I have almost lost my son 4 times due to an adrenal crisis. He is a severe salt waster and one of the times he hadn't even vomited or had diareah. He just wasn't feeling well and passed out in the car on the way to the ER. On anohter occasion, we had given him a shot late the night before and were told that if he was still not doing well by morning to rush him in before giving the shot. Just bring him right to the ER. Even though I checked on him regularly through the night, within 4 hours his extremeties were turning blue and I put him in the car and took him to the ER. The six hour rule didn't even work for us at that time. He was so dehydrated that they had to drill a hole into his bones to rehydrate him because his veins were flat from being dehydrated. We almost lost him that day. I will never wait again. If I feel that it is serious enough to give him the shot, I will rush him to the ER no matter what. Laurel,we have had to put my son in a Growth Hormone Study that is two hours away from us. They require that they are the head caregivers to my son so as to avoid conflict with his current ped endo and the hospital he is affiliated with. Due to our past experiences, we know that there may be cases that my son wouldn't survive the two hour ride, so we have maintained a relationship with his original hospital and the ER staff. Please keep that in mind when making your decision. So far it has worked out well for us. Good luck in you decision making. P.S. We do not double or triple dose for a cold unless there is a fever involved or he becomes lethargic.