An adrenaline auto-injector (commonly known as an EpiPen or Jext pen) is a life-saving device for children at risk of anaphylaxis. As a Consultant Paediatrician with a special interest in allergy, I prescribe adrenaline auto-injectors for children who need them and provide training to families and schools. This article explains who needs one, which device to use, and how to use it.

Who Needs an Adrenaline Auto-Injector?

An adrenaline auto-injector is recommended for children who:

  • Have had a previous anaphylactic reaction
  • Have a confirmed allergy to a high-risk allergen (e.g. peanut, tree nut) with a history of systemic reactions (affecting more than one body system)
  • Have a food allergy combined with poorly controlled asthma (which significantly increases the risk of a severe reaction)
  • Have idiopathic anaphylaxis (anaphylaxis with no identified trigger)
  • Have had a severe reaction to an insect sting

Not every child with a food allergy needs an adrenaline auto-injector. The decision is based on the severity of previous reactions, the allergen involved, and other risk factors such as asthma. I will advise whether your child needs one based on their individual history.

Which Device Should My Child Use?

There are two adrenaline auto-injectors available in the UK:

  • EpiPen: Available in EpiPen Jr (0.15mg, for children 15–30kg) and EpiPen (0.3mg, for children over 30kg)
  • Jext: Available in Jext 150 micrograms (for children 15–30kg) and Jext 300 micrograms (for children over 30kg)

Both devices are effective. The choice of device is usually based on availability and personal preference. I will prescribe the appropriate device and dose for your child's weight.

How Many Devices Should My Child Carry?

Children should always carry two adrenaline auto-injectors. This is because a second dose may be needed if symptoms do not improve after the first injection, or if the first device malfunctions. Both devices should be carried at all times — at school, at nursery, at sports clubs, on trips and on holidays.

How to Use an Adrenaline Auto-Injector

The general steps for using an adrenaline auto-injector are:

  1. Remove the device from its carrier and take off the safety cap
  2. Hold the device firmly in your dominant hand (blue end up, orange end down for EpiPen)
  3. Place the orange tip against the outer thigh (can be given through clothing)
  4. Push down firmly until you hear a click, then hold in place for 3 seconds
  5. Remove the device and massage the injection site for 10 seconds
  6. Call 999 immediately — all children who receive adrenaline must go to hospital by ambulance
  7. Lay the child flat with legs raised (unless breathing is difficult)
  8. A second dose can be given after 5–15 minutes if symptoms do not improve

I will provide hands-on training in using the adrenaline auto-injector at your child's appointment, and will provide a written emergency action plan for home, school and nursery.

School and Nursery

Children with adrenaline auto-injectors should have an individual healthcare plan (IHP) in place at school or nursery. I will provide a written emergency action plan that can be shared with school staff. School staff should be trained in recognising anaphylaxis and using the adrenaline auto-injector.

Replacing Adrenaline Auto-Injectors

Adrenaline auto-injectors have an expiry date and must be replaced before they expire. Check the expiry date regularly and request a new prescription from your GP or from me before the device expires. Never use an expired device.

See also: Anaphylaxis Assessment and Management

Dr Mugilan Anandarajan, Consultant Paediatrician (FRCPCH, MD). Also see: belfastallergyclinic.com | belfastchildrensclinic.com