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Paediatric anaphylaxis and adrenaline auto-injectors
What is paediatric anaphylaxis?
Anaphylaxis is a severe, life-threatening allergic reaction that can affect the airway, breathing and circulation of infants and children within minutes of exposure to a trigger. Typical features include swelling of the lips or tongue, breathing difficulty, wheeze, widespread rash, collapse or a combination of these signs after food, medicine, sting or other exposure.
Because anaphylaxis can progress very fast, first aid needs to focus on immediate actions rather than observation: give intramuscular adrenaline in the outer thigh using any prescribed auto-injector, call 999, position the child safely and be prepared for further doses if advised. Early adrenaline and prompt ambulance activation are the key interventions that improve survival and reduce complications in children with severe allergic reactions.
UK medicines regulators report that hospital admissions in England for allergy and anaphylaxis have more than doubled over the last twenty years, with nearly 26,000 admissions in 2022-23, which is why government guidance now strongly reinforces when and how to use adrenaline auto-injectors.
Who needs this skill?
Health & Social Care
In health and social care, staff working in paediatrics, allergy clinics, community nursing, learning disability and residential care will routinely encounter children with allergy action plans that include adrenaline auto-injectors. Training must cover recognition of anaphylaxis, the differences between device brands, correct administration sites, post-adrenaline positioning and the need for observation in hospital after any serious reaction.Licensed venues & nightlife
Licensed venues hosting children's parties or family events may not routinely think about food allergy risk, yet nuts, dairy, eggs and other allergens feature in many menus. A small number of trained first aiders who understand allergy, cross-contamination and anaphylaxis management can significantly reduce risk and improve the venue's position if an incident is later scrutinised.Schools
Schools and early years settings are central to allergy management; statutory guidance and best practice expect schools to maintain care plans, store AAIs safely but accessibly, train staff and consider spare device schemes. Staff must recognise early signs of anaphylaxis in the classroom or playground and act before a child deteriorates.Workplaces
In workplaces and community venues serving children - nurseries, leisure centres, sports clubs, holiday parks - managers increasingly hold spare adrenaline devices or host children with their own AAI. Staff must know where devices are kept, when they can legally use them, and how to give adrenaline confidently without delaying a 999 call.How to manage paediatric anaphylaxis
- 1Recognise allergic reaction versus anaphylaxisNotice early allergy symptoms such as itching, hives, flushing, swelling of lips or eyes, tummy pain or vomiting after a likely trigger. Be especially concerned if these progress quickly or are accompanied by breathing difficulty, noisy breathing, tight chest, hoarse voice, confusion, drowsiness or collapse - classic signs that anaphylaxis may be developing.Distinguishing mild allergy from anaphylaxis guides urgency: mild local symptoms may only need observation and antihistamines, whereas breathing or circulation problems after allergen exposure are red flags for anaphylaxis and 999 activation.
- 2Call 999 and follow the child's allergy planIf you suspect anaphylaxis, call 999 immediately, stating 'suspected anaphylaxis in a child' and follow any written allergy action plan the child has. The plan usually states when to give adrenaline, how many devices to use, and what position the child should be in while you wait for the ambulance.Qualsafe's paediatric guidance stresses recognising serious illness and summoning appropriate assistance early; anaphylaxis is always a 999 condition rather than one for home observation or routine appointments.
- 3Prepare and give the adrenaline auto-injectorLocate the child's prescribed auto-injector and check the name and expiry date; remove safety caps, position the device as directed (usually mid-outer thigh) and press firmly until you hear or feel the click, holding in place for the recommended time. Massage is not always needed; follow device instructions and the child's plan, and note the time you gave the dose.Adrenaline given into the mid-outer thigh is the first-line treatment for anaphylaxis; paediatric first aiders do not need to calculate doses, only to use the prescribed device correctly and promptly for the child in front of them.
- 4Position and monitor the childUnless breathing is severely compromised, keep the child lying flat with legs elevated to support circulation; if they are struggling to breathe, a semi-sitting position may be more comfortable but avoid letting them stand up or walk. Monitor breathing, colour and response continuously and be ready to start CPR if they collapse or stop breathing normally.Positioning is not cosmetic; standing or walking can worsen collapse in anaphylaxis, whereas lying flat supports blood flow to vital organs while adrenaline takes effect.
- 5Repeat adrenaline if directed and hand overFollow the allergy plan and 999 advice about repeat doses if symptoms do not improve or return; many plans allow a second dose after 5 minutes if there is no response. Hand over devices and timing details to the ambulance crew, along with information about the suspected trigger and how the reaction evolved.Children treated for anaphylaxis need hospital assessment and monitoring; clear handover about timing, doses and symptoms helps the receiving team make safe decisions about ongoing care.
This guide is a learning reference only. It does not replace attended, assessed first aid training.
Qualifying courses
Qualsafe Level 3 Award in Paediatric First Aid (RQF)
2 days
3 years
Qualsafe Level 3 Award in First Aid at Work (RQF) & Qualsafe Level 3 Award in Paediatric First Aid (RQF) - Combined
3 days
3 years
Common questions
Practical answers for employers, venue managers, and healthcare teams about paediatric anaphylaxis training.
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Rapid progression, breathing difficulty, swelling affecting the airway, hoarse voice, dizziness, collapse or changes in consciousness after allergen exposure all point to anaphylaxis rather than a mild reaction. In doubt, it is safer to treat as anaphylaxis, give prescribed adrenaline and call 999 than to wait and see.
Policies differ, but many UK schemes and local protocols allow staff to use a school’s spare AAI in an emergency on a child who is known to be at risk and has parental consent in place. You must follow your organisation’s policies, care plans and training; when in doubt in a life-threatening situation, focus on acting in good faith to save life.
Some side effects such as palpitations or anxiety can occur, but deterioration in breathing or circulation after adrenaline usually reflects the severity of the reaction rather than the medicine. Do not give more doses than the plan allows without clinical advice; keep the child in the recommended position and be ready to start CPR if necessary.
Everyone in a child-facing environment should at least recognise basic red flags and know who to call; designated first aiders and key staff for known allergy patients need full, practical training in using AAIs and managing anaphylaxis. That balance keeps risk manageable without over-burdening every member of staff.