Enema in pediatrics involves introducing fluid into a child’s rectum to stimulate bowel movement, relieve constipation, or prepare for diagnostic procedures. It must be performed with care, using age-appropriate techniques and solutions.
Indications
- To encourage the expulsion of feces and flatus
- To soften stools or soothen the membranes
- To reduce the hyperthermia
- To administer the nutrition and medication
Types of Enemas
| Type | Solution Used | Purpose |
|---|---|---|
| Cleansing enema | Saline, glycerin, or phosphate | Stimulates bowel evacuation |
| Retention enema | Mineral oil or medicated solution | Held in rectum to soften stool or deliver medication |
| Diagnostic enema | Barium solution | Enhances imaging of the colon |
Amount
Amount of fluid to be introduced depends upon the size of the child:
- Infants: 150-250 mL
- Young child: 250-350 mL
- Older child: 300-350 mL
- Adolescent: 500-750 mL
Note: For oil-retention enema, use 10-12 Fr catheter. The catheter should be inserted into the rectum depending on the age of the child as follows:
- Infants: 2.5 cm
- 2-4 years: 5 cm
- 4-10 years: 7.5 cm
- >11 years: 10 cm
Temperature of the solution: 105°F or 45.5°C; for oil-retention enema 100°F (37.7°C)
Equipment Needed
A clean tray containing:
- Enema bag or can and tubing with clamp or syringe with rubber tubing
- Lubricant (liquid paraffin)
- Enema solution
- 10-12 Fr rectal catheter
- Gauze pieces in bowl
- Pair of gloves
- Bedpan padded at the edges
- Kidney tray or paper bag
- Toilet tissue
- Lotion thermometer
- Mackintosh
General Instructions
- The can should not be held > 18″ above the child’s hip. So that solution may run slowly by gravity and pressure into the bowel.
- An isotonic solution or physiologic saline is used. Tap water alone is not used because of the danger of fluid shift and overload.
- Commercially prepared disposable pediatric enemas may be used only when especially prescribed. That can result in rapid harsh action and can be dangerous when used on dehydrated children, children with megacolon or azotemic children.
- A cleansing enema can be given 30-40 minutes after the oil-retention enema.
Position
- Infant and toddler lie on abdomen with knees bent.
- Older children and adolescent lie on left side with right leg flexed toward chest.
Preparation
- Explain the procedure to the parents and child.
- Allow the child to do it on dummy or toys
Procedure
- Gather supplies
- Wash hands and don gloves
- Position the child
- Clamp the enema tubing, remove the cap, and apply lubricant to the tip of the catheter.
- Insert the tube into the rectum.
- Unclamp the tubing and administer the prescribed volume of enema solution at a rate of about 100 mL/min.
- Remove the catheter gently and put in kidney tray.
- Hold the child’s buttocks together if needed to encourage retention of enema for 5-10 minutes.
- Offer bedpan.
- In case of ambulatory and older children. assist them to go to toilet.
Post procedure Care
- Praise the child for cooperation.
- Make the child comfortable.
- Record the procedure in nurse’s record:
- Type of solution used
- Time
- Any other remarks.
- Clean and replace the supplies.
Use of Other Methods over Enema
- A preoperative bowel preparation solution given orally or through a nasogastric tube.
- The polyethylene glycol electrolyte lavage solution (GoLYTELY) mechanically flushes the bowel without significant absorption, thereby avoiding potential fluid and electrolyte imbalances.
- Another effective oral cathartic is magnesium citrate solution.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
