1.4 Administration of vaccines

Please note: due to continuous updates being made to the Immunisation Handbook, the page number on the electronic version will not always match the hard copy version.


It is important that infants and children do not move during injection of vaccines. However, excessive restraint can increase their fear and result in increased muscle tension. The following section describes a variety of positions which may be used for vaccinating different age groups.

Positioning of infants <12 months of age

• Cuddle position for infants

Position the infant in a semi-recumbent cuddle position on the lap of the parent/carer. The infant’s arm adjacent to the parent/carer should be restrained underneath the parent/carer’s arm or against the parent/ carer’s chest. The knee should be flexed to encourage relaxation of the vastus lateralis for IM vaccinations. The infant’s other arm must also be held securely (see Figure 1.4.1).

This position can also be used for young children.

Figure 1.4.1: The cuddle position for vaccination of a child <12 months of age

Photo courtesy Dr Joanne Molloy, VIC

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• Positioning infant on an examination table

An alternative is to lay infants on their backs on an examination table, with the infant’s feet towards the immunisation service provider, and the parent/carer beside the provider to immobilise and distract the baby (see Figure 1.4.2).

Keep the infant’s hip and knee flexed by cupping the patella in the non-injecting hand.

The thumb and index finger of the non-injecting hand may be used to stabilise the hub of the needle once the needle has been inserted.

Figure 1.4.2: Positioning an infant on an examination table for vaccination

Photo courtesy Dr Joanne Molloy, VIC

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• Prone position across the lap for ventrogluteal vaccination

For ventrogluteal injection, position the child face-down across the parent/carer’s lap. This allows the hips to be flexed and provides access to the ventrogluteal area (see Figure 1.4.8).

Positioning of children ≥12 months of age

• Cuddle position for older child

Sit the child sideways on the lap of the parent/carer, with the arm to be injected held close to the child’s body while the other arm is tucked under the armpit and behind the back of the parent/carer.

The child’s exposed arm should be secured at the elbow by the parent/carer, and the child’s legs also secured by the parent/carer (see Figure 1.4.3).

Figure 1.4.3: Positioning an older child in the cuddle position

Photo courtesy Ann Kempe, MCRI, VIC

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• Straddle position

An older child may be positioned facing the parent/carer with the legs straddled over the parent/carer’s lap. The child’s arms should be folded in front, with the parent/carer hugging the child’s body to the parent/carer’s chest. Alternatively, the child may be positioned to ‘hug’ the parent with the parent’s arms holding the child’s arms in a reciprocal hug (see Figure 1.4.4). This position allows access to both deltoids and both anterolateral thighs.

Figure 1.4.4: Positioning a child in the straddle position

Photo courtesy Dr Joanne Molloy, VIC

• Prone position across the lap for ventrogluteal vaccination

For ventrogluteal injection, position the child face-down across the parent/carer’s lap (see Figure 1.4.8).

Positioning of older children, adolescents and adults

• Solo sitting position for deltoid injections

Most vaccines can be administered into the deltoid area. Adults should sit in a straight-backed chair, feet resting flat on the floor with forearms and hands in a relaxed position on the upper thighs. Keep the arms flexed at the elbow to encourage the deltoid muscle to relax.

Encourage shoulders to drop by asking the person to raise the shoulders up while taking a deep breath in and to drop them while breathing out fairly forcefully. Use distraction to keep muscles relaxed during the procedure, eg. have an interesting poster or similar for the person to concentrate on during the procedure and ask him/her to give you a detailed description of what can be seen.

The ventrogluteal and vastus lateralis are alternative sites if needed (see above,and below).

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