The rectal examination is not part of the routine pediatric examination, but should be done whenever intra-abdominal, pelvic, or perirectal disease is suspected.
The rectal examination of the young child can be performed with the child either in the side-lying or lithotomy position. For many young children, the lithotomy position is less threatening and easier to perform. Have the child lie on the back with the knees and hips flexed and the legs abducted. Drape the child from the waist down. Provide frequent reassurance during the examination, and ask the child to breathe in and out through the mouth to relax. Spread the buttocks and observe the anus. You can use your lubricated gloved index finger, even in small children. Palpate the abdomen with your other hand, both to distract the child and to note the abdominal structures between your hands. The prostate gland is not palpable in young boys.
In young girls, a rectal examination is useful for detecting tenderness or masses. The rectal examination for older girls who are undergoing a pelvic examination should proceed as it does for the adult patient.
Anal skin tags are present in inflammatory bowel disease, but are more often an incidental finding.
Tenderness noted on rectal examination of a child usually indicates an infectious or inflammatory cause, such as an abscess, or appendicitis.
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