Question on Pediatric IM injection sites

[Rhonda V]

I work in a very busy family practice clinic, and a big part of my job is doing pediatric immunizations. Many of our pediatric patients are now getting the H1N1 and seasonal flu vaccine in addition to the required immunizations due for their age. Unfortunately, this results in some of our pediatric patients getting up to 6 injections in one visit! I am experienced in doing pediatric injections, but sometimes I'm not sure where I can safely give some of the IM injections. I understand that the vastus lateralis is the preferred site, and I will normally give no more than 2 IM injections in one leg. Sometimes I get into a situation where I have 6 IM injections to give, and I'm not sure if the deltoid is OK to use, especially in children 6-12 months. I don't normally use the deltoid in children that young, since the muscle may not be as developed. What is the maximum number of IM injections (0.5 ml each) you can safely give in the vastus lateralis? Can the deltoid be used in a child 6-12 months? Thanks for all replies.

[PedsAtHeart, LPN]

I have been giving pediatric immunizations for 8 years and have on occasion given up to 6 seperate injections at a time. I do not like to do it, but sometimes it needs to be done. i will give up to 3 in the VL, and as another commenter stated, they need to be an inch apart. The way I do this is to make a triangle with the injections instead of trying to do a straight line. Our state guidelines say that is a child is able to walk they can receive IM injections in the deltoid. Personally, I use my own judgement on this. Not every 1 yr old's deltoids are developed enough for this, and I find it easier and less painful for the kids to get them in the VL, its much easier to hold them still and thus reduce the risk of injury or resticking. This is why it is so important for parents to keep their children up to date with their immunizations! If they do, then they wont have to worry about their child being stuck this many times...

With that being said, I have to brag on my son... he turned 4 today and I brought him in to give him his shots (yes I give them to him and yes I did it on his birthday!) and he was such a big boy!! Sat there and took them, 2 in one arm, 1 in the other, and didnt move and only cried a couple of tears on the MMR, which burns like crazy!!! Sorry... but I was so proud of him!!