Step-by-step instructions for parents on giving injections into the fatty layer below the skin (subcutaneous) at home, as well as tips to make injections less painful for your child.
Key points
A subcutaneous injection is a medicine that is injected into the fatty layer just below the skin. It is just above the muscle.
The injection site varies with the age of your child.
Insert needle directly through the skin at a 45° angle into the fatty layer.
Give the injection quickly, and do not pull back on the plunger (aspirate) prior to injection.
Discard the needle and syringe in a thick, plastic bottle or sharps container with a lid.
Do not discard the needle in your regular garbage.
Introduction
What are subcutaneous injections?
A subcutaneous (SC) injection is a medicine that is injected into the fatty layer just below the skin. This is called the subcutaneous layer. It is just above the muscle.
More information
Getting your child comfortable with needles
Children take their cues from their parents. Any fear or dislike you have of needles may make your child afraid too. Some parents find that reminding themselves that the injection allows their child to survive and stay healthy makes injection time easier. For example, if parents say, "I need to give your injection so you will have lots of energy to play and to grow," the child begins to understand. Follow up each injection with positive words (e.g., “you did so well!) and comfort measures.
Who should give the injection?
In many families, one person takes on most of the responsibilities for injections. However, there may be problems when that person is not there. It is important for all regular caregivers to share the responsibility of giving the injection. It is ideal for your child to feel safe and confident with more than one caregiver. Families with only one caregiver should try to seek the help of a friend or relative. Strategies for support models could include creating a schedule (i.e., one caregiver might take care of the morning injections and the other caregiver looks after the evening injections).
Sharing the burden is a good coping strategy to deal with the daily demands of your child's condition and to prevent caregiver burnout.
Preparing for the treatment
Injection sites and needle sizes
The injection site depends on the age of your child. The diameter of the needles also varies depending on your child's age. This size is described in units called "gauge numbers". Needles with larger diameters have smaller gauge numbers. Even though these needles are larger, the injection is quicker and less painful for your child.
The needle should not be longer than 16mmand not larger than 25 gauge. You might be given a shorter needle for specific drugs. Check with your healthcare provider to ensure you have the right length needle. Make a note on your phone or write down the following information:
The gauge of the needle is ________.
Your child's injection site is _______.
If the injection you are giving is more than 1.5 mL in volume, check with your child’s health-care provider about which location is appropriate (1.5 mL is the maximum volume per injection).
Treatment
Birth to 12 months
For newborns and infants, inject medicine into the middle of the thigh where there is a lot of fatty tissue. Use the front, outer top of the thigh. Do not use the inner thigh or back of the thigh.
12 months and older
For children older than 12 months, medicines can be injected into two sites: the thigh or the tricep.
Thigh injection site
Middle of the thigh. Inject medicine into the middle of the thigh where there is a lot of fatty tissue. Use the front, outer top of the thigh. Do not use the inner thigh or back of the thigh.
Triceps injection site
Back of the arm. This is the fatty tissue over the back part of the upper arm.
Points to keep in mind:
Change sites with each injection.
Separate each injection by at least one inch.
Avoid areas that are bruised, scarred from injuries, swollen or tender.
More information about the treatment
Giving a subcutaneous injection
You will need:
soap and water to cleanse the skin
the vial of medication (check the date on the medication vial to make sure it has not expired)
syringe and needle in the size (as specified by your child’s health-care provider)
a cotton ball
a container to throw away needles. This can be a thick, plastic bottle or a sharps container with a lid
Choose the injection spot. Clean the skin with soap and water (do not need to use an alcohol swab) and pat dry. Try to change injection sites with each injection you give. For example, inject into the left thigh in the morning and right thigh at night.
Pinch up on the fatty (subcutaneous) tissue to prevent injection into muscle.
Insert needle at a 45° angle to the skin. You do not need to pull back on the syringe plunger after inserting the needle (aspirate).
Give the medication quickly to reduce pain by firmly pushing the plunger down as far as it will go.
Pull the needle out gently at the same angle you put it in. As you take out the needle, let go of the pinched skin.
Apply firm pressure with a cotton ball to the injection site for 30 seconds following each injection to reduce the chance of bruising. Do not rub the area as it may irritate the skin.
Put the needle and syringe in a thick, plastic bottle or sharps container with a lid. Do not try to put the cap back on the needle. This is for safety. When the container is full, bring it to your local pharmacy. They can safely dispose of it for you. Do not put it in your regular garbage.
Some medicines need to be injected at a 90° angle
Your child's health-care provider will let you know when you need to make a SC injection at 90°.
Complications
What does it mean if there is bruising at the injection site?
This can happen from time to time. It is not harmful. It usually means the needle has nicked a tiny blood vessel. To reduce the chance of bruising, apply gentle pressure to the site with a dry piece of cotton or a clean finger after injecting. Also, be careful not to pinch the skin too tightly or insert the needle too slowly. If you have too much bruising, consult your child’s health-care team.
What would happen if an air bubble was accidentally injected into your child?
It is not harmful to inject an air bubble under the skin. However, make sure the full volume of medicine is injected.
Helping your child
How to make injections less painful for your child
Medicines
Topical anesthetic agents (EMLA, lidocaine, tetracaine) can be applied to the site before giving the injection. Your child’s pharmacist or nurse can tell you how long to apply these agents on your child's injection site prior to injection.
Sugar mixture (oral sucrose 24%) - You can make this at home by mixing one packet of sugar to two teaspoons of water. Place a few drops of the mixture onto your baby's tongue a few minutes before the injection and while you are giving the injection. This will make it less painful for your baby. This works in children up to 18 months of age.
Distraction
Babies can be distracted with colourful toys, mobiles and mirrors. Younger children can be distracted with blowing bubbles or party blowers, reading a favourite book, playing with a musical toy or with the use of virtual reality glasses. Older children can choose what they wish to be distracted with: a hand-held video game, for example.
Imagery and Relaxation
Ask your child to try to imagine a pleasant experience. As your child focuses on something other than the pain, ask them to describe it using all their senses. Your child can also pick an image that feels relaxing to them. You can also suggest other sensations such as sound, smell, taste and touch that go with the situation. You may suggest that as they breathe steadily in and out, they are blowing away the tension in their muscles.
Straddle position
Reducing pain for babies and toddlers
Straddle your baby on your lap so that they are facing you and their limbs on are on each side of you. This is similar to giving your child a "bear-hug". This position is easy to do when there are two people present. The other person can inject on one of the injection sites as you securely hold your baby in place.
Breastfeeding is a good time to give your baby an injection. This will make the injection less painful. This is possible if there is a second person available to give the injection while your child is feeding.
Let your child suck on a pacifier during the injection. Many toddlers and babies find this soothing and feel less pain during the injection. You can also dip the pacifier in the sugar mixture (described above).
When to seek medical attention
When to call a health-care provider
Call your child's health-care provider if your child experiences:
