Pediatric Patients > Gastrointestinal Tract

Perform examination during the morning unless an emergency. Genitourinary examinations, ultrasonography, or nuclear scintigrams should precede gastrointestinal studies if more than one study is to be perfomed.

A. Barium Swallow, Upper gastrointestinal series, small bowel follow through:

1. Newborns - 6 months: Nothing by mouth (NPO) 2-3 hours prior to examination.
2. 6 months - 3 years: NPO 3-4 hours prior to examination.
3. Over 3 years: NPO after midnight (or 6 - 8 hours before examination). May have fruit juice or water up to 5 hours prior to examination.
4. Note: Laxative and enemas recommended in patients with previous barium enema study. For instructions, see barium enema (routine), below.
   

B.  Barium enema (routine):

1. 0 - 1 year: Nothing by mouth (NPO) 4 hours prior to examination.
2. Over 1 year old: Light, low-residue supper (see item 3h). No solid foods on day of examination. NPO 4 hours prior to examination. Give magnesium citrate (<1 year, none; 1 to 3 years, 1.5 oz; 3 to 5 years, 2.5 oz; 6 to 8 years, 3 oz; 9 to 12 years, 4 oz; 12 to 18 years, 5 oz) the evening preceding the examination. If poor results, give a saline or Fleet enema (see Notes below). Cleansing enemas may be required in the radiology department.
3. Notes:
   • In children 2 to 6 years, if the response to magnesium citrate is poor and a fairly large bowel movement is not produced, a Fleet or saline enema is recommended. Pediatric Fleet enema (2.5 oz sqeeze bottle) is used in children 2 to 10 years and adult Fleet enema (4.5 oz sqeeze bottle) is used in children over 10 years.
   • In patients in whom Fleet enema may be contraindicated (renal failure, diabetes insipidus, some other water-losing states), use soapsuds enema.
     
   • In patients with chronic constipation and suspected megacolon (e.g. Hirschsprung disease), perform examination without preparation.
   • In patients with known or suspected ulcerative colitis, no colon preparation is indicated.
     
   • In patients with acute abdominal conditions, no preparation is necessary.
     
   • If polyp is suspected, request air contrast barium enema (see below).
     
   • Consult radiologist when in doubt.
     
   • Low residue diet: noodles, rice, ripe bananas, saltines, melba toast, white toast, clear broth, strained fruit juices, tender beef or lamb, fish, eggs. No milk, potatoes or vegetables.

C.  Air Contrast Barium enema:   Note that this examination is usually performed for rectal bleeding. If severe inflammatory bowel or acute abdominal disease is suspected, no preparation should be given. Because of vigorous preparation for air contrast barium enema, please consult with radiologist prior to scheduling.

1. 0 - 3 years: Liquid diet for 24 hours and nothing by mouth for 4 hours. Magnesium citrate (<1 year, none; 1 to 3 years, 1.5 oz) after school on the day preceding examination and again (<1 year, none; 1 to 3 years, 1.5 oz) at bedtime. Further cleansing enemas may be required in the radiology department.
2. 3 - 18 years: Low-residue diet for 3 days prior to examination. See Note 3h under barium enema (routine). Clear liquid diet for 24 hours. No milk or milk products for 48 hours. Magnesium citrate (3 to 5 years, 2.5 oz; 6 to 8 years, 3 oz; 9 to 12 years, 4 oz; 12 to 18 years, 5 oz) on the day preceding the examination and another dose (3 to 5 years, 2.5 oz; 6 to 8 years, 3 oz; 9 to 12 years, 4 oz; 12 to 18 years, 5 oz) at bedtime. Further cleansing enemas may be required in the radiology department.