Milk and molasses enemas: clearing things up.

INTRODUCTION: We aimed to describe current nursing practice and clarify the safest and most effective dose of milk and molasses enemas used to relieve constipation in pediatric patients presenting to a suburban pediatric emergency department. METHODS: We surveyed emergency nurses about current practice in administration of milk and molasses enemas. In addition, we identified consecutive patients aged 2 to 17 years with a discharge diagnosis of constipation or abdominal pain between 2009 and 2012. Stable patients were included from the emergency department, in the absence of chronic medical conditions. For each patient, we recorded demographic characteristics, chief complaint, nursing administration technique, stool output, patient tolerance, side effects, amount of enema given, and patient disposition. RESULTS: We identified 500 patients with abdominal pain or constipation, 87 of whom were later excluded. Milk and molasses enemas were found to be effective at relieving constipation in our population, with a success rate averaging 88% in patients given 5 to 6 mL/kg with an institutional guideline maximum of 135 mL. The success rate was found to vary with age, along with the amount of enema given. DISCUSSION: Our nursing survey showed that varying practice exists regarding technique and dosing of milk and molasses enemas. Historical chart review showed that milk and molasses enemas in our emergency department were safe and effective with minimal side effects.

Accuracy of non-contact infrared thermometry versus rectal thermometry in young children evaluated in the emergency department for fever.

OBJECTIVE: We evaluated the accuracy of a non-contact infrared thermometer compared with a rectal thermometer. METHODS: Two hundred patients, ages 1 month to 4 years, were included in the study. Each child underwent contemporaneous standard rectal thermometry and mid forehead non-contact infrared thermometry. Clinical features, including chief complaint, recently administered antipyretic agents, and ambient temperature at the time of measurement, were included. ANALYSIS: Linear models were used to compare agreement between the 2 techniques, as well as to determine bias of infrared thermometry at different rectal temperatures. Multivariate linear models were used to evaluate the impact of clinical variables and ambient temperature. RESULTS: A linear relationship between rectal and infrared temperature measurements was observed; however, the coefficient of determination (r(2)) value between was only 0.48 (P < 0.01). Infrared thermometry tended to overestimate the temperature of afebrile children and underestimate the temperature of febrile patients (P < .01). Ambient temperature and child age did not affect the accuracy of the device. CONCLUSION: In this study, non-contact infrared thermometry did not sufficiently agree with rectal thermometer to indicate its routine use.