On 26 August Ms. Davis writes that a digital rectal exam in the case referred
to is "sexual abuse." This description is both inflammatory and misguided.
Child sexual abuse refers to the mistreatment of a child for the purposes of
sexual gratification. A gentle rectal exam can be an important part of the
evaluation of constipation even in infants, for evaluation of Hirschprung's
disease for example, although I agree that as presented this would be low on
my differential. Most likely this infant is fine. Stooling patterns for
infants vary extremely from many per day to up to every 10 days in my
experience. There are also likely to be changes during dramatic adjustments
in diet, such as changing from BF to formula or vice-versa. My concern is not
with the evaluation or the pronouncement that "everything is fine" but with
the prescription for suppositories every 3 days! If everything is fine, then
there is no need for such. Overuse of suppositories may result in trauma, or
dependence, or in some cases may obscure a more significant problem.
Constipation should be judged more by the character of the stool rather than
its frequency. And true constipation should usually be treated with
additional fluid in the diet, rather than suppositories--certainly not
regular periodic suppositories.

Brian Hall, MD
Staff Neonatologist
US Naval Hospital, Okinawa
e-mail: [log in to unmask]