Enema for children is recommended to relieve severe constipation. Enema is a procedure where fluid is injected into the rectum via the anal opening. It helps in expelling impacted stools. Disimpaction of hardened stools is necessary before commencing any maintenance therapy. Doctors recommend enema only when the child does not respond to dietary changes such as consuming a fiber-rich diet and oral laxative medications. Moreover, it may be used to clear the bowel before surgery, administer some medications, or permit imaging (X-ray) for diagnostic purposes (1) (2). Read this post to learn about the types of enema in children, its method of administration, side effects, and precautions.
What Are The Types Of Enema For Children?
The fluid enters the rectum during an enema, softens the stools, and stretches the rectum, increasing bowel movement and urge to pass the stools. Doctors may decide the appropriate enema among the many types (3) (4).
Sodium phosphate enema (available as Fleet’s enema, Pedia-Lax enema): Contains water and phosphate, and the unabsorbed phosphate retains water in the colon.
Normal saline enema: Contains salt water solution only.
Mineral oil enema: Performed using mineral oil only.
Soap suds enema: Contains water with a small quantity of soap. The soap suds cause mild irritation and stimulation in the colon, leading to the urge to pass stools.
Milk-molasses enema: Contains lactose (milk sugar), milk protein, and molasses. Retains water as none of the ingredients get absorbed from the colon.
Saline and mineral oil enemas are considered safe options for children with constipation due to the minimal risk of adverse effects. Enemas or their ingredients are available over the counter (OTC) in pharmacies, but you should consult a pediatrician before giving them to children (5). Enemas that are used for purposes other than constipation include the following.
Air enema: The fluid is replaced with air released under high pressure. It is predominantly used in the treatment of intussusception, where one section of the intestine folds on itself. The air enema helps push the bowel back into the right position (6).
Barium contrast enema: It is used for colon and rectal examination (large bowel) through X-rays. A radiologist or a radiographer carries out the test to diagnose the root cause of problems such as chronic diarrhea, constipation, abdominal pain, unexplained weight loss, or anemia (7).
What Age Is Appropriate For Enema?
Most enemas, especially those containing sodium phosphate, are not recommended for children below two years of age. The amount of solution required depends on your child’s age and body weight. However, it is advisable to consult your healthcare provider before starting an enema for your child (5) (8).
What Is The Dosage Of Enema For Children?
The dosage depends on the age and body weight of the child. Some enemas are available OTC in pharmacies, and you must check with your doctor to find out the correct product and dosage for your child. General instructions for the enemas commonly used in children may include the following (5).
Fleet’s phosphate enema is available ready-to-use in small-size (2.25 ounces) packages for children. If your child is two to five years of age, give half the contents of the small-size enema pack. For that, remove half of the pack’s content before starting the procedure.
For mineral oil enema, about two ounces is sufficient for children aged two to six years.
Saline enemas may be prepared at home by mixing two teaspoons of table salt in 33 ounces (one liter) of tap water (9). Image: Shutterstock
Soap studs and milk-molasses enemas vary in their formulation and are prepared as per the instructions from the healthcare provider. It is not a common option for home treatment and is mostly performed in hospital settings.
How To Give A Child An Enema?
Ready-to-use enema formulations (mostly for phosphate enemas) come in bottles with nozzles for application to the anus. Otherwise, supplies needed include an enema bag with soft silicone tubing (Foley catheter available at pharmacies), water-soluble lubricant (not petroleum jelly), measuring cup, and the enema ingredients as per the doctor’s instructions (9) (10). It is important to prepare your child by explaining why you are giving the enema and the process involved. Children tend to respond better when they understand and cooperate. It takes about 45 minutes for the complete process. Try to keep your child occupied with games, music, or videos. You may begin the process by positioning the child. Position your child in the following ways.
Lie on the left side with right leg bent towards the chest Lie on the back with legs bent towards the chest (as when changing a diaper) Lie on the stomach or over your lap with knees bent to the chest
Below are the steps to give an enema to the child. If your child complains of cramps or severe discomfort, stop the enema temporarily and restart after a few minutes. Have your child remain in the position until the urge for bowel movement becomes strong, which is usually after five minutes. Take the child to the toilet, where they will pass stools with the enema solution. You may observe the consistency of stools to report its attributes to the child’s doctor.
What Are The Side Effects Of Enema For Children?
Enemas may have certain side effects such as (11):
Nausea Abdominal pain Bloating Discomfort such as stinging or blistering in the anal area
Some serious side effects for which you should seek medical help include:
Vomiting Dizziness Swelling in hands or feet Reduced urination
What Precautions Should Be Taken When Administering Enema?
Precautions that need to be taken when using enema in children are (10) (12):
Consult a pediatrician first if your child has any existing gastrointestinal or renal problems. Inform the doctor about any laxative or stool softener medication taken by your child in the past two weeks.
Enemas may cause dehydration and disturb electrolyte levels. Make sure your child drinks lots of water and liquids before and after the procedure.
The solution should not be infused too fast as it may cause dizziness.
Ensure you apply adequate lubrication on the tube’s tip to minimize any discomfort and make removal easy.
Usually, one enema a day is sufficient. Ask your doctor how long you should continue giving enema to your child and always follow the instructions for administering enema.
When To See A Doctor?
Consult a doctor immediately in the following scenarios.
The enema is unable to cause a bowel movement. The child complains of pain that does not stop after the procedure. You notice rectal bleeding during or after the procedure. The child develops diarrhea after the enema. The child vomits, has seizures, or has altered alertness after the procedure. The child experiences frequent stool accidents (accidental or involuntary passing of motion) after an enema.
A provider will need to slowly break up the impacted mass by inserting one or two fingers into the rectum. The smaller pieces may come out quickly. Suppositories may be inserted into the rectum between attempts to help clear the stool.
