Appropriate treatment for a conscious child with anaphylaxis includes:

• A. 0.01 mg/kg epinephrine 1:1,000 IM
• B. 0.3 mg auto-injector
• C. 0.01 mg/kg epinephrine 1:1000 IM
• D. 0.01 mg/kg epinephrine 1:10,000 IM

Answer: (C)

Epinephrine given by intramuscular injection is the first-line treatment for a child with anaphylaxis, and the dose should be based on weight. The recommended dose is 0.01 mg per kilogram of body weight, using a solution of 1:1000, injected into the mid-outer thigh. This dose provides rapid reversal of airway swelling, bronchospasm, and low blood pressure. The dose is limited to a maximum of 0.3 mg per injection to prevent overdose in larger children.

Because the concentration is 1:1000 (1 mg/mL), the volume to inject equals the weight-based dose divided by 1 mg/mL. For example, a 20 kg child would receive 0.2 mg, which is 0.2 mL of 1:1000 epinephrine. This helps tailor treatment to the child’s size rather than giving a fixed amount.

A fixed 0.3 mg auto-injector is not appropriate for smaller children, since it can exceed the weight-based dose. Conversely, a 1:10,000 concentration is intended for intravenous use in hospital resuscitation, not for intramuscular management of a typical pediatric anaphylactic reaction.