No one likes feeling stressed, but for people of all ages living with the classic type of congenital adrenal hyperplasia (CAH), stress can trigger a serious condition called an adrenal crisis.

Parents of children with CAH want to avoid an adrenal crisis, so helping your child cope with physical stress is essential — not just now but also as they grow and learn to handle it on their own. Here’s what you need to know to help your child stay well.

How Does Stress Affect Children With CAH?

Cortisol is a hormone that helps the body respond to stress, such as illness or injury. People with CAH don’t make enough cortisol, so their bodies can’t handle stress the same way that other children’s bodies can.

An untreated adrenal crisis can be life-threatening. Without enough cortisol, a child may vomit, have severe diarrhea, get dehydrated, feel confused, or have seizures. Their blood pressure can drop quickly, leading to shock, which may cause coma or even death if not treated right away.

Stress Dosing and CAH

Your child’s pediatric endocrinologist will tell you how much hydrocortisone and other medications your child needs each day. If your child’s body doesn’t make enough aldosterone — a hormone that helps control salt and water balance — the doctor may also prescribe fludrocortisone, a medicine that acts like aldosterone.

The doctor may also tell you to give extra hydrocortisone when your child is under physical stress, such as having a fever, broken bone, head injury, surgery, or sickness with vomiting and diarrhea. This is called a “stress dose” because it’s given only when the body is under extra stress.

Stress dosing is a common part of CAH care. It’s important to understand when your endocrinology team wants you to give your child a stress dose, how much to give, and how to administer the medication. This helps make sure your child has the cortisol they need to get through an illness or injury without an adrenal crisis.

What Are Signs of Stress in Children With CAH?

Children with CAH may show many of the same signs of stress as other kids. However, physical stress — like illness or injury — can be especially challenging for them. Their bodies may not respond the same way as other children’s, making recovery harder.

A child with CAH who’s under physical stress may:

• Get sick more often
• Sleep more than usual
• Seem irritable or angry for no clear reason
• Ignore their usual tasks or responsibilities
• Change their usual patterns of behavior, such as suddenly not wanting to leave the house or not following directions as well

If you notice any of these signs, especially several at once, your child may be under too much stress. It’s important to tell your child’s endocrinology team about these changes. They may want to check if your child’s steroid dose needs to be changed or if stress dosing is required.

Although extra medication isn’t given for emotional stress, it could be beneficial for managing stress in general. Some of the stress management techniques listed below may also help.

Stress Management Strategies for Children

There are many ways to help your child manage stress. Keeping a consistent routine, encouraging relaxation techniques, and offering emotional support can all make a difference. Doing activities they enjoy, like reading, drawing, or playing outside, may also help lower stress levels.

Exercise and Outdoor Play

Getting at least 60 minutes of activity each day can help reduce stress for children aged 6 and older. Outdoor activities like playing in the yard, walking a pet, hiking, swimming, or participating in sports provide both exercise and a natural way to relieve stress.

Help your child find activities they enjoy, whether it’s dancing, biking, or simply running around outdoors. Being active and spending time in nature can boost mood, improve sleep, and build healthy habits for life.

Good Sleep Habits

It’s always important to get enough sleep, especially because sleep helps manage stress levels. Children aged 6 to 12 need about nine to 12 hours of sleep each night, and teens should get eight to 10 hours.

To help your child sleep better, try limiting screen time before bed and keeping phones and other devices out of the bedroom. Playing calming music or white noise may also help them fall asleep more easily.

Journaling

If your child is old enough to write, journaling may help them express their feelings and feel less stressed. They can use a notebook or computer, whichever they prefer.

Encourage your child to write about their day or how they feel about living with CAH. Describing positive experiences, like what they’re grateful for, may help improve their mood.

Muscle Relaxation

Tensing and releasing muscles one at a time can help lower stress levels. You can guide your child by telling them which muscles to squeeze and when to let go. Start at either the top of the body or the feet and work through each muscle group. This can help them focus and feel more relaxed.

Self-Care Tips for Parents

Caring for a child with CAH can be overwhelming, and your well-being matters, too. When you also prioritize your own physical and mental health, you’ll have more energy to support your child. Try these self-care tips:

• Use stress management techniques — Practicing relaxation techniques, exercising, or journaling can help you stay balanced.
• Seek support — Joining a CAH parent support group or arranging help with child care can lighten your load.
• Model healthy coping — Children learn by watching you. Managing your own stress shows them how to handle theirs.

By prioritizing your well-being, you set the foundation for all family members to be healthier and more resilient.

Having a child, teen, or young adult with a serious diagnosis like CAH can be stressful. Supporting someone else’s emotional and physical health can wear you down over time. Remember, being a caregiver can be hard — and it’s OK to ask for help.

Talk With Others Who Understand

On CAHteam, people share their experiences with congenital adrenal hyperplasia, get advice, and find support from others who understand.

Do you expend a lot of effort managing your child’s stress because of CAH? What has worked best for you? Share your thoughts in the comments below.