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Updated: Aug 17, 2026
Intravenous Injections in Neonatal Mice
Published on: November 11, 2014
Optimal technique for intramuscular injection of infants and toddlers: a randomised trial
1Discipline of General Practice, School of Medical Practice and Population Health, University of Newcastle, Callaghan, NSW. drifcook@bigpond.com
Insights
The World Health Organization (WHO) vaccination technique for anterolateral thigh injections in children resulted in fewer adverse reactions, including irritability and bruising, compared to Australian and United States methods. This WHO technique is recommended for optimal outcomes in pediatric immunization.
Area of Science:
- Pediatric Vaccinology
- Immunization Practices
- Clinical Trials
Background:
- Anterolateral thigh injection is a common route for childhood vaccinations.
- Different injection techniques may influence adverse reaction rates and parental acceptance.
Purpose of the Study:
- To compare adverse reaction rates and parental approval for three anterolateral thigh vaccination techniques in children.
- To identify the optimal injection technique for pediatric immunization.
Main Methods:
- A randomized, observer-blind trial involving 375 children aged 2-18 months.
- Children received pertussis-containing and Haemophilus influenzae type b vaccines using Australian, World Health Organization (WHO), or United States injection techniques.
- Local and systemic adverse reactions, along with parental acceptance, were assessed 24 hours post-injection.
Main Results:
- The WHO technique significantly reduced "irritability" compared to other methods (P = 0.0039).
- A significant difference in "bruising" was observed, with the WHO technique showing lower rates than the US technique (P = 0.0418).
Conclusions:
- The WHO technique is recommended as the optimal method for anterolateral thigh injections in children.
- This technique ensures intramuscular delivery, minimizes adverse reactions, and is simpler to perform.
- Improved technique adherence can lead to better pediatric vaccination experiences.
Objective:
To compare the rates of adverse reactions and parental approval ratings for three different techniques for anterolateral thigh vaccination in children aged 2, 4, 6 and 18 months.
Design:
Randomised, observer-blind trial.
Participants:
375 children who received pertussis-containing vaccines in a regional New South Wales town between 29 May 2001 and 30 June 2002.
Interventions:
Children were randomised to receive intramuscular injection with acellular pertussis-containing and Haemophilus influenzae type b vaccines with one of three recognised injection techniques (Australian, World Health Organization or United States).
Main Outcome Measures:
Local adverse reactions (bruising and redness/swelling), systemic adverse reactions (irritability, perceived fever, persistent crying/screaming, drowsiness, vomiting/poor feeding) and parental acceptance were assessed 24 hours after injection.
Results:
361 children (96%) were evaluated 24 hours after vaccination. The WHO technique resulted in significantly fewer children, than with the other two techniques, with the systemic adverse reaction variable "irritability" (P = 0.0039). There was a significant difference between the technique groups overall for the local adverse reaction "bruising" with acellular pertussis-containing vaccines (P = 0.0418), due to a lower reaction rate in the WHO group compared with the US group (P = 0.0356).
Conclusion:
The WHO technique appears to be the optimal technique for anterolateral thigh injection in children--it ensures that the injection is intramuscular, results in fewer adverse reactions, and is the easiest technique to perform as it does not require angling of the needle to the long axis of the femur.
