Proper Technique for Administering a Saline Enema in Children
For pediatric patients requiring a saline enema, the recommended dosage is 10 mL/kg of normal saline solution administered rectally with appropriate technique and safety precautions to minimize discomfort and complications. 1
Preparation and Equipment
- Solution: Use normal (0.9%) saline at body temperature
- Volume: 10 mL/kg of body weight 1, 2
- Equipment needed:
- Appropriate-sized enema bag or bottle with tubing
- Lubricant (water-based)
- Clean gloves
- Waterproof pad
- Towels
- Access to toilet or diaper for infants
Step-by-Step Administration Technique
1. Preparation
- Warm saline solution to body temperature (37°C/98.6°F) 3
- Position child on their left side (Sims' position) with knees flexed
- Place waterproof pad under the child
- Explain the procedure in age-appropriate terms to reduce anxiety
2. Administration
- Put on gloves
- Lubricate the tip of the enema tube with water-based lubricant
- Gently separate the buttocks to visualize the anus
- Insert the lubricated tip 2-4 cm into the rectum:
- Infants: 2-3 cm
- Toddlers/young children: 3-4 cm
- Older children: 4-5 cm
- Direct the tip toward the umbilicus (following the natural curve of the rectum)
- Slowly administer the solution over 3-5 minutes to prevent cramping
- Keep the container elevated 30-45 cm above the anus during administration
3. Retention and Completion
- For infants: Hold buttocks together gently for 2-3 minutes to help retain fluid
- For older children: Encourage them to hold the fluid for 5-10 minutes if possible
- Provide immediate access to toilet or bedpan when ready to expel
- Dispose of materials properly and wash hands thoroughly
Special Considerations
Age-Specific Modifications
- Infants: Use smaller volumes (start with 5 mL/kg) and ensure gentle pressure 4
- Young children: May need distraction techniques during administration
- Older children: Provide privacy and clear instructions about the retention process
Safety Precautions
- Never use substantial force during insertion 5
- Never clamp tubing if child complains of pain or discomfort 5
- Monitor for signs of distress throughout the procedure
- Discontinue immediately if resistance is met or child experiences severe pain
Potential Complications
- Discomfort or pain (reported in about 50% of cases, usually mild) 4
- Mucosal irritation
- Rare but serious: perforation (especially with forceful administration)
- Electrolyte imbalances (with repeated use)
Effectiveness and Expected Outcomes
- Mean response time after administration is approximately 26 minutes 4
- About 62% of children report some degree of relief after administration 4
- Effectiveness increases with age:
- Under 3 years: 48.6% report relief
- 3-7 years: 70.4% report relief
- Over 7 years: 75% report relief 4
Follow-Up Care
- Monitor bowel movements after the procedure
- Ensure adequate hydration
- Consider underlying causes of constipation for long-term management
- Document response to treatment
By following these guidelines, healthcare providers can safely and effectively administer saline enemas to pediatric patients when clinically indicated, minimizing discomfort while maximizing therapeutic benefit.