Anaphylaxis Treatment in Infants

Introduction to Anaphylaxis Treatment

The American Academy of Pediatrics recommends that in a life-threatening anaphylactic emergency when no other epinephrine is available, an adult EpiPen (0.3 mg) can be given to a baby, as the risk of death from untreated anaphylaxis far exceeds the risk of epinephrine overdose 1, 2

The recommended epinephrine dose for anaphylaxis in children is 0.01 mg/kg, up to a maximum of 0.3 mg, according to the American Academy of Pediatrics 1, 2, 3
For a 5 kg baby, the appropriate dose would be 0.05 mg, which is significantly lower than the 0.3 mg delivered by an adult EpiPen 1
This represents a 6-fold overdose when using an adult EpiPen for a 5 kg baby 1, 2

If EpiPen Jr (0.15 mg) is available, it should be used for babies and small children, even though it may still represent an overdose for very small infants, as recommended by the American Academy of Pediatrics 1, 2, 3
If only an adult EpiPen (0.3 mg) is available, it should be administered without hesitation if the baby is experiencing anaphylaxis, as the mortality risk from untreated anaphylaxis exceeds the risk from epinephrine overdose 1, 2

The American Academy of Pediatrics recommends injecting epinephrine into the anterolateral aspect of the mid-thigh (vastus lateralis muscle), which can be done through clothing if necessary 3
Monitoring for adverse effects such as pallor, tremor, elevated blood pressure, and tachycardia is crucial after epinephrine administration 1, 2

The American Academy of Pediatrics studied parents who were trained to draw up precise epinephrine doses from vials using syringes and found that dosing accuracy was poor, with a nearly 40-fold variation in the epinephrine content 1, 2
Delaying epinephrine administration to calculate exact doses or find alternative formulations during an anaphylactic emergency is not recommended by the American Academy of Pediatrics 1, 3
The intramuscular route into the lateral thigh achieves peak plasma concentrations in 8±2 minutes, making it the preferred route for first-aid treatment, as recommended by the American Academy of Pediatrics 2, 3