Is my baby too small for an epinephrine autoinjector?

Your little one may not be quite mature enough to choose their own bedtime, and there’s a reason they would need your supervision to get into an R-rated movie.

But it’s their weight, not their maturity, that might get in the way of whether or not they can be prescribed epinephrine in the form of an epinephrine autoinjector (an EpiPen Jr. or a generic brand) as a treatment for a serious allergic reaction.

Who needs an epinephrine autoinjector?

Epinephrine autoinjectors are typically prescribed when there is a diagnosed allergy that has resulted, or could result, in anaphylactic shock. Anaphylactic shock causes swelling in the mouth or throat that can interfere with breathing, and epinephrine is the only treatment that’s been proven to reverse an anaphylactic attack.

It can be hard for healthcare providers to tell which children might be at risk for anaphylactic attacks, which is why, just to be safe, most allergists will prescribe epinephrine to all children who they think might be at risk for severe allergic reactions. These children may:

  • Have allergies to peanuts, tree nuts, or seafood
  • Have had severe allergic reactions in the past
  • Have asthma

One of the most serious limitations of epinephrine is that it’s mainly delivered in two devices: the EpiPen and the Auvi-Q. Each of these only offers two dose sizes. The first, which is prescribed to most children, delivers 0.15 mg of epinephrine, and is recommended for children between 33 and 60 pounds (15 -27 kg). The larger size, which delivers 0.30 mg of epinephrine, is prescribed to people 60 pounds or heavier.

Unfortunately, there is no current injector that gives a smaller dose than 0.15 mg of epinephrine.

Should children smaller than the weight recommendation still be prescribed epinephrine autoinjectors?

Since children smaller than 33 pounds can still have serious allergies, and can still have anaphylactic reactions to epinephrine, many doctors prescribe the EpiPen Jr. (0.15 mg) to children lighter than 33 pounds.

The Canadian Society of Allergy and Clinical Immunology’s 2015 position paper recommends prescribing epinephrine to children lighter than 33 pounds based on the fact that side-effects of epinephrine are generally mild, and pass as the epinephrine passes out of their systems. Since anaphylaxis can be so serious, and the side effects of epinephrine are so mild, the CSACI feels it’s more beneficial to have epinephrine available than not to.

A paper by Hugh Sampson published in the journal Pediatrics declared that most allergists in the US prescribe the EpiPen Jr. to children who weigh 22 pounds (10 kg) or more, and that for children smaller than 22 pounds who have may be at risk for anaphylaxis, they may prescribe epinephrine to be hand-measured into a syringe based on a child’s specific weight.

Other allergists may decide that hand-measuring is more of a risk than the higher dose, however, and so may prescribe the EpiPen Jr. instead.

The bottom line

Anaphylactic shock is nothing to mess around with, so it’s important to have a discussion with your little one’s pediatrician or other healthcare provider about whether or not to obtain an epinephrine autoinjector, depending on your child’s weight and allergic risk. If you plan to have an autoinjector, you should make sure that every caretaker (babysitters, grandparents, aunts, uncles, etc.) is comfortable with the injector and knows where it is in your home.

  • Michelle Halbrich, Douglas P. Mack, Stuart Carr, Wade Watson, Harold Kim. “CSACI position statement: epinephrine auto-injectors and children Allergy, Asthma, & Clinical Immunology. 11(1): 20. Web. 2015.
  • Phil Lieberman. “Use of an EpiPen Junior when a child is not of sufficient weight according to the package insert.” American Academy of Allergy, Asthma, & Immunology. American Academy of Allergy, Asthma, & Immunology. Web.
  • Mayo Clinic Staff. “Anaphylaxis.” Mayo Clinic. Mayo Clinic, January 6 2013. Web.
  • Hugh A. Sampson. “Anaphylaxis and Emergency Treatment.” Pediatrics. 111(3). Web. June 2003.
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