What is the dose of epinephrine (adrenaline) for anaphylaxis in a child?

From the Guidelines

The recommended dose of epinephrine for anaphylaxis in children is 0.01 mg/kg of 1:1000 (1 mg/mL) solution, administered intramuscularly into the anterolateral thigh, with a maximum single dose of 0.3 mg for children 1. The dose may be repeated every 5-15 minutes if symptoms persist or worsen. For convenience, auto-injectors come in fixed doses, but the specific dose should be determined based on the child's weight, with a dose of 0.01 mg/kg up to a maximum of 0.3 mg for children 1. After administering epinephrine, the child should be placed in a supine position with legs elevated unless respiratory distress is present, and emergency medical services should be called immediately. Epinephrine works rapidly by constricting blood vessels, increasing blood pressure, relaxing bronchial smooth muscles, reducing mucosal edema, and suppressing inflammatory mediator release. Some key points to consider when administering epinephrine for anaphylaxis in children include:

• The importance of prompt administration of epinephrine in the event of anaphylaxis, as delayed treatment can increase the risk of morbidity and mortality 1
• The need for careful consideration of the child's weight and medical history when determining the appropriate dose of epinephrine 1
• The importance of monitoring the child closely after administering epinephrine and being prepared to provide additional doses if necessary 1 Secondary treatments may include antihistamines and corticosteroids, but these should never replace or delay epinephrine administration as they do not treat the life-threatening aspects of anaphylaxis 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Anaphylaxis: Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0. 5 mL) intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary ( 2) Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0. 3 mL), intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary ( 2)

The dose of epinephrine for anaphylaxis in children is:

• For children 30 kg (66 lbs) or more: 0.3 to 0.5 mg intramuscularly or subcutaneously
• For children 30 kg (66 lbs) or less: 0.01 mg/kg, up to 0.3 mg intramuscularly or subcutaneously 2

From the Research

Anaphylaxis Dose in Children

• The recommended dose of adrenaline (epinephrine) for anaphylaxis in children varies based on weight 3, 4, 5.
• For infants and children weighing 7.5-10 kg, a 0.15 mg adrenaline injector device may be prescribed 3.
• For children over 20 kg, the recommended dose is 0.3 mg 3, 4.
• Different doses and needle lengths are available for pediatric and adult patients, especially obese patients, to ensure intramuscular delivery in the thigh 4.
• The administration of an appropriately low epinephrine dose due to the limitations imposed by the availability of only two fixed-dose auto-injectors (EpiPen Jr 0.15 mg or EpiPen 0.3 mg) can be a concern 5.
• Additional fixed-dose formulations of epinephrine are needed to facilitate optimal first-aid dosing in patients of all ages and sizes 5.

Administration and Dosage Considerations

• Epinephrine should be administered intramuscularly, with the preferred route being the thigh 4, 6.
• The dose of epinephrine should be administered promptly, as failure to do so can result in fatalities 4, 5.
• A second dose of epinephrine may be required in some cases where symptoms of anaphylaxis fail to resolve following an initial dose 7.
• Education about anaphylaxis and prompt treatment are critical for patients and their caregivers 4.