Administration of rectal suppositories in children

The administration of rectal medication is frequently performed in children’s nursing and is often viewed as a basic skill. However, it may hold potential risks.¹ Children may view this procedure as distressing and embarrassing and appropriate knowledge and skills are essential in order to ensure safe and effective care. 

Nursing priorities include individual child assessment, medication knowledge, safe medication practices and the promotion of optimum comfort for the child. 

Adopting an evidence-based approach to this procedure promotes safe practice while creating a more positive experience for the child. This article presents a structured approach to administering rectal suppositories to children, which aims to minimise distress, and ensure correct administration and optimal efficacy of the medication.  

Rectal suppositories

A suppository is a solid bullet-shaped preparation,² which is inserted into the rectum. It is administered when the oral route is not acceptable or when a local effect on the bowel is required (see Table 1). 

 (click to enlarge)

There are two types of suppositories:³

• A stimulant suppository – stimulates bowel activity, softens stool (for example, glycerine, sodium bicarbonate)
• A retention suppository – delivers medication (for example, paracetamol).

Suppositories may exert a local effect on the gastrointestinal mucosa or have systemic effects. They dissolve at body temperature⁴ and are absorbed via the intestinal blood supply. Absorption may be unreliable if a stool is present in the rectum and/or if medication is passed along with a stool after administration.⁵

Common medications administered via this route are analgesics, sedatives and anti-emetics.⁶ Suppositories are generally indicated for use in infants and young children. 

Administration 

It is important to limit distress during the administration of a suppository as some children may find the procedure uncomfortable or embarrassing. Each child should be individually assessed to determine their suitability for the procedure. Meanwhile, explaining the process fully to both the child and parent will improve co-operation and trust. 

If possible, encourage the child to empty their bowels prior to the administration of the suppository. This will avoid the medication being expelled prior to its absorption³ and it will also improve the efficacy of the medication. Older children may be able to self-administer their medication with some supervision. 

Insertion technique

Debate exists in relation to the insertion technique of suppositories.⁷ Inserting the blunt end first has been advocated in order to improve retention.⁸ However, manufacturer’s instructions usually advise that suppositories should be inserted apex first. As there is little evidence to support this change in practice, suppositories should be administered in accordance with the manufacturer’s instructions.

Administration of suppositories is an invasive experience for any child. Table 2 presents a standardised approach to administering rectal suppositories to children so as to create minimal distress. 

 (click to enlarge)

References

1. Ford L, Maddox C, Moore E, Sales R. The safe management of medicines for children. In Practices in Children’s Nursing: Guidelines for Community and Hospital (Trigg E,  Mohammed TA, Eds). Edinburgh; Churchill Livingstone, 2010; 3rd edn: 45-74
2. Barrett G, Fletcher T, Russell T. Fundamental aspects to safe administration of medicine. In Fundamental aspects of children’s and young people’s nursing procedures (Glasper A, Aylott M, Prudhoe G. Eds). Quay Books, 2007: 123-80
3. Dougherty L, Lister S. Manual of clinical nursing procedures, 7th Edn, Blackwell Science, Oxford; 2008  
4. Higgins D. Administering a suppository. Nursing Times. 2007; 103(10): 26-7
5. Algren CL, Arnow D. Pediatric variations of nursing interventions. In Wongs’ nursing care of infants and children, (Hockenberry MJ, Wilson D. Eds.), Mosby Elsevier: Missouri; 2007; 8th edn: 1083-139
6. Bindler RC, Ball JW. Clinical skills manual for pediatric nursing, 4th Edn., Pearson Prentice Hall, New Jersey; 2008 
7. Bradshaw A, Price L. Rectal suppository insertion: the reliability of the evidence as a basis for nursing practice, J Clinical Nursing. 2005; 16(1): 98-103
8. Abd-El-Maeboud K, El-Nagger T, El-Hawi E, Mahound S, Abd-El-Hay S. Rectal suppository: commonsense and mode of insertion, The Lancet 1991; 338(8770): 798-800
9. Barron C, Hollywood E. Drug administration. In Clinical Skills in Children’s Nursing (Coyne I, Neill F, Timmins F, Eds.), Oxford University Press, Oxford; 2010: 147-81
10. An Bord Altranais. Guidance to nurses and midwives on medication management, An Bord Altranais: Dublin; 2003