Should the injection site be rubbed after administering an intramuscular (IM) vaccine to a child?

Intramuscular Vaccine Administration: Do Not Rub the Injection Site

Firm pressure should be applied to the injection site after administering an intramuscular vaccine to a child, without rubbing, for at least 2 minutes. 1 Rubbing the injection site after vaccination is not recommended and may increase the risk of local reactions.

Proper Technique for Post-Injection Care

When administering intramuscular vaccines to children, the following post-injection care is recommended:

• Apply firm pressure: After needle withdrawal, apply firm pressure to the site
• Avoid rubbing: Do not rub the injection site as this can increase local irritation
• Duration: Maintain pressure for at least 2 minutes
• Purpose: This helps prevent hematoma formation and reduces bleeding

Special Considerations for Children with Bleeding Disorders

For children with bleeding disorders or those on anticoagulant therapy:

• Use a fine needle (23 gauge or smaller)
• Apply firm pressure to the site, without rubbing, for at least 2 minutes 1
• Instruct parents about the risk of hematoma formation
• Consider scheduling vaccination shortly after antihemophilia therapy if applicable

Anatomical Considerations for Intramuscular Injections

The proper injection site varies by age:

• Infants (<12 months): Anterolateral aspect of the thigh is preferred due to larger muscle mass

  • Use 7/8 to 1-inch, 22-25 gauge needle
  • Bunch the muscle with free hand during injection 1

• Toddlers and Older Children (12 months-18 years):

  • Deltoid muscle if adequate muscle mass is present
  • Anterolateral thigh can still be used with longer needle (7/8 to 1¼ inches)
  • Needle size: 22-25 gauge 1

Evidence on Injection Technique

Research shows that proper injection technique can reduce pain and local reactions:

• Rapid intramuscular injection without aspiration is associated with less pain compared to slow injection with aspiration 2
• Injection in the thigh is associated with a significantly lower risk of medically attended local reactions to DTaP vaccination among children 12-35 months of age 3
• Having the child sit up (or holding an infant) during vaccination may reduce pain 2

Common Pitfalls to Avoid

1. Rubbing the injection site: This can increase local irritation and potentially lead to increased local reactions 1

2. Improper needle selection: Using needles that are too short may lead to inadvertent subcutaneous injection and increased local reactions 1

3. Incorrect anatomical site: Avoid using the buttock for routine vaccinations due to risk of sciatic nerve injury and decreased immunogenicity 1

4. Improper handling of multiple vaccinations: When administering multiple vaccines, use different anatomic sites and separate injections by 1-2 inches if using the same limb 1

By following these guidelines, healthcare providers can minimize pain, reduce the risk of local reactions, and ensure proper vaccine delivery while maintaining immunogenicity.