Caring for a child with congenital adrenal hyperplasia (CAH) often involves addressing unique challenges related to their body’s ability to manage stress, salt, and water balance. There’s no special diet that cures CAH. However, choosing the right foods can help manage symptoms and support overall health.

This article explains how CAH affects the body and suggests six food groups for your young children’s diet. There is no single “best” diet for children with CAH, and research on this topic is limited. It’s important to talk to a nutritionist or dietitian to find the best plan for your child’s needs.

How CAH Affects Adrenal Function

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, which can increase the risk of osteoporosis. To help lower this risk, it’s important to get enough vitamin D and calcium.

6 Food Groups To Include in Your Child’s CAH Diet

A diet with essential nutrients can help support adrenal health, bone health, and overall growth. Here are six food categories that might help.

1. Foods High in Sodium (When Advised)

For children with salt-wasting CAH, their bodies lose too much sodium, which can lead to dehydration and low blood pressure. To prevent this, healthcare providers may recommend adding extra salt to their diet. Examples include:

• Breast milk (if you are breastfeeding) or formula with added salt
• Lightly salted baby food or snacks like pretzels or crackers
• Naturally salty foods, such as broth-based soups

Newborns with salt-wasting CAH usually need salt supplements to stay healthy. Since too much sodium can lead to high blood pressure and fluid retention, your child’s doctor will help find the right balance.

2. Calcium-Rich Foods

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, so getting enough calcium helps keep bones strong and lowers the risk of slow growth or weak teeth.

Here are some calcium-rich options:

• Dairy products — Milk, yogurt, and cheese are good sources of calcium. Choose low-fat or fat-free versions for older children, since whole milk has more saturated fat, which can be unhealthy in large amounts.
• Fortified plant-based milk — Soy milk, almond milk, or oat milk with added calcium can be good alternatives for children who can’t have dairy.
• Other calcium sources — Calcium is naturally found in foods like leafy greens (such as kale and bok choy), tofu made with calcium sulfate, canned fish with bones (like sardines or salmon), and foods with added nutrients like cereal and orange juice.

When adding calcium to your child’s diet, note that too much can lead to constipation, kidney stones, or interfere with the absorption of other essential minerals like iron. A balanced approach is generally safer.

3. Foods With Vitamin D

Vitamin D is a vital nutrient that helps the body absorb calcium, which is essential for building and maintaining strong bones. It 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:

• Fortified foods — Many dairy products, soy milk, almond milk, and some cereals are fortified with vitamin D.
• Egg yolks — These are a simple and natural source of vitamin D that can be easily added to meals.
• Fatty fish — Salmon, mackerel, and sardines are excellent sources of vitamin D and healthy fats.
• Other sources — Some mushrooms exposed to ultraviolet light contain vitamin D, and supplements may help if a child isn’t getting enough from food or sunlight.

4. Colorful Fruits and Vegetables

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 to include are:

• Berries and citrus fruits — These are rich in vitamin C, which supports the immune system and helps the body heal.
• Leafy greens (like spinach and kale) and broccoli — These are high in calcium, along with vitamin K and magnesium, all of which are important for bone health.
• Orange and yellow vegetables (like carrots, sweet potatoes, and bell peppers) — These types of veggies are loaded with beta-carotene, which supports vision and skin health.
• Tomatoes and red bell peppers — These contain lycopene, a powerful antioxidant that helps protect cells and support heart health and brain function.

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.

5. Whole Grains

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 to include are:

• Brown rice, quinoa, and whole-wheat bread — These healthy staples can be eaten with meals or as snacks.
• Oatmeal and whole-grain cereals — These are high in fiber and often fortified with additional nutrients like iron or B vitamins. Be sure to check labels for added sugar.
• Other options — Whole-grain pasta, farro, bulgur, or barley can add variety to meals.

6. Lean Proteins

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:

• Eggs — Packed with high-quality protein and essential vitamins like B12, eggs are versatile and easy to prepare.
• Lean meats — Skinless chicken, turkey, or lean cuts of beef offer high-quality protein and important nutrients like iron and zinc.
• Legumes — Foods such as beans, peas, lentils, and peanut butter are excellent plant-based protein sources, offering fiber, magnesium, and iron.
• Other plant-based options — Tofu, edamame, and quinoa are nutritious options that fit different dietary preferences.

The Importance of Hydration

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 stress hormones.

Here are some tips for staying hydrated:

• Encourage drinking water throughout the day, especially during hot weather or physical activity.
• Ensure that infants receive enough breast milk, formula, or doctor-recommended fluids.
• Avoid sodas and other sugary or caffeinated drinks, which can worsen dehydration.
• Encourage foods with high water content, such as strawberries, watermelon, lettuce, and spinach.

Work With Your Child’s Doctor

Eating a variety of healthy foods is important for overall health, but it cannot replace the medical treatment 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.

Talk With Others Who Understand

On CAHteam, the site for individuals with congenital adrenal hyperplasia and their loved ones, people come together to gain a new understanding of CAH and share their stories with others who understand life with the condition.

What nutrition advice can you share with other parents and caregivers of children with CAH? Share your questions, experiences, and insights in the comments below.