(See original article here.)

When parents are clearly informed that the procedure may be uncomfortable and could cause the child to cry, and they still consent, I do not believe the physician is acting inappropriately. Given the close proximity of the genital area and the possibility of a resisting child, inadvertent contact and minor local irritation can occur despite appropriate technique. If we were to require sedation or anxiolytics for all minor procedures, most pediatric office-based care would become impractical and many necessary interventions would be deferred, which is a form of defensive medicine. A clear explanation of the indication, steps, potential discomforts, and alternatives, followed by informed parental consent, is what is ethically and legally required, and I intend to continue performing appropriate minor procedures in the office without routine sedation.

—Venkata Dharbhamulla, MD

Absolutely not! This is rarely if ever a true emergency in pediatrics and is not worth the risk of rectal trauma when there are other ways to initiate clean-out in pediatric patients. This is unlike our elderly adult patients who, with a larger anus [and being] less susceptible to trauma, can often go home after disimpaction. These kids should be monitored and evaluated for motility anyway if it is that severe and manual, or instrumented disimpaction should be done in a controlled setting under sedation.”

—Kurtis Mayz, MD, JD, MBA