Allergies in children: Giving an epinephrine shot to a child

There are some important things to think about before you give the shot:

• The shot does not replace the need to be seen by a doctor. After giving your child the shot, seek emergency medical care. Symptoms of a severe allergic reaction can return or get worse after an epinephrine shot.
• The shot should only be injected into the side of the thigh. Do not give the shot into a buttock or a vein.
• Be familiar with the symptoms of a severe allergic reaction. If your child feels or you observe the symptoms coming on, act quickly. The sooner the shot is given, the better the chances of a good outcome.
• If your child is not able to be still, get someone to hold the child while you give the shot. If you are alone, put the child down on his or her back and lay your upper body across the child's body. Use one hand to hold the child's leg while you give the shot with the other hand.

It is also important to:

• Have an allergy kit near your child at all times. Keep one at home and one at school or day care. An older child can wear a fanny pack with the kit in it.
• Keep two epinephrine shots in each kit in case a second shot is needed.
• Always have your child wear a medical alert bracelet to let others know about the allergies.
• Make sure your child's school administrators, teachers, babysitters, and friends know how to give your child the shot and to call 911 after giving the shot. At school, stress the need for the kit to be with your child, not locked away where it could not be reached quickly.
• Explain to your child why the shot is necessary, how it helps, and what you will do when the shot is needed. It may help to show the child what will happen. You can get an epinephrine shot trainer from your pharmacist to use for practice.
• As soon as your child is old enough, teach him or her to give the shot and call for help.

Test Your Knowledge

1. All I have to do is give my child the shot.

   1. True

      This answer is incorrect.

      After giving your child a shot, you will still need to get your child emergency medical care. Symptoms of a severe allergic reaction can return or get worse after an epinephrine shot.

   2. False

      This answer is correct.

      After giving your child a shot, you will still need to get your child emergency medical care. Symptoms of a severe allergic reaction can return or get worse after an epinephrine shot.

An epinephrine shot can slow down or stop your child's allergic reaction. Epinephrine prevents the body from releasing the chemicals that cause an allergic reaction. Epinephrine relieves wheezing, breathing difficulties, and itching from hives. It helps keep blood pressure within a normal range and also reduces swelling that can occur in the hands, feet, eyelids, tongue, and throat.

If your child has had a serious allergic reaction in the past, his or her risk of having another is high. But people react differently when they are exposed to the allergen that causes their allergic reaction. It is important to get clear instructions from your doctor on when you should give your child an epinephrine shot.

An epinephrine shot comes as an automatic injector that is prefilled with one shot of epinephrine. It is made to be quick and simple to use.

Take care of your child's epinephrine shot:

• To protect it from light, keep the epinephrine shot in the tube provided until you are ready to use it.
• Store epinephrine shot at room temperature-15 °C (59 °F) to 30 °C (86 °F). Do not refrigerate.
• Check the expiration dates of the medicines in the allergy kit, and replace them as needed.
• Check the medicine in the epinephrine shot. It should be clear. If the solution is pinkish brown or has solid particles in it, the epinephrine shot should be replaced.

Test Your Knowledge

1. I should keep my child's allergy kit in my car so it is always handy.

   1. True

      This answer is incorrect.

      To work properly, epinephrine needs to be kept at room temperature. A car can get too hot. A better idea would be to keep one kit in your purse or briefcase, one at home, and one at your child's school.

   2. False

      This answer is correct.

      To work properly, epinephrine needs to be kept at room temperature. A car can get too hot. A better idea would be to keep one kit in your purse or briefcase, one at home, and one at your child's school.

1. Grasp the epinephrine shot injector in your hand with the black tip pointing down. Form a fist around the injector. Do not touch the black tip.
2. With the other hand, pull off the gray cap.
3. Hold the black tip close to your child's outer thigh. Press the black tip firmly into your child's thigh (through clothing if necessary). The injector should be at a 90-degree angle to the thigh.
4. Keep the injector in your child's outer thigh while you slowly count to 5.
5. Remove the injector, and rub the area where the medicine entered the skin.
6. Look at the black tip: If the needle is showing, your child received the dose. If not, you need to repeat steps 3 through 5. Note: It is normal for most of the liquid to be left in the injector. Do not try to inject the remaining liquid.
7. After the shot, push the needle against a hard surface to bend the needle back. Put the injector back in its case, needle first. Do not put the gray activation cap back on the injector.
8. Have your child take the antihistamine tablet in the allergy kit.

Your child should feel the effects of the medicine almost right away. These will include a rapid heartbeat and nervousness as well as improved breathing. The benefits of the shot usually last 10 to 20 minutes.

In some severe cases, you may need to give a second shot. Your doctor will explain when a second shot is needed. Make sure you understand, and ask questions if you are not sure. Too much epinephrine can cause serious side effects, such as difficulty breathing.

What do I do after I give the shot?

• Immediately call 911 . Tell the operator that you gave your child a shot and more epinephrine needs to be brought in the ambulance. Or if a hospital is close by, take your child to the emergency room. At the hospital, give the doctor or nurse the used injector. It will be checked and then disposed of properly.
• Your child will need to be observed in the hospital for at least 4 hours to make sure symptoms don't return. If your child is discharged from the hospital before this time is up, sit in the waiting room. Do not count on being able to get back in time.
• If your child has any heart problems, be sure to tell the doctor or nurse.

Test Your Knowledge

1. I don't feel comfortable giving my child a shot. If she has an allergic reaction, I can just take her to the hospital.

   1. True

      This answer is incorrect.

      Your child was prescribed an allergy kit because she is at risk for a dangerous allergic reaction. Symptoms can come on within seconds and quickly become life-threatening. If your child has a reaction, she cannot wait until you get to a hospital to be treated. You must give her the shot right away. Luckily, giving the shot is easy.

   2. False

      This answer is correct.

      Your child was prescribed an allergy kit because she is at risk for a dangerous allergic reaction. Symptoms can come on within seconds and quickly become life-threatening. If your child has a reaction, she cannot wait until you get to a hospital to be treated. You must give her the shot right away. Luckily, giving the shot is easy.

If you have any questions about giving your child an epinephrine shot or about when to give a second shot, discuss them with your doctor. It is important to know how to administer an epinephrine shot before you need it.