Tag: IM

Which Vaccines can be Given SQ?

When most folks think about getting a vaccine, they typically picture someone getting a shot.

It is important to remember that not all vaccines are shots though.

And even for those vaccines that are given as shots, not all of them are given intramuscularly (IM).

Some vaccines are also given orally, nasally, and subcutaneously.

Which Vaccines can be Given SQ?

Vaccines that are given by subcutaneous injection include:

  • MMR
  • ProQuad (MMR/V combination of MMR and chickenpox vaccines)
  • Pneumovax* (Pneumococcal vaccine)
  • IPV* (polio vaccine)
  • Varivax (chickenpox vaccine)
  • Zoster (shingles vaccine)

*The Pneumovax and IPV vaccines can be given either IM or Subcutaneously (SQ). And there are some other exceptions too. Kids with hemophilia can get the hepatitis A and B vaccines SQ, instead of IM.

Where to Give SQ Injections?

After asking how many shots they are going to get, kids often ask where they are going to get them?

While infants get their subcutaneous injections in the fatty tissue over their anterolateral thigh muscle, toddlers and older children get them in the fatty tissue over their anterolateral thigh muscle or triceps.

Older children get SQ injections in the the upper-outer triceps area.
Older children get SQ injections in the the upper-outer triceps area.

Be sure to use the correct needle size, length and gauge (typically 5/8″ and 23-25 gauge), and insert the needle with a quick thrust at a 45° angle to the skin (rapid injection technique), pinching up on the SQ tissue to avoid hitting the muscle, and instead injecting in the subcutaneous tissue between the skin and muscle.

Also keep in mind that it is not necessary to aspirate after injecting the needle and that multiple injections in the same extremity should be separated by at least one inch.

What to Know About SQ Vaccines

It is important to know which vaccines need to be given subcutaneously (SQ) and both how and where to give these shots.

More on SQ Vaccines

 

Which Vaccines Can Be Given IM?

When most folks think about getting a vaccine, they typically picture someone getting a shot.

It is important to remember that not all vaccines are shots though.

And even for those vaccines that are given as shots, not all of them are given intramuscularly (IM).

Some vaccines are also given orally, nasally, and subcutaneously.

Which Vaccines Can Be Given IM?

Vaccines that are given by intramuscular injection include:

  • DTaP, Pediarix, Pentacel, Kinrix, Quadracel (DTaP containing vaccines)
  • hepatitis A
  • hepatitis B
  • Hib containing vaccines (Hib, Pentacel, Comvax, Kinrix, Quadracel)
  • Gardasil9 (HPV vaccines)
  • flu shots
  • Menactra, Menveo, Bexsero, Trunembra (Meningococcal vaccines)
  • Prevnar13, Pneumovax* (Pneumococcal vaccines)
  • IPV* (polio vaccine)
  • Boostrix, Adacel (Tdap vaccines)

*The Pneumovax and IPV vaccines can be given either IM or Subcutaneously (SQ).

There are exceptions though. Kids with hemophilia can get IPV and the hepatitis A and B vaccines SQ, instead of IM.

Where to Give IM Injections?

The upper arm is the best place to give shots to older kids.
The upper arm is the best place to give shots to older kids.

After asking how many shots they are going to get, kids often ask where they are going to get them.

While newborns, infants, and younger toddlers get their IM injections in their anterolateral thigh muscle, older children typically get them in their anterolateral thigh muscle or in the deltoid muscle of their arm.

Be sure to use the correct needle size, length and gauge, and insert the needle with a quick thrust at a 90° angle to the skin (rapid injection technique). Keep in mind that it is not necessary to aspirate after injecting the needle and that multiple injections in the same extremity should be separated by at least one inch.

What to Know About IM Vaccines

It is important to know which vaccines need to be given intramuscularly (IM) and both how and where to give these shots.

More on IM Vaccines

Vaccines and Hemophilia

Kids with hemophilia bleed.

The Medical and Scientific Advisory Council of the National Hemophilia Foundation recommends "that patients with bleeding disorders continue to follow the American Academy of Pediatrics’ and CDC’s vaccine recommendation route and schedule for their age."
The Medical and Scientific Advisory Council of the National Hemophilia Foundation recommends “that patients with bleeding disorders continue to follow the American Academy of Pediatrics’ and CDC’s vaccine recommendation route and schedule for their age.”

