In pediatrics, a suppository is a solid, cone- or bullet-shaped medication designed to be inserted into the rectum, where it melts at body temperature and is absorbed into the bloodstream. This route is especially useful when oral administration is not feasible.
Indications for Suppository Use in Children
| Indication | Rationale |
|---|---|
| Fever or pain | When the child is vomiting or refuses oral medication (e.g., paracetamol suppository) |
| Constipation | To stimulate bowel movement (e.g., glycerin or bisacodyl suppository) |
| Seizure management | Rectal diazepam for acute seizure control when IV access is unavailable |
| Nausea or vomiting | To bypass the GI tract and ensure medication absorption |
| Preoperative preparation | To evacuate the bowel or administer sedative medications |
Equipment Needed
- Suppository
- Pair of disposable gloves
- Mackintosh and towel
- Lukewarm water
- Bedpan
Preparation of the Child and Parents
- Explain the parents and the child as appropriate for indication of the procedure and how it will be done.
- Provide privacy.
- Position the child in Sims’ position.
- Expose only the anal region.
- Spread the mackintosh and towel under the buttocks.
Procedure
Here’s a step-by-step guide for inserting a suppository in pediatric patients, based on best practices and child-friendly techniques:
- Position the child:
- Expose the anal area and place a towel under the buttocks.
- Remove the suppository from its wrapper.
- Lubricate the tip with water or water-based gel (not petroleum jelly).
- Separate the buttocks with your non-dominant hand.
- Insert the suppository gently with the rounded end first, using your index finger:
- Insert about 1–2 cm in infants, 2–3 cm in older children.
- Hold the buttocks together for 10–15 seconds to prevent expulsion.
- Keep the child lying down for 15–20 minutes to allow absorption.
Aftercare
- Clean and replace the articles
- Remove the gloves
- Offer bedpan as necessary
- Document the procedure in nurse’s record
Nursing Considerations
- Assess for contraindications: Avoid if the child has rectal bleeding, diarrhea, or recent rectal surgery.
- Explain the procedure: Use age-appropriate language to reduce anxiety and gain cooperation.
- Ensure privacy and comfort: Close curtains, warm the room, and involve caregivers when appropriate.
- Be sensitive to emotional distress—some children may feel embarrassed or fearful.
- Use distraction techniques like storytelling or toys to ease the experience.
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/
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