Paracetamol suppositories for toddlers and young children

[AWanderingMinstrel]

I had my children in Europe. There it is normal to give children paracetamol via suppositories as it doesn’t upset their stomach, it is absorbed quicker and you always know the dose and it’s not spat out etc. I was surprised to find you cannot buy these over the counter in the Uk- does anyone know why- - is this cultural? Not as acceptable??

Just to be clear, it wasn’t a big deal and I wouldn’t have been bothered but I was rather startled as it was unexpected! So I’d always assumed that was because everyone on the Continent is super-blasé about suppositories that it didn’t occur to her that it needed specifying exactly what she was about to do. I’d just pushed a whole human being out of my nether regions after all. Apologies for any offence caused.

Maybe some posters who haven’t seen suppositories are concerned it might hurt the child? It doesn’t, its small and slippery and babies hardly even notice it. I had my kids in the EU and got used to administering them although it was a bit weird for me at first.

Oh yes, after the birth of one of my DCs I was v constipated and had to have a glycerine suppository. My husband (medic) put it in. I didn’t feel a thing, which made me feel better about the DC who had to have one in hospital.

It’s a cultural thing I think. When I lived in the UK I would always bring a supply back from Ireland or France. They work a treat if child upset and vomiting or spitting out calpol etc. they are tiny and babies don’t feel a thing. Readily available over the counter in the EU.

Totally agree that the "suppositories are child abuse" posts are ridiculous and that the rectal route is very useful when the oral route is unavailable, but if a child will take paracetamol orally there are sound reasons for choosing that. In most circumstances paracetamol is absorbed faster and more predictably if given orally than rectally. Obviously if you can't get it in in the first place, or the child vomits or has delayed stomach emptying for any reason then it's a different story, but if you have access to a normally functioning gut, oral is the preferred route.
We frequently gave rectal paracetamol to children in theatre throughout most of my career until the intravenous preparation became available when it became far less common, and I've given my own children suppositories when they wouldn't take oral paracetamol. It's not a "bad" choice but it does have disadvantages - it's not just about squeamishness or hang ups . (There are lots of scientific papers in the public domain on the subject of the bioavailability of paracetamol given via different routes if anyone is really interested.)

@AgeingDoc surely in infants it's also about dosing reliability?

If you give oral paracematol to a crying drooling baby there is every chance some of it will leak back out. So you don't really know how much they've had. With a suppository you do.

Yes, far better for a tiny child to develop febrile convulsions because they are so poorly that they cannot regulate their own body temperature and can’t keep oral paracetamol down because they are vomiting. How about we just put their little bodies through even more stress by holding them down to cannulate them and give it intravenously?

I wish we had paracetamol suppositories for children, had to go to A&e once with 8 month old daughter as unwell, would vomit up calpol as soon as touched lips and was getting very dehydrated and struggling to stay awake. After unsuccessful calpol in hospital projectile vomiting over doctor twice who thought I was just being stupid gave the paracetamol suppository which then brought temp down so I could actually give rehydration fluids. Perked up very quickly after this. If I could have done this at home we could have avoided going to hospital

I also used to get them on prescription for my son when he was little. Actually, not for Calpol - he loved that. It was for antibiotics, which would end up all over the me, the walls, the carpet ... My initial request to the GP was for me to be taught how to give him jags! It was the GP who suggested suppositories.

My DC have had paracetamol suppositories in hospital for fever (great because they can't puke it back up) and GP prescribed suppositories for constipation. They both worked a treat. I assume it's just cultural opposition.

I’ve never ever heard of suppositories for children or babies. Quite horrified really.

Honestly after managing tonsillitis in my DC over the years, which almost always leads to terrible vomiting in the night, usually 5 minutes after water or medicine, I would have preferred the suppository option. Honestly don’t know why it isn’t more of a thing here.

You'd be more likely to find yourself in bother for refusing to give medication for a sick child than for giving them medication which happens to be in the form of a suppository so it can actually be delivered!

They are thinner than a pencil and about the length of a drawing pin, if not smaller. They are really effective if you have a vomiting child, as so many small children with fevers tend to do. I was prescribed some for my 9mo when he came down with a fever of 40 on holiday in Croatia and was projectile vomiting so I couldn’t get any oral medication into him. The suppositories controlled the fever and he was able to rest, recover and tolerate fluids. He didn’t even notice the suppository. Horrified indeed 🙄

Just bring some from holidays if you can.

I'm getting ibuprofen powder sachets for a relative (adult) who has issues swallowing pills every time I get to Spain, because my country has only pills and baby liquids.

BTW,I read a lot about calpol jere - which is paracetamol. You don't use ibuprofen for children?

In my country the ultimate parental trick for parents of ill children is a small notebook to write times of administration of paracetamol and ibuprofen using an interlaced time schema.

Jesus. How ill-informed and backward.

Have you not read the thread? Suppositories are widely used for both adults and children in many other countries. What exactly is your concern?

Yep it's a cultural thing 😂

@FourSevenThree yes we also have ibuprofen, also in a syrup form.

Horrified that there’s a simple and reliable way to get pain relief into children who need it and can’t take it orally?

What is remotely horrifying about that? Should children like my DD just suffer? Or have to deal with IV painkillers on a regular basis simply because folks with zero experience of it think it’s somehow horrifying.

It's normal in the UK after birth but they do normally warn you it's a suppository!

Kindly…if your child is in pain and they are vomiting with high fever you would be foolish to object! It literally takes two seconds. My ds had suspected meningitis or leukaemia, it was suppository or let him suffer until the bloods came back!

he was only a baby and they had to wait for the neonatal doctor to get his line in as his veins were so small. Should I have let him suffer?

They really are amazing and absorbed quickly. I’m a nurse so would have no issue administering them, we have so much we give suppository other than paracetamol too! Also when my mum was end of life very young from a bleed on the brain she had crazy temperatures and was in a hospice and paracetamol was administered as a suppository. Obviously she couldn’t swallow and no IV’s as hospice and it kept her comfortable

It takes a very strange mind to sexualise a normal way of giving medicine. What is wrong with people?
The suppositories are available, they are just very expensive for what they are because they aren’t widely used.

Mmm, but you don't really - you know what you have put into the body, but you don't know how much is absorbed and how quickly. And it's not as simple as say, you get twice the bioavailability from an oral dose so you need to give double the dose rectally, it's quite unpredictable. Of course this is an issue to at least some degree with all drugs given enterally and why pharaceutical companies invest so much time and money on developing how drugs are delivered.There isn't a perfect answer. And I am absolutely not saying that suppositories are a bad idea or that they shouldn't be used, just that they are not a panacea. And whilst there clearly is an unreasonable cultural resistance to this route in the UK that is not the only reason why oral medication may be preferable. I would have no hesitation in giving my own child a suppository if they were unable or really unwilling to take oral paracetamol and agree the option should be more readily available here. But if they were able to take an oral form then I'd do that, not because I have any weird hang ups but because I know it's likely to be absorbed more quickly and reliably.