The allergist may decide to conduct skin testing on a child to determine the specific allergen that is causing a reaction in the child. In a skin test, a small dose of suspect antigens is injected under the skin. The physician looks at the injected area 20 minutes later; if it is red, with a raised area (wheal) in the center, the reaction is positive.
Skin testing should only be performed under the supervisions of a board certified allergist. The child should be followed closely during a skin test, because occasionally skin testing causes a severe reaction. This condition is unusual, since the amount of allergen used is small; however, it can happen if the child is highly sensitive to the allergen.
Preparing the shot
Once the testing is finished, the allergist prepares an allergen abstract (serum) specially for the child. If the child is sensitive to multiple allergens, the physician may mix similar abstracts in one vial. Preparing the vials in combination extracts ensures that the child receives only one shot for each group of extracts, thus reducing the number of injections needed for effective therapy.
INJECTIONS The first intramuscular injection (shot) is important because based on this experience the parent and child build an attitude toward future injections. If the child is old enough to understand, the nurse or physician will explain why the child must receive the injection. The procedure should be explained in simple terms, and should proceed quickly and as gently as possible. The child should be allowed to express his fear and resentment of needles.
Although the healthcare professional will record the allergy shot in the medical record, the parent may want to keep an updated record of the treatment for quick reference during emergencies and when the child is traveling.
INJECTION SITES The following injections sites are recommended for children:
Infants: Outer front thigh. The parent should place the child in a secure position to prevent movement of the extremity. The parent should hold and cuddle the infant following the injection.
Toddlers and school-age children: Buttocks, upper outer side. The buttocks do not develop until the child begins to walk, so this site is used only when the child has been walking for one year or more.
Older children: Upper portion of the buttocks. This site provides a dense muscle mass in older children, which eliminates the possibility of injuring the nervous and vascular organs. The disadvantage of this site is that it is visible to the child who may become apprehensive when the injection is given. Older children can also receive shots in the upper arm and in the upper outer part of the thigh.
After the injection, the parent and nurse should take time to praise the child for his cooperation. Infants and small children should be cuddled and given affection for a few minutes so they do not associate the experience only with the pain. A small child may be given a toy to divert attention. Older children may be allowed to select the site for the injection. In addition, nasal sprays are in the early 2000s being developed as a painless alternative to injection delivery.