Forgive me, I'm new

[Bat_Ish_Crazy]

DD is all of 18 lbs at 14 mo old.  She has recently been diagnosed with a peanut allergy.  She developed hives on her face and chest, and itchy water eyes after her first exposure to peanut butter.

Allergist has prescribed epinephrine for treatment of an ana reaction.  Ideally, we will never need it.

DD attends daycare at a large corporate chain.  We *LOVE* her daycare.  Her teachers love her, she loves her teacher, lots of friends, lots of smiles, life is good. 

Allergist did NOT prescribe an epipen jr ... DD is too small, the dose would be too high ... she has been prescribed vials of epinephrine that would be measured into a syringe and administered with a traditional needle into the thigh.  DDs DC teachers were totally OK with this when I let them know about it, but the director might as well have fallen out of her chair.  The risk management dept, the legal dept, the center & the district/regional managers are all involved to determine if they will allow the staff to administer the medication this way if needed.

Is the law on my side here? 

If the law *IS* on my side, I don't know if I would move forward with forcing them to agree to administer the meds or not ... but I'd at least like to know where I stand.  What resources can I reference here?

[eragon]

the reason for not giving the epi pen at such a low weight is the very rare risk of brain damage (so our allergist told us) , however, anaphylaxis itself carries that risk.
My own son was refused epi pens for this reason from one pead, but when he was 2  we asked for epi pens from his GP, and later on the allergiest prescribed them to him. My son only reached the magic 25 lbs at 3yrs old, and that depended on his health at the time.
(its a long , and complicated story really...)

I would ask for a second opinon on this if i was you, and ask about the risks etc, IF you are unhappy with your current emergency medication.

If you are advised to carry such emergency medication, then really you are aknowledging that at some point in your child's life this medication will be needed. Its all part of accepting the change that severe allergies bring in to your life. There is no 'ideally we will never need it' , but on the other hand most children need epi pens when they are older. It depends on the allergy list and the daily avoidance management you have in place.

you have to think carefully about how confidant you are , and how well you have been trained to use vials and needles. If you are confidant, then hopefully other medical professionals can do the same training for the day care staff.

However, vials and needles are not normally given out, the last i heard of them being in use was from an article i read in a old uk allergy magazine of a woman who said that while going through anaphylaxis is was difficult to assemble the vials and needles herself. But difficult for untrained  others to also assemble in an emergency situation. The arrival of the epi pen heralded a new freedoom for her at the time.

what is your childs full emergency treatment plan?
what other health problems does your child have , eczema? asthma? envrio allergies? can she eat egg? do you suspect that other allergies may be added to her list?


I am sure other members here will fill you in on the law and how it can help you, and how best to get the correct support you need for your baby.
Am glad the day care staff are understanding and supportive, lets hope the director problem will be overcome.

good luck!

[my3guys]

My DS was given an epipen jr. at 1 yr old, no doubt weighing less than your dd.  I believe many other members have too.  You might want to get the opinion of another allergist. 

In the heat of the moment in a reaction, it would be more challenging for anyone, in my opinion, to give epinephrine to your dd in that way.  As a parent, I would certainly be afraid to do it.  You need to be able to react quickly, and without much room for error in a serious reaction.  Just my 2 cents.

Would the daycare be more comfortable with a traditional epipen rather than measuring out the epinephrine?  Yes, I do think the law is on your side, but I'm not the best resource for giving you cases to bring up with them.

Sorry you're in this predicament, and sorry too about your daughter's diagnosis.  You've found a great resource in this site though, so I hope that's some comfort!

[SilverLining]

I'm not sure what country you are in.  I'm in Canada.  Here schools are not allowed to give a shot that it not an auto injector.

There is on the market something called a twin-ject.  The first dose is auto-injectible (same as epi-pen).  The second dose is pre-measured, but not auto-injectible.  School staff will give the first dose, but not the second.  This is due to their contractual agreement.

As far as I know, day cares are the same.....only give the auto-injectible shot.

[hezzier]

Ok, I have a dumb question on this.  When giving an epipen, we are to hold it on the skin once the needle is in for 10 seconds.  Could it be held for less time so a full dose is not given?  I realize this would not be a scientific method of delivering the exact amount of epinephrine, but Dey must know the rate at which the medicine is delivered.  Just wondering

[SilverLining]

Not a dumb question hezz. 

But, it wouldn't make an appreciable difference.  Those 10 seconds only add a few drops.  Have you ever used an expired epi to practice/teach with?  The mechanism inside flies down.  If you pull the needle out right away, you will sometimes see a few drops dribble out.

(It may sound odd, but over the years I have done various experiments with expired epi's.  I once got into a looooong phone conversation with a woman at the Canadian distributor for epi, and we compared notes on some of the various experiments we had done.)

[hezzier]

I have not played around with that many expired epis since we've only been at this a couple years and I tend to save them so I can train the babysitters.  Will have to once we have new epis after our allergist appt in August.

[CMdeux]

My DD was prescribed autoinjectors (Epi Jr) at exactly that weight and age.

(Well, actually, given full-scale anaphylaxis at 11mo, she'd been prescribed them at around 17 lbs and 11 mo.  But I digress.)

While yes, there is a real risk with over-dosage... there is also that risk of catastrophic over-dosage with vials/syringe.  In fact, most reports of harm from epinephrine administration are related to such human errors.  So using a vial and syringe hasn't eliminated that particular risk.

In addition, the added complexity will make laypersons reluctant to administer, and may well cost time during a reaction.


I'd also seek clarification from a good physician who is willing to discuss this with you.  Your concerns are quite valid.  Not everyone is comfortable with drawing a dose under the best of circumstances, and watching a child under your care in anaphylaxis is, I think anyone would agree, far from "ideal" in every way. 

I'd bring a copy of AAAAI's ask the expert addresses Epinephrine dosing in infants  with me, too.

[YouKnowWho]

My son was about 10lbs when he was prescribed his first epi jr.  Every allergist we have seen felt like the benefit outweighed the risk. 

[joanna5]

My son first needed an Epi Jr. when we discovered his milk allergy at eight months old and maybe 16 pounds.  We gave it without incidence and had to use it one other time (when we discovered his mustard allergy) at eighteen months, so maybe 21-22 pounds.  For us and our allergists, the benefits far outweighed the risk. 

Oh, and my youngest was prescribed an Epi Jr at 7-8 months and about 15-16 pounds, as well, although we haven't had to use his.