Child anaphylaxis: IM adrenaline 🚨 👶
🚨 👶 PAEDIATRIC HIGH ALERT — EDUCATIONAL DRAFT, NOT A PRESCRIBING ORDER. Drug choice, indication, formulation, dose, route and monitoring require current BNF/BNFC, product SmPC and local NHS protocol. Source reviewed 3 November 2026; independent clinical/pharmacy sign-off pending.
🧬 Mechanism and reason for use
- IM adrenaline stimulates alpha-1, beta-1 and beta-2 receptors, reversing airway oedema, bronchospasm and vasodilatation.
- Sudden life-threatening airway/breathing/circulation features of anaphylaxis in a child; skin signs may be absent.
💊 Indication-specific UK regimen / dosing boundary
- IM ONLY; adrenaline 1 mg/mL (1:1000) into anterolateral thigh, RCUK anaphylaxis age bands:
- Age under 6 months: 100–150 micrograms (0.10–0.15 mL); 6 months to 6 years: 150 micrograms (0.15 mL); 6–12 years: 300 micrograms (0.30 mL); over 12 years: 500 micrograms (0.50 mL).
- Repeat IM dose after 5 minutes if inadequate response; refractory symptoms after two appropriate IM doses require specialist refractory-anaphylaxis pathway.
🔎 Before writing a prescription
- Immediately summon paediatric resuscitation help and assess ABCDE; check correct concentration and IM versus IV route.
🧪 Monitoring and reassessment
- Continuous clinical reassessment: airway, work of breathing, BP, ECG, SpO₂.
🚨 Serious pitfalls / when to escalate
- Do not use cardiac-arrest IV adrenaline concentration or dose as an anaphylaxis IM protocol.
- Do not delay IM adrenaline while waiting for antihistamines or corticosteroids.
📖 UK reference documents
Editorial status: Source checked for the specific statements above on 3 November 2026. References may be updated. This card has not had formal independent pharmacist/consultant approval; no unlisted indications, paediatric extrapolation or automatic renal-dose adjustments are implied.
