I provide adrenaline auto-injector training to every family whose child I prescribe one to at Pratiksha Rainbow Children's Hospital, Guwahati, because the auto-injector is only effective if the person using it can do so correctly and without hesitation in a frightening situation. Let me explain the steps clearly. Remove the cap from the auto-injector, which reveals the needle tip at one end. Place the auto-injector firmly against the outer mid-thigh, which is the fleshy part of the thigh on the side, not the inner thigh and not the buttock. The outer mid-thigh is used because it has sufficient muscle mass for rapid absorption and is accessible through clothing: you do not need to remove trousers or a school uniform before giving the injection. Press the auto-injector down firmly until you hear or feel a click. Hold it firmly in place for a full ten seconds. This ensures the full dose is delivered into the muscle. Then remove the device and massage the area briefly. The child should begin to feel some improvement within minutes. After giving the adrenaline, call 108 immediately: every child who has received an adrenaline auto-injector for anaphylaxis must be taken to hospital for observation even if they appear to be recovering, because a biphasic reaction, a second wave of anaphylaxis that can occur hours later, is a recognised risk that requires monitoring. I also advise every family to carry two auto-injectors at all times, because in some cases a single dose is not sufficient to fully reverse the anaphylaxis and a second dose is needed before emergency services arrive. If there is no improvement within five to fifteen minutes and a second auto-injector is available, use it. Device-specific technique differs slightly between brands, and I review the exact technique for the specific device prescribed at every consultation.
Written by Dr. Nayan Mani Deka, MBBS, MD (Paediatrics), Diploma in Allergy and Asthma (CMC Vellore), Certified PALS, APLS, NSSK, Consultant Paediatrician, Asthma Allergy Specialist and Immunotherapist, Pratiksha Rainbow Children's Hospital, VIP Road, Borbari, Guwahati, Assam 781036. Phone: +91 9436732863 / +91 6000714825 / +91 8812866239.
Related reading:
Anaphylaxis in Children: How to Recognise It and What to Do in the First Five Minutes
Pediatric Allergy: Focus on Food Allergy and Anaphylaxis
