Is a glycerin suppository safe for a 15-month-old child with constipation?

Glycerin Suppository Safety in a 15-Month-Old Child

Yes, glycerin suppositories are safe and appropriate for a 15-month-old child with constipation that has persisted for several days, provided you first rule out contraindications including fecal impaction with obstruction, thrombocytopenia, neutropenia, recent colorectal surgery, anal trauma, or severe colitis. 1, 2, 3

Critical Pre-Treatment Assessment

Before administering a glycerin suppository to this toddler, you must:

• Perform a digital rectal examination to rule out fecal impaction and assess for possible bowel obstruction 1, 3
• Check for absolute contraindications including thrombocytopenia, neutropenia, recent colorectal or anal surgery/trauma, and severe colitis 1, 2, 3
• Ensure the child has no symptoms of intestinal obstruction such as severe abdominal distension, bilious vomiting, or absent bowel sounds 1, 3

When Glycerin Suppositories Are Indicated

Glycerin suppositories are appropriate for this 15-month-old when:

• Constipation has persisted for several days despite conservative measures like adequate fluid intake 1, 2
• The rectum is full on digital examination but there is no complete impaction 3
• First-line measures have been insufficient, including ensuring adequate hydration and age-appropriate dietary modifications 1, 3

Mechanism and Administration

• Glycerin works through local rectal irritation and by drawing water into the rectum, which softens stool and facilitates evacuation 1, 3
• Insert one pediatric glycerin suppository rectally, with retention for 15-30 minutes if possible to maximize effectiveness 3
• This is a well-established treatment used across pediatric hospitals, though with significant practice variation (0% to 37% utilization rates across institutions) 4

If Glycerin Suppository Fails

If the glycerin suppository does not relieve constipation within 24 hours:

• Escalate to bisacodyl suppository (one rectally daily to twice daily) as the next step 2
• Consider an osmotic micro-enema containing sodium citrate and glycerol as an alternative 2
• Add oral polyethylene glycol (PEG) if impaction persists, which is the first-line oral agent for pediatric constipation 2, 5, 6
• Reassess for underlying causes including hypercalcemia, hypokalemia, hypothyroidism, or constipating medications 1, 3

Safety Profile

• Glycerin suppositories are generally safe with minimal adverse events reported in pediatric populations 2, 4
• Minor rectal bleeding or anal fissures can occur but are uncommon; one study in premature infants noted 10% experienced rectal bleeding, though this population is more vulnerable than a 15-month-old 7
• No serious adverse events such as rectal perforation have been reported with glycerin suppositories in the pediatric literature 7, 4

Important Caveats

• Avoid enemas entirely if the child has neutropenia, thrombocytopenia, recent surgery, or severe colitis 1, 2
• Do not use repeatedly without addressing underlying causes, as chronic constipation requires maintenance therapy with oral agents like PEG 2, 3
• Ensure adequate hydration before and after treatment, as dehydration can worsen constipation 1, 2