What Should Be in a CAH Emergency Kit for Your Child?

Your child’s congenital adrenal hyperplasia (CAH) emergency kit must include unexpired injectable hydrocortisone (such as Solu-Cortef), syringes, needles, alcohol swabs, a clinician-completed action card, an emergency medical letter, and your care team’s contact information. This kit is a vital safety tool that must travel everywhere your child goes, and every caregiver must be trained to use it.

Emergency Action Sequence

If your child shows signs of an adrenal crisis (a dangerous, life-threatening shortage of cortisol) such as persistent vomiting, inability to keep oral medication down, severe weakness, unusual sleepiness, or collapse, follow your child’s written plan immediately. The standard emergency sequence is:

1. Inject: Give the prescribed intramuscular (into the muscle) hydrocortisone injection immediately ^[1]. Do not wait for an ambulance to give the injection.
2. Call: Call emergency services (911) right away. Tell the dispatcher your child has CAH (adrenal insufficiency), has received emergency hydrocortisone, and requires urgent medical evaluation.
3. Evaluate: Take your child, the emergency kit, and the medical letter to the emergency room. The injection is a temporary, life-saving measure; it does not replace a full medical assessment, IV fluids, or further monitoring.

Medication and Supplies

Your child’s kit must contain exactly what is needed to manage a crisis until medical help takes over. Include:

• Injectable hydrocortisone: A glucocorticoid (cortisol-replacement steroid) often prescribed as a vial of powder and liquid that must be mixed right before use (e.g., Solu-Cortef) ^[1].
• Syringes and needles: The exact sizes prescribed for drawing up and injecting the medication. Include extra supplies in case a needle is dropped or bent.
• Alcohol swabs: To clean the injection site.
• Laminated Action Card: A customized, easy-to-read card stating your child’s specific dose, mixing steps, injection instructions, and clear rules on when to use oral stress-dosing (giving extra oral medication during illness) versus when to use the emergency injection.

Medical Documents and Contact Info

• Emergency medical letter: An up-to-date, signed letter from your child’s endocrinologist ^[1]. It should list your child’s weight, daily medications (including fludrocortisone, if applicable), allergies, exact emergency injection instructions, and clinician contact details.
• Emergency contacts: A clear list of numbers including local emergency services, the endocrinologist, the pediatrician, and trusted family members ^[1].
• Medical alert identification: While worn on the body rather than kept in the kit, your child should have a medical ID (like a bracelet or necklace) stating “CAH/Adrenal Insufficiency – Needs emergency hydrocortisone” ^[2].

Storage, Training, and Access

• Safe Storage: Follow the pharmacist’s instructions for temperature and light. Never leave the kit in a freezing car or a hot vehicle. Check expiration dates regularly and replace vials before they expire.
• Caregiver Training: Simply having a kit is not enough. Anyone supervising your child—teachers, daycare staff, babysitters, and relatives—must receive hands-on training on how to mix and give the injection. Schools should have a documented action plan on file.
• Always Close By: Adrenal crises can escalate quickly from common infections or stomach bugs ^[3]. Research indicates that parents sometimes miss the window to administer stress-dose medication before seeking emergency care ^[4]. Because delayed treatment can lead to severe or fatal outcomes ^[5], the kit must physically travel with your child at all times, with backup kits safely stored at home and school.