What is the recommended number and dosage of glycerin (glycerin) suppositories for an 8-year-old child with constipation?

Glycerin Suppository Prescription for an 8-Year-Old with Constipation

For an 8-year-old child with constipation, prescribe a single pediatric glycerin suppository (1-1.5 grams) to be inserted rectally as needed, with instructions to retain for 15-30 minutes if possible. 1, 2

Critical Pre-Treatment Assessment

Before prescribing any rectal intervention, you must:

• Perform a digital rectal examination to rule out fecal impaction versus simple constipation 1, 2
• Rule out intestinal obstruction through physical examination 1, 2
• Ensure the child does not have neutropenia, thrombocytopenia, recent colorectal surgery, anal trauma, or severe colitis 1, 2
• Confirm there is no undiagnosed abdominal pain, which is an absolute contraindication 2

When Glycerin Suppositories Are Indicated

Glycerin suppositories are appropriate when:

• Constipation has persisted for several days despite initial conservative measures (increased fluids, dietary fiber, exercise) 1
• The rectum is full on digital rectal examination 2
• The child does not have fecal impaction requiring more aggressive disimpaction 3

Mechanism and Expected Effect

• Glycerin suppositories work through local rectal irritation and by drawing water into the rectum, which softens stool and facilitates evacuation 1, 2
• The suppository should be retained for 15-30 minutes if possible to maximize effectiveness 2
• A bowel movement typically occurs within 15-60 minutes after insertion 4

Quantity to Prescribe

Prescribe 6-12 suppositories for initial management, allowing for:

• Use as needed when constipation recurs (typically 1 suppository per episode) 1
• Adequate supply for 1-2 months of intermittent use
• This quantity balances ensuring availability while avoiding overuse

Critical Pitfalls to Avoid

• Do NOT prescribe adult-sized glycerin suppositories—use pediatric formulations only (1-1.5 grams) 2
• Do NOT give oral laxatives alone if there is fecal impaction—the physical mass must be mechanically disrupted first 2, 3
• Do NOT prescribe rectal interventions without first ruling out obstruction, as this can lead to perforation 2
• Do NOT recommend fixed-dose laxatives without clear instructions to adjust dosing based on response—this is a common cause of treatment failure 3

When Glycerin Suppositories Are Insufficient

If constipation persists after glycerin suppository use:

• Reassess for underlying causes (hypercalcemia, hypokalemia, hypothyroidism, diabetes, constipating medications) 1
• Consider adding bisacodyl suppository, polyethylene glycol (PEG), lactulose, or magnesium hydroxide 1
• For true fecal impaction, more aggressive disimpaction with oral cathartics, enemas, or manual evacuation may be necessary 3

Maintenance Therapy Instructions

Provide concurrent recommendations to prevent recurrence:

• Increase fluid intake and dietary fiber if the child has adequate oral intake 1, 2
• Encourage appropriate exercise if the child's condition allows 1
• Ensure proper toileting habits with privacy and proper positioning 1, 2
• Consider daily PEG (polyethylene glycol) if constipation is chronic or recurrent, as this has superior evidence for maintenance therapy 5, 6

Evidence Context

The recommendation for glycerin suppositories is based on guideline consensus for acute constipation management 1, 2. While research evidence for glycerin specifically is limited, it remains a first-line rectal intervention due to its safety profile and local mechanism of action 4. The most common treatment error in primary care is undertreatment—37-40% of children remain symptomatic after 2 months when treated conservatively 3. If this child requires frequent suppository use, transition to daily oral PEG, which has the strongest evidence for pediatric constipation management 5, 6.