What is the appropriate dose of glycerine enema for a 5-year-old child weighing 22kg?

Glycerine Enema Dosing for a 5-Year-Old Child

Direct Answer

For a 5-year-old child weighing 22kg, administer a pediatric glycerine enema using 2-4 mL/kg (approximately 44-88 mL total volume), though standard pediatric glycerine enema preparations typically come in pre-measured doses of 2.3-4 mL for children under 6 years of age.

Dosing Considerations

Age-Appropriate Volume

• Children under 6 years should receive pediatric-sized glycerine enema preparations, which are substantially smaller than adult formulations 1
• The typical pediatric dose ranges from 2-4 mL/kg of body weight, which for this 22kg child would be approximately 44-88 mL 2
• Commercial pediatric glycerine enemas are pre-packaged in smaller volumes (typically 2.3-4 mL) specifically designed for young children to minimize risk of rectal trauma or excessive fluid administration 1

Administration Protocol

• Use a pediatric-sized rectal applicator to minimize trauma risk during insertion 1
• Insert the applicator gently 2-3 cm into the rectum (approximately half the length of the applicator tip for this age group) 1
• Administer slowly over 30-60 seconds to allow the rectum to accommodate the volume and reduce discomfort 1
• Have the child retain the enema for 5-15 minutes if possible before allowing evacuation 1

Safety Considerations

Contraindications to Assess

• Do not administer if there is suspected bowel obstruction, perforation, or acute surgical abdomen 1
• Avoid in children with recent rectal surgery or known rectal pathology 1
• Exercise caution in immunocompromised children due to potential mucosal injury risk 3

Monitoring for Complications

• Watch for rectal bleeding, which indicates mucosal trauma and requires immediate cessation 3, 4
• Monitor for signs of electrolyte disturbance if repeated enemas are needed, though this is rare with single-dose glycerine enemas 3
• Observe for abdominal distension or pain that could indicate complications 4

Clinical Context

Evidence Quality

• The available evidence for glycerine enema use in children is primarily derived from premature infant studies, which show earlier meconium evacuation but uncertain clinical significance 3, 4
• No high-quality pediatric trials exist for school-age children, making dosing recommendations based on clinical practice patterns and extrapolation from adult guidelines 1
• Some evidence suggests a potential trend toward increased necrotizing enterocolitis risk in premature infants (though not statistically significant), but this has not been demonstrated in older children 4

Alternative Considerations

• If the child has chronic constipation requiring regular enemas, consider antegrade continence enema protocols using diluted glycerine (typically 30 mL glycerine with 50 mL tap water flush) for better long-term management 2
• For acute constipation relief, a single pediatric glycerine enema is appropriate first-line therapy 1

Common Pitfalls

• Avoid using adult-sized enema volumes (typically 120-150 mL), which can cause rectal distension, discomfort, and potential trauma in young children 1
• Do not force insertion if resistance is met, as this increases perforation risk 1
• Ensure proper positioning (left lateral position with knees drawn up) to facilitate safe administration and retention 1