Assess and manage ABCs.
For patients with signs of hypoperfusion or hypovolemic shock:
- Initiate IV/IO access and give 20 mL/kg isotonic fluid bolus over 5-10 minutes (repeat as needed).
For patient with peritonitis, other signs of perforation, or signs of sepsis/septic shock:
- Refer to TREKK Pediatric Severe Sepsis Algorithm for management.
- Administer empiric antimicrobials for gut flora (e.g., ceftriaxone 100 mg/kg/dose IV Q24H (MAX 2000 mg/dose) and metronidazole 30 mg/kg/day IV divided Q8H (MAX 500 mg/dose).
- Obtain an EMERGENT pediatric/general surgery consultation or contact Pediatric Referral Centre.
- Assess and treat pain. IV opioids are recommended for associated moderate/severe pain; choice of agent should include consideration of the child’s hemodynamic status. Refer to TREKK Recommendations for Pain Treatment.

If pediatric radiology is not available for air enema reduction, arrange transport to Pediatric Referral Centre.
Pediatric/general surgery team must be readily available, as perforation is a complication of air enema reduction in <¹% of patients. If surgery team is not available, transfer to Pediatric Referral Centre BEFORE attempting reduction.
Do not use pre-reduction antibiotics for uncomplicated (non-perforated) intussusception.
Either ultrasound or fluoroscopic guidance should be utilized to confirm successful reduction and have similar success rates (80-90%).²
Risk factors for failure of reduction or recurrence post-reduction include fever, rectal bleeding, vomiting, lactic acidosis, and female gender.³

Contact pediatric/general surgery team.
Potential next steps include further air enema reduction attempts or operative reduction.