Which muscle is the preferred site for injections on infants to 2 years of age?

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Aim: This study was conducted to determine whether the ventrogluteal site could be used for intramuscular injections in children under the age of 3 and to compare the subcutaneous and muscle layer thickness at the anterolateral, deltoid and ventrogluteal site in the different age groups and in both sexes.

Background: Although recent literature has reported that the ventrogluteal area can be an alternative site for intramuscular injections in children ≤12 months of age, little research-based evidence has been found for the use of the ventrogluteal site in infants and toddlers.

Design: A descriptive study which took place between November 2013-August 2014.

Method: A total of 142 children between the ages of 1-36 months were selected by random sampling and ultrasound measurements were made of subcutaneous and muscle thicknesses in the anterolateral, deltoid and ventrogluteal areas. Measurements were analysed using one-way anova and independent samples t-test.

Results: The subcutaneous tissue thicknesses in the deltoid, anterolateral and ventrogluteal areas in children between 1-12 months old (n = 56) were 5·20, 6·62 and 7·26 mm respectively, while in children between 13-24 months old (n = 42), these measurements were 4·35, 6·72 and 7·98 mm; in children between 25-36 months old (n = 44), the measurements were 5·92, 7·97 and 13·5 mm. The muscle thicknesses in the deltoid, anterolateral and ventrogluteal areas in children 1- 12 months old were 5·86, 9·10 and 8·17 respectively, while in children between 13-24 months old, the measurements were 7·71, 12·92 and 17·32 mm; in children 25-36 months old, the measurements were 9·28, 18·81 and 19·62 mm.

Conclusion: This study found that the muscle in the ventrogluteal site is adequately developed, even in infants between the ages of 1-12 months and that in particular, in children 12-36 months old, the ventrogluteal site is even thicker than the anterolateral.

Keywords: infants; intramuscular injection; muscle thickness; subcutaneous tissue; toddlers; ultrasound; ventrogluteal site.

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Use the intramuscular (IM) injection route in pediatric patients only when the benefits outweigh the pain of injection or when it is the recommended route for a prescribed medication.

Take steps to eliminate interruptions and distractions during medication preparation.

OVERVIEW

The purpose of IM injections is to administer medication safely into the muscle below the subcutaneous layer. Many medications must be injected intramuscularly because of chemical properties, pharmacokinetics, desired onset, intensity and duration of the effect, and certain patient characteristics related to treatment compliance. An IM injection should be given only when less painful options are not feasible.

The injection site affects how much fluid can be given and how quickly the medication will be absorbed. The most appropriate sites for IM injections are the vastus lateralis (anterolateral thigh) for infants and toddlers and the deltoid muscle for pediatric patients 3 years and older. Selection of the injection site is based on the patient’s age, muscle mass, medication volume, and medication viscosity.

Local anesthesia or tactile stimulation should be considered to decrease pain at the injection site. Breastfeeding or giving supplemental breast milk during the injection can reduce pain in infants. The combination of oral sucrose and radiant warmth is effective analgesia for healthy neonates and young infants receiving IM vaccination. Diversional activities and education may comfort a patient receiving an IM injection. A child life specialist should be enlisted to support the patient, if available.

Because the recommended sites for pediatric IM injections for vaccines have no large blood vessels, the practice of aspiration for immunization or toxoids is unnecessary. However, aspiration is routinely used and is recommended when medications other than vaccines or toxoids are administered.

If the patient or family expresses concern regarding the accuracy of a medication, the medication should not be given. The concern should be explored, the practitioner notified, and the order verified.

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