They bleed into their joints, into their skin (hematoma), and from their mouth and gums. They can bleed after surgery and even after getting their vaccinations.

Vaccines and Hemophilia

Having hemophilia is certainly not a contraindication to getting vaccinated though.

“Your child should get regular immunizations with necessary precautions to prevent bleeding from the injection sites.”

Hemophilia FAQs

There are some precautions that are recommended before giving vaccines to a child with hemophilia, including:

  • using a 23-gauge or smaller caliber fine-gauge needle – consider a 25- or 27-gauge needle
  • when possible, giving the vaccine SQ instead of IM – for example, although the IPV (polio), hepatitis A, and hepatitis B vaccines are usually given IM, studies have shown that they can be given SQ to kids with hemophilia
  • applying firm pressure, without rubbing, after the vaccine is given for at least two minutes and up to 5 to 10 minutes
  • giving acetaminophen for pain relief, if necessary, instead of ibuprofen
  • warning about the risk of a hematoma developing at the injection site

Most importantly, if the child with hemophilia is already getting routine prophylaxis to prevent bleeding, schedule their vaccines around the same time to decrease the risk of bleeding.

Your child’s hematologist will likely give you specific instructions to provide to your pediatrician regarding immunization precautions.

What to Know About Vaccines and Hemophilia

Kids with hemophilia should get all of their vaccines on schedule, but precautions should be taken to decrease the chance of bleeding after getting an immunization.

More About Vaccines and Hemophilia

Where Will Your Kids Get Their Shots?

Once older kids know that they are getting vaccines, guess what the next question is that they usually ask?

That’s right.

Where are the shots going?

After a lighthearted, “where ever you want them,” I explain that shots are typically given in a child’s arm or leg.

Best Sites to Give Shots to Infants

The thigh is the best place to give shots to infants.In general:

  • newborns and infants get intramuscular (IM) shots in the vastus latrealis muscle in their anterolateral thigh
  • newborns and infants get subcutaneous vaccines in the fatty tissue overlying the anterolateral thigh muscle

So basically, through their first birthday, shots are given in a child’s leg, specifically the anterolateral thigh muscle.

Best Sites to Give Shots to Older Kids

After their first birthday, your pediatrician starts having some more options on where to give vaccines – arm vs leg.

In addition to the child’s age and degree of muscle mass, where they get their shots is often determined by how easy or hard it will be to hold them.

Subcutaneous vaccines can now be given either in the fatty tissue overlying the anterolateral thigh muscle or the triceps muscle.

The upper arm is the best place to give shots to older kids.

For intramuscular (IM) shots:

  • toddlers (1 to 2 years) – IM shots are still typically given in the child’s anterolateral thigh muscle. The deltoid muscle of their arm becomes an alternative site though if they have enough muscle mass.
  • children (3 to 10 years) – IM shots are now typically given in the deltoid muscle of the child’s upper arm. The anterolateral thigh muscle remains an option though.
  • older children (11 years and older) – IM shots are now typically given in the deltoid muscle of the child’s upper arm. The anterolateral thigh muscle remains an option though.

Notice a location that is missing?

“In the past, the upper, outer quadrant of the buttocks was the usual site of intramuscular vaccination. The buttocks should not be routinely used as a vaccination site for infants and children; and, to avoid injury to the sciatic nerves, they are generally not used in adults.”

CDC on General Recommendations on Immunization (1983)

Kids should never get a shot in their buttocks!

That being said, the ventrogluteal area is sometimes considered an alternative site for IM shots for kids over age 12 months. This is not the dorsogluteal area that was more traditionally thought of as the buttocks injection site though.

What else is missing?

That’s right. Vaccines are not injected into a child’s bloodstream! They are injected into the muscle because the relatively small amount of antigens in the vaccines act locally to trigger an immune response.

What to Know About the Best Sites to Give Shots to Kids

Where your kids get their shots is going to depend on the specific vaccines they are getting, their age, and size of their muscles, but shots typically go in their arm or leg.

More on the Best Sites to Give Shots to Kids