|Suppositories & Enemas
The information below is take from Freeman Miller & Steven J. Bachrach's (1995) Cerebral Palsy: A Complete Guide for Caregiving. Guideance is offered for applications of suppositories and enemas when caring for a child with cerebral palsy. When addressing constipation and using enemas for embedding medications, the content of this page will offer instruction and details.
“You may have to give your child an enema, either occasionally or on a regular basis. Enemas work by distending the rectum and making the child feel the need to have a bowel movement; in addition, they clean out stool that has been held in the rectum. You can buy Fleet plain water enemas (with salt additives) at the drugstore, or you can use plain tap water in a enema bag. Check with your doctor about what’s best for your child. Use about 1 ounce of water for every 20 pounds of the child’s weight. Unless recommended by your doctor, do not use more than 4 1/2 ounces of water. Before you give an enema to your child, be sure to explain what you will be doing, and what will happen.
- The enema should be warm – close to body temperature, not hot or cold.
- Position the child in one of three ways: sitting on the toilet or potty chair; lying on a rug on the bathroom floor, face down with hips and knees bent toward the chest; or positioned on the rug on the left side, with the left leg straight and the right leg bent at the hip and knee and placed on toop of the left leg.
- For a disposable enema: Remove the protective cap from the enema bottle. Gently insert the tip about one inch into the rectum. Slowly squeeze the enema container until it is nearly empty. (A small amount of the contents of the container will remain after squeezing.) Remove the tip from the rectum. For an enema bag: Put Vaseline jelly on the enema tip; gently insert the tip about one inch into the rectum and slowly squeeze the water into the rectum. Hold the bag about one foot above the child’s body.
- Hold the child’s buttocks together, if necessary, to keep the water inside the rectum until the child tells you he or she needs to have a bowel movement, usually after about three to five minutes.
- Help the child to the toilet or potty chair, or place him or her over a bedpan that has been placed in her bed. Or allow the enema to be expelled into a diaper, if necessary.
- Keep a record of the results.
(Cerebral Palsy: A Complete Guide for Caregiving p. 330-331)
“For a variety of reasons, some medications may be given by rectum. When a child is throwing up and it’s important for her to have the medication, the medication can make its way into the child’s system if is administered rectally. Medications are also given rectally to children who have difficulty swallowing or who are unable to swallow. Finally, a child who will be having surgery within a day often must refrain from having anything by mouth, but some necessary mediations can nevertheless be administered by rectum.
The medications most commonly given by rectum are sedatives, antipyretics (medications that help control temperature), antiemetics (medications that help control nausea), and bowel-stimulating suppositories, usually composed of glycerin. Rectal medications, too, are primarily supplied in suppository form (suppositories are shaped like bullets, with one rounded end and one flat end) (Some medications are delivered rectally through a catheter…You can lubricate a suppository for easier insertion by dipping it in water or in a water-soluble lubricant. Do not use an oil-based lubrication, since it may interfere with medication absorption.
- Before getting started, ask the child to try to move his bowels, since if there is stool in the rectum, this may interfere with absorption of the medication.
- To get started, position the child either on his left side, with hips and knees flexed, or on his abdomen with knees flexed and positioned toward the chest. Older children prefer to lie on their sides, whereas insertion is easier in infants if they are placed on their abdomen.
- Put a latex glove on the hand you will be using. With a gloved finger, insert the medication beyond the sphincter. Use the pinky finger to insert the suppository in infants and toddlers. In older children, use the index finger. The usual distance for the insertion of rectal medications is an follows:
- in infants and young toddlers, about 1 to 1 1/2 inches
- in older toddlers and preschoolers, about 2 to 3 inches
- in school age or adolescents, about 3 to 4 inches.
- For the medication to be effective, it must be held in the rectum for 10 minutes. To prevent early expulsion of the medication – before it has been fully absorbed – it may be necessary to hold the buttocks together for 5 to 10 minutes. Older children are generally able to control their sphincter better than younger children. A suppository that has been administered to stimulate a bowel movement ought to be held for 5 minutes, or until the child states a need to move his bowels.
Give your child medications by rectum only if your physician has approved the medication and rectal administration of it. (Cerebral Palsy: A Complete Guide for Caregiving: 331 – 332)