Northern Light Pediatrics-Newsletter

Know how to use epinephrine during a child's allergic reaction

When a child is having a severe allergic reaction, or anaphylaxis, parents need to reach quickly for an EpiPen, Twinject, or other self-injectable epinephrine product prescribed by their physician, and use it with confidence. It might save the child's life.

Yet a recent survey of parents of children with food allergies reveals most parents were uncomfortable administering their EpiPen: They were afraid they wouldn't recognize the signs and symptoms of anaphylaxis and feared hurting their children or forgetting how to use the device in an emergency. The authors concluded that health care professionals should take every opportunity to train parents on how to use the EpiPen properly.

So how can you tell if a child is having a severe allergic reaction? Symptoms of anaphylaxis can include hives, shortness of breath, cough, wheezing, chest tightness, congestion, flushing of skin, nausea, vomiting, diarrhea and swelling of lips and tongue.

During a potentially dangerous reaction to foods, insect stings or bites, drugs or other substances, the injected epinephrine (adrenaline) acts quickly to open the airway, reduce throat swelling and maintain blood pressure.

Following are general directions for using an EpiPen (for patients 66 pounds or more) or EpiPen Jr (33-66 pounds). Always check with your doctor for instructions on the care, storage and handling of these products.

Remove the EpiPen from its storage tube. It will be used on the fleshy outer portion of the thigh (it's also OK to administer through clothes if necessary).
Make a fist around the auto-injector (black tip facing down). Don't remove the gray safety cap until you are ready to administer the device. Avoid placing your fingers over the black tip when removing the safety cap or after the safety cap has been removed.
With your other hand, pull off the gray safety release.
"Hold the black tip near the outer thigh, over the patient's clothing. Do not place your thumb over the end of the device.
Using a quick motion, swing and jab the device firmly into the thigh, until it clicks, so that the unit is perpendicular to the thigh (never inject into a vein or the buttocks). A spring-activated mechanism will inject the epinephrine. Hold the device firmly in place for about 10 seconds after activation then remove it from the thigh (the window on the injector will show red).
Finally, replace the used auto-injector needle-first into the storage tube of the carrying case.
Go to the nearest emergency department (ED) or call 911. Bring the auto-injector with you to the ED and inform the physician that epinephrine was used.

Most of the liquid (about 90%) stays in the auto-injector and can't be re-used. You will know the patient has received the correct dose of medication if the red flag appears in the window.

-Alyson Sulaski Wyckoff
-2005 American Academy of Pediatrics, December of 2005