Subcutaneous injection (SC) in pediatrics involves administering medication into the fatty tissue just beneath the skin. It’s commonly used for insulin, vaccines, growth hormone, and allergy medications, and is generally less painful than intramuscular injections due to fewer nerve endings in the subcutaneous layer.
Purpose
- Deliver medications that require slow, sustained absorption
- Manage chronic conditions like diabetes, arthritis, or growth disorders
- Provide vaccines or emergency drugs (e.g., epinephrine)
Indications for Subcutaneous Injection
| Medication Type | Examples |
|---|---|
| Hormones | Insulin, growth hormone |
| Vaccines | MMR, varicella |
| Biologics | Adalimumab, etanercept |
| Anticoagulants | Low molecular weight heparin |
Preferred Sites & Volume for Age group
| Age Group | Preferred Sites | Max Volume |
|---|---|---|
| Infants (<12 mo) | Anterolateral thigh | 0.5 mL |
| Toddlers/Children | Thigh, upper outer arm | 0.5–1 mL |
| Older children | Abdomen, triceps, thigh | Up to 1.5 mL |
Avoid inner thigh or bony areas. Rotate sites to prevent lipodystrophy.
Equipment Needed
A tray containing:
- Syringe package
- Alcohol wipes
- Cotton ball or gauze piece
- Site rotation chart
- Prescribed medicine
- Paper bag
Procedure
- Wash hands
- Wipe the top of the medicine with the alcohol wipe and leave to dry.
- Choose the injection site.
- Open the syringe package and put on a clean surface.
- Insert the needle into the top of the bottle at an angle of 90°.
- Pull back the plunger and draw up slightly more than the prescribed dosage.
- Remove the needle from the bottle.
- By holding the needle upward, tap the syringe gently to move any air bubbles toward the needle.
- Push the plunger gently to remove the air bubbles and squirt a small amount of medicine into the air.
- Lift the skin in the chosen injection site between your thumb and index finger.
- Holding the needle at 45° angle insert the needle into the skinfold, so that the needle is at an angle of 90°. If you are using a 5- to 6-mm needle, you do not need to lift the skin into a skinfold as described above. You can insert the needle at an angle of 90° to the skin surface.
- Continue to hold the skin and push the syringe plunger to inject the medicine.
- Remove the needle from the skin and let go off the skinfold.
- Put a piece of cotton wool or gauze over the injection site for a few seconds.
Post procedure Care
- Throw the syringe in sharps bin.
- Mark the injection site on your site rotation chart.
- Praise the child for cooperation.
Tips to Reduce Discomfort
- Use numbing cream or ice before injection
- Distract with toys, videos, or breathing exercises
- Let older children choose the site or help with prep
- Use short, thin needles to minimize pain
- Offer a reward or sticker afterward
Special Considerations
- Use short, fine-gauge needles (e.g., 25–30G).
- Rotate sites to avoid lipohypertrophy or scarring.
- Avoid injecting into bruised, inflamed, or scarred areas.
- For home use, teach caregivers safe disposal of sharps and site rotation tracking.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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