CAH, especially, the body loses too much sodium, which can lead to dehydration and low blood pressure. To prevent this, healthcare providers may recommend adding more naturally salty foods (such as broth-based soups) and salted snacks (like pretzels or crackers) to the diet.
Newborns with salt-wasting CAH need salt supplements to stay healthy. Your child’s doctor will help find the right balance.
Calcium is an essential mineral that helps build strong bones and teeth, supports muscle movement, and keeps nerves working properly. All children need enough calcium to develop a healthy skeleton, but it’s especially important for those with CAH. Long-term glucocorticoid therapy can weaken bones, especially by adulthood, so getting enough calcium from an early age helps keep bones strong and decreases the risk of slow growth or weak teeth.
Here are some calcium-rich options:
Note that adding too much calcium can lead to constipation or kidney stones or interfere with the absorption of other essential minerals like iron. A balanced approach is generally safer.
Vitamin D helps the body absorb calcium, which is essential for building and maintaining strong bones. This vital nutrient also supports the immune system and helps reduce inflammation. Without enough vitamin D, children may be at risk of rickets (a condition that weakens bones) or poor bone growth.
Children with CAH who take steroids may need extra vitamin D to prevent bone loss and help the body absorb calcium.
Here are some vitamin D-rich options to include in your child’s diet:
Eating a variety of colorful fruits and vegetables is important for overall health. Fruits and vegetables provide vitamins and minerals, as well as antioxidants, which protect cells from damage caused by harmful molecules called free radicals. These nutrients help keep the immune system strong. They also support healthy growth and provide energy.
Examples of nutrient-packed produce include:
When choosing fruits and vegetables for your child, variety is key. Fresh produce is great, but frozen and canned (with no added salt or sugar) options are convenient and nutritious as well.
Whole grains give the body steady energy and important nutrients like fiber and B vitamins. This can help children with CAH stay healthy and feel their best.
Unlike refined grains, whole grains keep all parts of the kernel, providing fiber and nutrients that support digestion, metabolism, and blood sugar control. Whole grains are also a good source of B vitamins, like B6 and folate, which help turn food into energy and support brain health and red blood cell production.
Examples of whole grains include:
Protein is key for growth and tissue repair. Lean options, like skinless chicken or beans, are healthier than processed meats like hot dogs or bacon because they have less unhealthy fat.
Some great lean protein options include:
Drinking enough water and fluids is critical for children with CAH, especially those with salt-wasting forms. Sodium and water help keep blood pressure steady, prevent dehydration, and support overall health. Without enough fluids, the body can’t keep electrolytes balanced or properly manage physical stress.
Here are some tips for staying hydrated:
Eating a variety of healthy foods is important for overall health, but it can’t replace the medical care needed for CAH. Medications like hydrocortisone, fludrocortisone, or other hormone replacements are vital for CAH management. Working with your child’s healthcare provider or a registered dietitian can help you create a plan that meets their nutrition needs and supports their growth with CAH.
On CAHteam, people share their experiences with congenital adrenal hyperplasia, get advice, and find support from others who understand.
Do you have nutrition advice for other parents and caregivers of children with CAH? Let others know in the comments below.
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