* The shot should only be injected into the side of the thigh. Do not give the shot into a buttock or a vein.
* Be familiar with the symptoms of a severe allergic reaction. It's important to know the difference between an allergic reaction and anaphylaxis. Talk to your child's doctor about specific symptoms and indicators to look for that indicates a reaction severe enough to warrant using your Epinephrine. If your child feels or you observe the symptoms coming on, act quickly. The sooner the shot is given, the better the chances of a good outcome.
* If your child is not able to be still, get someone to hold the child while you give the shot. If you are alone, put the child down on his or her back and lay your upper body across the child's body. Use one hand to hold the child's leg while you give the shot with the other hand.

It is also important to:

* Have an allergy kit near your child at all times. Keep one at home and one at school or day care. An older child can wear a fanny pack with the kit in it.
* Keep two epinephrine shots in each kit in case a second shot is needed.
* Always have your child wear a medical alert bracelet to let others know about the allergies. I recommend using a product called Who's Shoes ID Tags for smaller children who may object to a bracelet.
* Make sure your child's school administrators, teachers, babysitters, and friends know how to give your child the shot and to call 911 after giving the shot. At school, stress the need for the kit to be with your child, not locked away where it could not be reached quickly. Be sure to explain what symptoms necessitate use of the epinephrine and which can be managed by administering antihistamines.
* Explain to your child why the shot is necessary, how it helps, and what you will do when the shot is needed. It may help to show the child what will happen. You can get an epinephrine shot trainer from your pharmacist to use for practice.
* As soon as your child is old enough, teach him or her to give the shot and call for help.

If your child has had a serious allergic reaction in the past, his or her risk of having another is high. But people react differently when they are exposed to the allergen

that causes their allergic reaction. It is important to get clear instructions from your doctor on when you should give your child an epinephrine shot.

An epinephrine shot comes as an automatic injector that is prefilled with one shot of epinephrine. It is made to be quick and simple to use.

Take care of your child's epinephrine shot:

* To protect it from light, keep the epinephrine shot in the tube provided until you are ready to use it.
* Store epinephrine shot at room temperature-15C to 30C. Do not refrigerate and do not keep it in your car.
* Check the expiration dates of the medicines in the allergy kit, and replace them as needed.
* Check the medicine in the epinephrine shot. It should be clear. If the solution is pinkish brown or has solid particles in it, the epinephrine shot should be replaced.

How to Administer the Epinephrine Shot:

1. Grasp the epinephrine shot injector in your hand with the black tip pointing down. Form a fist around the injector. Do not touch the black tip.
2. With the other hand, pull off the gray cap.
3. Hold the black tip close to your child's outer thigh. Press the black tip firmly into your child's thigh (through clothing if necessary). The injector should be at a 90-degree angle to the thigh.
4. Keep the injector in your child's outer thigh while you slowly count to 5.
5. Remove the injector, and rub the area where the medicine entered the skin.
6. Look at the black tip: If the needle is showing, your child received the dose. If not, you need to repeat steps 3 through 5. Note: It is normal for most of the liquid to be left in the injector. Do not try to inject the remaining liquid.
7. After the shot, push the needle against a hard surface to bend the needle back. Put the injector back in its case, needle first. Do not put the gray activation cap back on the injector.
8. Have your child take the antihistamine dose in the allergy kit.
9. CALL 911. If a reaction is serious enough to warrant use of the epinephrine, your child needs to be seen by a doctor as quickly as possible. Be sure to tell the emergency operator the dosage of epinephrine and antihistamine given and that another dose should be brought by emergency personnel in case the effects begin to wear off en route to the hospital.

Your child should feel the effects of the medicine almost right away. These will include a rapid heartbeat and nervousness as well as improved breathing. The benefits of the shot usually last 10 to 20 minutes.

In some severe cases, you may need to give a second shot. Your doctor will explain when a second shot is needed. Make sure you understand, and ask questions if you are not sure. Too much epinephrine can cause serious side effects, such as difficulty breathing.

What do I do after I give the shot?

* Immediately call 911. Tell the operator that you gave your child a shot and more epinephrine needs to be brought in the ambulance. Or if a hospital is close by, take your child to the emergency room. At the hospital, give the doctor or nurse the used injector. It will be checked and then disposed of properly.
* Your child will need to be observed in the hospital for at least 4 hours to make sure symptoms don't return. If your child is discharged from the hospital before this time is up, sit in the waiting room. Do not count on being able to get back in time.
* If your child has any heart problems, be sure to tell the doctor or nurse.