How to Insert a Rectal Suppository in a Newborn
Preparation and Positioning
Position the newborn on their side (lateral decubitus position) or on their back with knees flexed toward the chest to optimize access to the rectum. 1
- Ensure the infant is calm and comfortable before beginning the procedure 1
- Have all necessary supplies ready, including the suppository, water-soluble lubricant, and gloves 2
- Wear clean gloves to maintain hygiene and prevent contamination 2
Suppository Preparation
- Remove the suppository from its wrapper just before insertion 2
- Lubricate the suppository generously with water-soluble lubricant to minimize discomfort and facilitate insertion 2
- The suppository should be at room temperature or slightly warmed in your hand to prevent shock from cold temperature 2
Insertion Technique
Insert the suppository pointed end first (not blunt end first) into the rectum, as recommended by most manufacturers and standard clinical practice. 3
- Gently separate the buttocks with one hand to visualize the anal opening 2
- Insert the lubricated suppository approximately 1-2 cm (about half the length of your little finger) into the rectum in newborns 2
- Use gentle, steady pressure—never force the suppository if you meet resistance 2
- Aim the suppository toward the umbilicus (anteriorly) to follow the natural curve of the rectum 2
- Hold the buttocks together gently for 1-2 minutes after insertion to prevent immediate expulsion 2
Important Caveats and Pitfalls
Avoid rectal suppositories in extremely preterm neonates with intestinal concerns, as they may develop intestinal hemorrhage (hematochezia). 1
- Do not use excessive force during insertion, as the rectal mucosa in newborns is delicate and prone to trauma 2
- Be aware that the evidence for "blunt end first" insertion comes from a single 1991 study that has not been adequately replicated, while manufacturers consistently recommend pointed end first 3
- Monitor for signs of rectal bleeding or discomfort after insertion 1
- For medications like glycerin suppositories used for constipation relief, these are appropriate for short-term use only 4
Special Considerations for Newborns
- Newborns have smaller rectal vaults, so insertion depth should be minimal (1-2 cm maximum) 2
- The suppository will dissolve at body temperature, typically within 15-30 minutes 2
- For systemic medications given rectally, absorption may be variable in neonates due to immature hepatic metabolism 5, 6
- Many drugs used rectally in newborns are off-label, as most medications lack adequate neonatal safety data 5, 6