From the Guidelines
EMLA cream for pediatric use should be applied to intact skin 60 minutes before painful procedures like venipuncture or minor skin procedures, with dosages varying by age, as it provides effective local anesthesia while minimizing distress. The dosage varies by age: for infants 0-3 months, apply no more than 1 gram over a maximum area of 10 cm² for no longer than 1 hour; for children 3-12 months, up to 2 grams over 20 cm² for 1-4 hours; for children 1-6 years, up to 10 grams over 100 cm² for 1-5 hours; and for children 7-12 years, up to 20 grams over 200 cm² for 1-5 hours 1.
Key Considerations
- The cream should be applied as a thick layer and covered with an occlusive dressing.
- Parents should avoid applying EMLA to broken skin, mucous membranes, or near the eyes.
- They should watch for signs of methemoglobinemia (bluish skin, fatigue, headache) 1.
- EMLA cream works by combining lidocaine and prilocaine to block nerve signals, providing effective local anesthesia for children undergoing painful procedures while minimizing distress.
Additional Guidance
- Topical anesthetics, including EMLA, can improve procedural success rates by decreasing movement and improving accuracy 1.
- For more extensive surgery, the combination of topical and infiltration anesthesia should be considered as an alternate to sedation or general anesthesia in pediatric patients 2.
- The use of topical anesthetic agents is recommended to lessen the pain of injection and reduce the dose of infiltration anesthesia needed for larger procedures 2.
Important Safety Information
- EMLA cream is not approved by the US Food and Drug Administration for laceration repair, although it can provide topical anesthesia for such procedures 1.
- Elective procedures and those not of urgent medical necessity requiring topical lidocaine in pregnant women should be postponed until after delivery 2.
From the Research
Directions for Pediatric Use of Emla Cream
The following directions are based on studies of the use of Emla cream in pediatric patients:
- Application time: Emla cream should be applied at least 60 minutes prior to the procedure 3, 4.
- Application method: The cream should be applied as a thick layer on the area of skin to be anesthetized and covered by a closed adhesive dressing 5.
- Dosage: A dose of 1 to 2 g was used in children of more than 1 year, and 0.5 to 1 g for those of less than 1 year 5.
- Home application: Home application of Emla cream by parents is safe, easy to perform, and well-tolerated 4.
- Age range: Emla cream has been used in pediatric patients aged 1 to 15 years 3, 5, 4, 6, 7.