What is the recommended dosage and brand of saline enema (hypotonic solution) for a 5-year-old child weighing 22kg with constipation?

Saline Enema Prescription for a 5-Year-Old Child (22kg) with Constipation

For a 5-year-old child weighing 22kg with constipation, prescribe normal saline enemas at a dose of 20 mL/kg (440 mL total volume), administered rectally as needed for fecal impaction or as part of a structured bowel management program.

Dosing Recommendations

Volume Calculation

• Standard starting dose: 20 mL/kg of normal saline 1, 2, 3
• For this 22kg child: 440 mL of normal saline per enema
• The effective therapeutic range in pediatric studies spans 5-48 mL/kg, with a median of 22 mL/kg 2
• Most children in structured bowel management programs respond well to 20 mL/kg as an initial dose 1, 3

Age-Specific Considerations

• Children aged 3-7 years show a 70.4% relief rate with saline enemas 4
• Children weighing 20-30 kg (which includes this patient) demonstrate a 78.3% symptomatic improvement rate 4
• Mean response time after administration is approximately 26 minutes (range varies) 4

Safety Profile

Why Saline is Preferred Over Phosphate Enemas

• Phosphate enemas (Fleet) are contraindicated in children under 2 years and should be used with extreme caution between 2-5 years 5
• Phosphate enemas can cause life-threatening complications including hyperphosphatemia, hypernatremia, hypocalcemia, and severe dehydration 5
• Normal saline enemas have no significant adverse effects and are well-tolerated in pediatric populations 4, 1

Tolerability Data

• 50% of children report mild discomfort (83% describe it as slight) 4
• No serious adverse effects reported in large pediatric series 4, 1, 3
• Treatment is well-accepted by families and healthcare staff with mean satisfaction scores of 5/10 4

Brand Recommendations

While specific commercial brands are not extensively discussed in the medical literature, the prescription should specify:

• 0.9% Normal Saline Solution (isotonic saline)
• Can be prepared using sterile normal saline for irrigation
• Pre-packaged pediatric saline enema kits are available but often come in smaller volumes (typically 60-120 mL), so multiple units or bulk saline may be needed

Prescription Format

Rx: Normal Saline 0.9% Solution

• Volume: 440-500 mL per administration
• Route: Rectal
• Frequency: As needed for constipation/fecal impaction, or daily if part of structured bowel management
• Instructions: Administer at room temperature; retain for 5-10 minutes if possible before evacuation

Clinical Implementation

Initial Treatment Approach

• For acute fecal impaction presenting to emergency department: single dose of 20 mL/kg (440 mL) 4
• For severe refractory constipation: may require enrollment in structured bowel management program with daily enemas 1
• Adjust volume based on clinical response; some children may require up to 48 mL/kg (1056 mL maximum for this child) 2

Expected Outcomes

• 62% of children report some degree of relief (42.9% symptomatic relief, 12.7% complete relief) 4
• In structured programs, hospital admission rates decrease by 82% after one year 1
• Response typically occurs within 26 minutes of administration 4

Important Caveats

• Contrast enema findings do not reliably predict effective therapeutic enema volumes, so empiric dosing starting at 20 mL/kg is appropriate 2
• Daily radiographs and clinical assessment may be needed in severe cases to optimize the regimen 1
• Compliance can be challenging for some families; education and support are essential 3
• This is distinct from the small-volume enemas (60-120 mL) used in emergency fluid resuscitation, which follow different dosing parameters 6