What is the recommended dose of glycerine enema (Glycerin) for children?

Glycerin Enema Dosing in Pediatric Patients

Direct Dosing Recommendation

For infants requiring bowel preparation, administer normal saline enema at 10 mL/kg rather than glycerin enema, as this is the guideline-recommended approach for this age group. 1

Age-Specific Dosing Guidelines

Infants (Normal or Frequent Bowel Movements)

• Normal saline enema: 10 mL/kg is the preferred enema formulation for infants undergoing bowel preparation 1
• This should be combined with clear liquid intake for 24 hours 1
• Glycerin enemas are NOT specifically recommended in major gastroenterology guidelines for routine infant bowel preparation 1

Older Children

• Older children typically undergo bowel preparation with intestinal lavage or laxatives combined with enemas, rather than glycerin enemas as monotherapy 1
• When enemas are used, the normal saline formulation at 10 mL/kg remains the guideline-supported approach 1

Critical Safety Concerns with Glycerin Enemas

Evidence of Potential Harm in Premature Infants

• Meta-analysis of 185 premature infants showed a concerning trend toward increased necrotizing enterocolitis risk with glycerin enemas or suppositories (risk ratio = 2.72, P = .13) 2
• No reports of rectal bleeding or perforation occurred, but the quality of evidence was rated as low to very low 2
• The meta-analysis concluded that evidence for glycerin use in premature infants is inconclusive and requires careful monitoring 2

Appropriateness Issues in Emergency Settings

• A study of 998 pediatric patients found that 45% received glycerin enemas inappropriately (Leech score < 8) 3
• Inappropriate use was more common in patients with nonspecific abdominal pain (40.8%) and acute gastroenteritis (8.3%) rather than true fecal impaction 3

Alternative Treatment Approaches

For Rectal Fecal Impaction in Children 4-16 Years

• High-dose oral PEG (1.5 g/kg/day for 6 days) is equally effective as enemas for treating rectal fecal impaction 4
• Success rates: enemas 80% vs PEG 68% (P = .28), showing no significant difference 4
• PEG causes more fecal incontinence but has comparable behavior scores and should be considered equally as first-line therapy 4

For Chronic Constipation Management

• PEG-3350 at 1.5 g/kg/day for 4 days is an effective purgative option for bowel preparation in children 1
• For infants and toddlers with functional constipation, PEG at 1 g/kg/day (adjusted to yield 1-2 soft stools daily) showed 85% short-term and 91% long-term success 5

Clinical Pitfalls to Avoid

• Do not use glycerin enemas routinely without assessing for true fecal impaction using validated scoring systems like the Leech score (≥8 indicates appropriate use) 3
• Avoid glycerin enemas in premature infants given the potential necrotizing enterocolitis risk signal 2
• Do not assume glycerin is superior to oral therapies—PEG offers comparable or better efficacy with oral administration 4, 5
• Maintain adequate hydration during any bowel preparation regimen in children, as this is critically important 1

Practical Algorithm for Enema Selection

1. Assess indication: Confirm true fecal impaction or appropriate bowel preparation need 3
2. Consider age:
   • Infants → normal saline enema 10 mL/kg 1
   • Older children → consider oral PEG first, then enemas if needed 4
3. Evaluate risk factors: Avoid glycerin in premature infants or those at necrotizing enterocolitis risk 2
4. Monitor response: Adjust therapy based on clinical effectiveness and tolerance 4, 5