Administering intramuscular injections to children: what does the evidence say?

Abstract

Many author’s argue that intramuscular injections (IM) are rarely used routinely in children’s nursing (Hemsworth, 2000). Owing to the decreased exposure of children’s nurses in administering intramuscular injections to children, there is a need for nurses to update themselves on the latest evidence-based practice regarding the theory and technical aspects of this clinical skill. There is a reasonable body of literature focussing on immunization of the young child (under two years of age); however, there is a serious deficit of literature relating to administering intramuscular injection to children and adolescents. The vastus lateralis is the site of choice for children under the age of two, followed by the deltoid site for children two years old and above (RCPCH, 2002). Current literature cites the ventrogluteal muscle as being the site of choice for IM injection in adults (Greenway, 2004). However, there is no recommendation given on the land marking of this site for children. With the exception of new born babies or premature neonates, evidenced-based practice demonstrates that a needle size of 25 Gauge (1 inch) 0.6mm by 25mm length, is the most appropriate size to ensure a true intramuscular injection occurs and also minimizes local irritation and pain (Diggle et al, 2006). Invasive procedures, such as intramuscular injections can cause substantial anxiety and pain to children (Ellisand Bentz, 2004). This paper includes a brief examination of the pharmacological and non-pharmacological treatments used in the management of injection procedures in children.