Objective: To compare the sedative effects of nasal feeding and oral administration of chloral hydrate on pediatric anorectal manometry under 4 years old. Methods: Infants and young children who underwent anorectal manometry in West China Hospital of Sichuan University from January 2018 to January 2020 were randomly divided into an oral group (n=255) and a nasal feeding group (n=264), and the two groups were compared in terms of medication operation time, onset time, examination time, sleep time, success rate of one-time feeding, the incidence rate of adverse reactions, the effectiveness of sedation, and satisfaction. Results: There are 20 cases of sedation failure in the oral group, and all children in the nasal feeding group was sedated successfully. Administration time of children in the oral group and the nasal feeding group was (15.38±2.34) and (4.02±2.38) min, respectively (t=3.311, P<0.001); the onset time was (26.85±3.61) and (18.56±2.58) min, respectively (t=3.312, P<0.001); the inspection time was (18.58±11.32) and (9.54±2.85) min, respectively (t=3.313, P<0.001); the sleep time was (58.61±22.67) and (48.54±18.85) min, respectively (t=3.101, P=0.002); the success rate of one-time feeding was 47.06% and 98.48%, respectively (Z=−13.225, P<0.001); the incidence of adverse reactions was 59.61% and 21.97%, respectively (Z=4.502, P<0.001), and the satisfaction rate was (9.66±1.34) and (9.67±1.33) points (t=−0.677, P=0.367), respectively. Conclusion: The nasal feeding of chloral hydrate is better than oral administration, with higher success rate of one-time administration, better sedation effect, faster operation, shorter onset and sleep time, and higher safety in pediatric anorectal manometry. The nasal feeding of chloral hydrate indirectly shortens inspection duration without reducing family satisfaction, which is worthy to be applied widely in pediatric anorectal manometry.