Vomiting can be an indication of low salt (with no illness ... salt-losing crisis). Also, since steroids can mask infections, etc. ... vomiting can indicate that an adrenal crisis is occuring inside their little bodies. Vomiting is often the first sign of an adrenal crisis (according to lots of literature). So, we never know if some illness, that has yet or never even to show a fever or any other symptoms, is brewing inside their little bodies. Seems all the literature popping up on the internet regarding handling illnesses for CAH, says double or triple the dose in ANY vomiting. Tripling or more provides for mineralcortoid properties, i.e. the florinef. And since the meds may not be absorbed in any vomiting or diarrhea illnesses EVEN when held down for an hour or several hours (may be just sitting in their tummy or going right through) ... then best the IM, with constant watch for the need for hospital IV fluids. Drowsy child may mean low blood glucose (i.e. that can turn into seizures, coma then to death within a few hours).