What is the recommended dose of glycerin (osmotic laxative) suppository for pediatric patients?

Pediatric Glycerin Suppository Dosing

For pediatric patients, glycerin suppositories should be dosed at 1 g/kg up to a maximum of 50 g per dose, administered rectally every 6 hours as needed. 1

Age-Based Dosing Guidelines

Infants and Young Children

• Neonates and infants:

  • Infant-sized suppository (1-1.5 g) or ¼ to ½ of a pediatric suppository
  • For premature infants, use with caution as evidence is limited 2
  • For term infants with normal bowel movements, clear liquids for 24 hours with a normal saline enema (10 mL/kg) may be sufficient 1

• Toddlers (1-3 years):

  • Pediatric-sized suppository (1-2 g)

Older Children

• Children (4-11 years):

  • Pediatric-sized suppository (2-4 g)

• Adolescents (≥12 years):

  • Adult-sized suppository (4 g)

Administration Technique

1. Store suppositories in a cool place to maintain firmness
2. Remove wrapper before insertion
3. Lubricate the rounded end with water or water-soluble lubricant
4. Insert the rounded end first into the rectum:
   • For infants: 1-2 cm into the rectum
   • For children: 2-5 cm into the rectum
5. Hold buttocks together for 1-2 minutes to prevent expulsion
6. Suppository should produce a bowel movement within 15-30 minutes

Monitoring and Precautions

• Duration of use: Limit use to short-term relief; not recommended for long-term management of constipation
• Adverse effects: Monitor for:
  • Rectal irritation or bleeding (reported in 10% of premature infants in studies) 3
  • Anal fissures (documented in some cases) 3
  • Potential risk of necrotizing enterocolitis in premature infants (trend noted in meta-analysis) 2

Special Populations

Premature Infants

• Limited evidence supports routine prophylactic use in premature infants 4, 2
• Meta-analyses show no significant effect on:
  • Time to full enteral feeds
  • Duration of hospital stay
  • Mortality 4
• May help with earlier initiation of stooling in some cases 2
• Caution: Potential increased risk of necrotizing enterocolitis (risk ratio = 2.72, P = .13) 2

Term Neonates with Hyperbilirubinemia

• May be beneficial as an adjunct to phototherapy for hyperbilirubinemia management 5
• In one study, half of a glycerin suppository every 12 hours with phototherapy showed:
  • Faster reduction in total plasma bilirubin levels
  • Shorter hospitalization (1.5 ± 0.4 days vs. 2.9 ± 1.1 days in control) 5

Clinical Pearls

• Pediatric dosing should consider age, size, and organ maturity rather than simply administering a "small adult" dose 6
• For infants with normal or frequent bowel movements, glycerin suppositories may not be necessary 1
• Alternative options for constipation in children include PEG-3350 (1.5 g/kg/day) 1
• Maintain adequate hydration, especially important when using osmotic laxatives in children 1