Published by the American Academy of Pediatrics, this two-page plan tells school, child care and other caregivers when and how to give epinephrine to a child at risk of anaphylaxis. The clinician records the child's allergies, asthma and anaphylaxis history, self-carry permissions, a weight-based epinephrine dose and other medicines, then signs alongside the parent. Families give the plan to every place that cares for the child.
The child's physician or other health care provider completes the plan and signs the Physician/HCP Authorization line, and the parent or guardian signs beside it. Page 2 holds additional instructions and contacts for the rescue squad, doctor, parents and other emergency contacts.
Attach the child's photo and record name, date of birth, date of plan, age, weight in kilograms and what the child is allergic to. Then answer yes or no: the child has asthma (flagged as a higher chance of a severe reaction), has had anaphylaxis, may carry medicine, and may give him or herself medicine. If the child refuses or is unable to self-treat, the form directs that an adult must give the medicine.
The reminder defines anaphylaxis as a potentially life-threatening, severe allergic reaction and tells caregivers to give epinephrine if in doubt. Check the Special Situation box and name the foods if the child has an extremely severe allergy to an insect sting or specific foods; caregivers then give epinephrine even for mild symptoms after a sting or after eating those foods.
The left column lists severe symptoms that call for epinephrine, with infant cues added in the 2026 update such as nasal flaring, a hoarse cry, or being limp and floppy. The right column sets the steps: give epinephrine right away and note the time, call for an ambulance with epinephrine, stay with the child, call parents and the doctor, give a second dose if symptoms get worse, continue or don't improve in 5 minutes, position the child, and give other prescribed medicines but never in place of epinephrine.
Mild symptoms such as an itchy nose or mouth, sneezing, a few hives or mild nausea mean the caregiver stays with the child, watches closely, gives an antihistamine if prescribed, and calls parents and the doctor. If more than one symptom or any severe symptom develops, caregivers switch to epinephrine under the severe section. Infant cues include repeated lip licking, ear pulling and spitting up more than usual.
Check the epinephrine route and weight-based dose: intramuscular 0.10 mg, 0.15 mg or 0.30 mg, or intranasal 1 mg or 2 mg, each with its printed weight range. If more than one epinephrine is selected, any one can be used. Then list the oral antihistamine type and dose, with non-sedating preferred, and any other medicine, such as an inhaler or bronchodilator for a child with asthma.
Both the parent or guardian and the physician or other health care provider sign and date the authorization lines at the bottom of page 1. These signatures make the plan an authorized set of instructions that schools, child care programs and other caregivers can follow. Page 2 repeats the child's name and the date of plan.
Use Additional Instructions for anything specific to this child, since AAP advises customizing the plan to the child's needs, allergies and family and to state and local regulations. The Contacts section lists the rescue squad, the doctor, two parents or guardians, and other emergency contacts with name, relationship and phone number.
Download the current version from the source each time; forms change without notice.
Allergy and Anaphylaxis Emergency Plan
Plan de emergencia para alergias y anafilaxia
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Yes. AAP publishes a Spanish version, Plan de emergencia para alergias y anafilaxia, updated in April 2026 with the same layout as the English plan, including the intramuscular and intranasal epinephrine dose options and the parent and physician authorization signatures. Both versions are two-page PDFs.
The form lists weight-based checkboxes. Intramuscular doses are 0.10 mg for 7.5 to under 13 kg, 0.15 mg for 13 to under 25 kg, and 0.30 mg for 25 kg or more, with 0.15 mg used if 0.10 mg isn't available. Intranasal doses are 1 mg for 15 to under 30 kg and 2 mg for 30 kg or more.
The plan asks two separate yes-or-no questions: whether the child may carry medicine and whether the child may give him or herself medicine. It adds that if the child refuses or is unable to self-treat, an adult must give the medicine. Answering both questions tells school and child care staff exactly what the child is allowed to do.
AAP says the plan is meant to be given to school, child care, after-school programs, or any place where others care for the child, such as teachers, coaches, nurses and babysitters. It is written to be understandable to anyone caring for the child when a parent isn't present.