Subcutaneous injection maximum volume Pediatric

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Please note that all guidance is currently under review and some may be out of date. We recommend that you also refer to more contemporaneous evidence in the interim.

Intramuscular (IM) injections in neonates may be required to administer medications or vaccines.

The anterolateral thigh is the preferred site for IM injection in infants under 12 months of age. Medications are injected into the bulkiest part of the vastus lateralis thigh muscle, which is the junction of the upper and middle thirds of this muscle.

Nursing and medical staff must be familiar with the principles of the administration of medications to an infant. These principles include:

  • observation of standard precautions
  • aseptic techniques
  • correct drug/dose/time/route/patient practices.

Equipment required

Equipment: required for IM injection includes:

  • IM medication ampoule
  • large-bore needle for withdrawing medication from ampoule
  • 1 mL or 2 mL syringe
  • 23 gauge 25 mm needle or 25 gauge 16 mm needle for preterm babies two months or younger (see table below)
  • antiseptic swab if used must be allowed to dry before injection given
  • cotton wool swab
  • gloves for standard precautions.
Preterm babies (< 37 weeks' gestation) up to two months of age and/or very small infants 23 or 25 gauge,* 16 mm
in length
90° to skin plane
Infant, child or adult for IM vaccine 23 or 25 gauge, 25 mm
in length
90° to skin plane
Subcutaneous injection in all infants 25 or 26 gauge, 16 mm
in length
45° to skin plane

* If using a narrow 25 gauge needle for an IM vaccination, ensure vaccine is injected slowly over a count of five seconds to avoid injection pain and muscle trauma.

Needle length

The use of short needles for administering IM vaccines may lead to inadvertent SC injection and increase the risk of significant local adverse events, particularly with aluminium-adjuvanted vaccines (for example, hepatitis B, DTPa, DTPa-combination or dT vaccines).

Refer to the Australian Immunisation Handbook 10th edition 2013.

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Li W, Chen J, Zhao S, Huang T, Ying H, Trujillo C, Molinaro G, Zhou Z, Jiang T, Liu W, Li L, Bai Y, Quan P, Ding Y, Hirvonen J, Yin G, Santos HA, Fan J, Liu D. Li W, et al. Nat Commun. 2022 Mar 10;13(1):1262. doi: 10.1038/s41467-022-28787-7. Nat Commun. 2022. PMID: 35273148 Free PMC article.