Children with life-threatening anaphylaxis usually have predominantly bronchospastic reactions and absorption of adrenaline from the intramuscular site will be good. Furthermore, hypotension can be difficult to assess in small children and at least one death has occurred where escalating intravenous doses of adrenaline have been given in error. Therefore, in small children it is probably safer to use a second intramuscular dose rather than an infusion, unless the reaction is being treated in an emergency/critical care area under specialist supervision. For the second dose give the same as the first, that is: