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

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.

Fleet's Phosphate enemas (called saline enemas on the package) can also be purchased without a prescription. 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.

Mineral Oil Enema:

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

Homemade saline solution:

To give a homemade enema, you need an enema bag, an enema tube, a lubricant (such as KY Jelly), and distilled water. You can buy these supplies at most pharmacies. Another option is to use a rubber bulb syringe.

You can make a homemade saline solution by adding 2 level teaspoons of table salt to a quart of lukewarm distilled water. Do not use soapsuds, hydrogen peroxide, or plain water as an enema. They can be dangerous.

The amount of normal saline solution that should be given to children at various ages is:

2 to 6 years . . . . . . . . . . . . . 6 ounces

6 to 12 years. . . . . . . . . . . . 12 ounces

Adolescents and adults. . . . . . 16 ounces

Phosphate solution:

Sodium phosphate solution is used in Fleet's 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. If you are giving a disposable enema, gradually squeeze the contents of the container into the rectum.

   If you are giving a homemade enema, put the solution into the enema bag. The fluid will flow down gradually by gravity. Keep the enema bag no more than 2 feet above the level of your child's bottom. Giving the enema should take 5 to 10 minutes. If your child gets cramps, slow down the flow by lowering the enema bag.

5. When the bag is empty, remove the tube.
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.
7. If the enema equipment is disposable, throw it away. If it is reusable, clean the tube as best you can with an antibacterial soap and water. Then sterilize it by putting it in boiling water for 10 minutes. The enema bag just needs to be rinsed with water.