If you have a child with food allergies, how do you decide when they are ready to carry epinephrine and/or use that epinephrine themselves if they are having a severe allergic reaction?

Epinephrine is the only treatment for severe allergic reactions, known as anaphylaxis [anna-fih-LACK-sis]. It gets injected into the outer thigh. It comes in a device that helps you give the injection. Epinephrine must be given quickly when symptoms begin. For this reason, it’s important to always have epinephrine nearby. People (of any age) who are at risk of severe allergic reactions should carry their epinephrine with them wherever they go.

How Do You Know When a Child Is Ready to Carry Their Own Epinephrine?

Every child develops on their own schedule. There is no specific age when a child must start to self-carry or administer. So how do you know when your child is ready to be responsible for carrying their epinephrine devices? The answer to this question depends on your child.

Here are some factors to keep in mind:

• Is your child comfortable carrying epinephrine at all times in a waist belt, backpack, purse, medicine bag, or other carrier?
• Does your child show they are able to remember their medicine bag or backpack and not lose it?
• Does your child show that they know not to play with the epinephrine?
  
  

How Do You Know When a Child Is Ready to Use Their Epinephrine and Inject Themselves?

There are no formal guidelines for when a child is ready to give themselves epinephrine. Many kids are ready to carry their epinephrine sooner than they are ready to self-inject. Many pediatric allergists agree that by age 9 to 11, a child should know:

• The symptoms of a severe allergic reaction
• The need to use epinephrine
• How to show the use of self-injectable epinephrine¹
  
  

By age 12 to 14, most allergists expect children to self-carry and self-administer epinephrine.

When your child is ready to self-inject depends on their maturity level, their needs, and their abilities. Here are some factors that will help assess if your child is ready to self-inject:

• Can your child use a training device to show they know how to use the device correctly?
• Can they recognize the symptoms of anaphylaxis?
• Do they express confidence they can self-inject in an emergency?
• Does your child have developmental delay, autism, attention-deficit/hyperactivity disorder (ADHD), depression, etc. that may impact their decision-making skills?
• Does your child have a history of anaphylaxis?
  
  

Keep in mind that an allergic reaction may be so severe that your child may not be able to self-inject, no matter their age or knowledge. Because of this, federal guidelines for schools call for a trained staff member to give epinephrine in case a school nurse is not available.

If your child has recently had a severe reaction and someone else gave them epinephrine, talk about how they might handle a future emergency when there is no adult around.

Talk with your child and your allergist if you think your child is ready to have more responsibility self-managing their food allergy.

It’s important to think about these issues when your child is younger. This will make it easier to teach them how to manage their food allergy as they grow and it will create a foundation for good food allergy management as they become teenagers and young adults.

Medical Review: May 2022 by Michael Pistiner, MD, MMSc

References
1. Children Assume Responsibility for Anaphylaxis Treatment | AAAAI. (2020, September 28). Aaaai.org. https://www.aaaai.org/Tools-fo...children-epinephrine