treatment algorithm for children for medical first responders

Last reviewed 01/2018

An outline anaphylaxis treatment algorithm for children for medical first responders is presented below (1):

  • consider anaphylaxis when compatible history of severe allergic-type reaction with respiratory difficulty and/or hypotension especially if skin changes present
  • administer oxygen treatment when available
  • assess for signs of stridor, wheeze, respiratory distress or clinical signs of shock (a)
  • administer adrenaline (epinephrine) 1:1000 solution (b). Dose is dependent on age and size of child (c)
    • > 12 years:
        • 500 micrograms IM (0.5 mL) i.e. same as adult dose
        • 300 micrograms (0.3 mL) if child is small or prepubertal
    • > 6 – 12 years:
        • 300 micrograms IM (0.3 mL)
    • > 6 months – 6 years:
        • 150 micrograms IM (0.15 mL)
    • < 6 months:
        • 150 micrograms IM (0.15 mL)

the adrenaline dose is repeated in 5 minutes if no clinical improvement

an antihistamine (chlorphenamine) is administered

  • >12 years: 10-20 mg IM
  • 6-12 years: 5-10 mg IM
  • 1-6 years: 2.5-5 mg IM

in addition

  • for all severe or recurrent reactions and patients with asthma give hydrocortisone
    • >12 years: 100-500 mg IM or slow IV
    • 6-12 years: 100 mg IM or slow IV
    • 1-6 years: 50 mg IM or slow IV
  • if clinical manifestations of shock do not respond to drug treatment give 20 mL/kg body weight IV fluid (e)
    • rapid infusion or one repeat dose may be necessary

Notes:

  • (a) an inhaled beta2-agonist such as salbutamol may be used as an adjunctive measure if bronchospasm is severe and does not respond rapidly to other treatment.
  • (b) if profound shock judged immediately life threatening give CPR/ALS if necessary. Consider slow intravenous (IV) adrenaline (epinephrine) 1:10,000 solution. This is hazardous and is recommended only for an experienced practitioner who can also obtain IV access without delay. Note the different strength of adrenaline (epinephrine) that may be required for IV use.
  • (c) for children who have been prescribed an adrenaline auto-injector, 150 micrograms can be given instead of 120 micrograms, and 300 micrograms can be given instead of 250 micrograms or 500 micrograms.
  • (d) absolute accuracy of the small dose is not essential.
  • (e) crystalloid may be safer than a colloid

Reference: