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Enemas: How to Give

What is an enema?

An enema is a liquid that is placed in your child's rectum to stimulate the release of large stools. Enemas may be prescribed by your child's healthcare provider if your child is blocked up (impacted). Some children need a second enema 24 hours later if they are still blocked up. Signs that your child is still impacted include continued soiling or a large lump that can be felt in the lower abdomen.

Once stool blockage is cleared, enemas are no longer necessary. Your child's constipation can be treated with oral medicines. Continuous use of enemas irritates the anus and can cause your child to hold back stools.

Use the enema solution recommended by your healthcare provider and follow the instructions carefully. Enemas are generally not used in children under 2 years of age.

Types of Enema Solutions: Mineral Oil, Phosphate, or Saline

Fleet's Phosphate enemas (called saline enemas on the package) are the ones most commonly used. They can be purchased without a prescription at pharmacies and supermarkets. If you use a phosphate enema you must be careful. The dosage of phosphate enemas must be accurate because they can cause serious side effects if given in too high a dose or given more than once per day. For all enemas, the amount of solution you give your child depends on the child's age or weight.

The only enemas that are completely safe in children are mineral oil and normal saline enemas. Normal saline enemas must be made at home. Mineral oil enemas can be purchased at your local drug store or pharmacy without a prescription.

Mineral oil enemas:

Mineral oil enemas come in one size (4.5 oz). The amount of solution you should give is based on your child's age:

2 to 6 years...... 2.0 oz (1/2 enema)

> 6 years old..... 4.5 oz

Phosphate solution enemas:

Sodium phosphate solution is used in Fleet's saline enemas. These enemas can be bought at pharmacies without a prescription. Often the pharmacy will also carry a store-brand enema containing the same ingredient. The advantage of phosphate enemas is they come in a disposable squeeze bag with a soft-tipped nozzle. You won't need any other equipment. They also are the most powerful enema.

If your healthcare provider recommends giving a phosphate enema, give 1 ounce for every 20 pounds of your child's weight. Don't give any child more than 4.5 ounces of the enema. Phosphate enemas come in two sizes: children (2.25 oz) and adult (4.5 oz).

Children under 2 years old should not have a phosphate enema. Dosage is based on your child's weight:

20 pounds............... 1 ounce

40 pounds............... 2 ounces

60 pounds............... 3 ounces

80 pounds............... 4 ounces

90+ pounds............. 4.5 ounces

Instructions for Giving an Enema

  1. Have your child drink 1 or 2 glasses of water before the enema. Sometimes enemas can cause dehydration.
  2. Have your child lie on his stomach with his knees pulled under him.
  3. Lubricate the enema tube or nozzle with a lubricant such as KY Jelly and gently put it 1 and 1/2 inches to 2 inches into the rectum.
  4. Gradually squeeze the contents of the container into the rectum.
  5. When the enema is empty, remove it.
  6. Your child should wait to go to the bathroom until he feels a strong need to have a bowel movement (in about 2 to 10 minutes). Encourage your child to hold back the enema for 5 minutes.
Written by Barton D. Schmitt, MD, author of “My Child Is Sick,” American Academy of Pediatrics Books.
Pediatric Advisor 2015.2 published by RelayHealth.
Last modified: 2014-06-10
Last reviewed: 2014-06-10
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright ©1986-2015 Barton D. Schmitt, MD FAAP. All rights reserved.
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