To detect hiatal hernia, diverticula, and varices

To aid in the diagnosis of strictures, ulcers, tumors, regional enteritis, and malabsorption syndrome

To detect motility disorders

To aid in the diagnosis of inflammatory disease

To detect polyps, diverticula, and structural changes in the large intestine

Withhold oral medications after midnight and anticholinergics and opioids for 24 hours because these drugs affect small intestine motility.

Withhold antacids, histamine-2 receptor antagonists, and proton pump inhibitors if gastric reflux is suspected.

Instruct the parents that the child is to maintain a low-residue diet for 2 or 3 days before the test and to fast after midnight before the test.

Assist the child in removing hair clips, jewelry, and other metal items as necessary.

Make sure that the lead apron is properly placed around the genital area.

Describe the milk shake consistency and chalky taste of the barium preparation. Although flavored, it may be unpleasant to swallow.

Warn the child that the abdomen may be compressed to ensure proper coating of the stomach or intestinal walls with barium or to separate overlapping bowel loops.

Inform the child and his parents that the test may take up to 6 hours to complete.

Explain that the test permits examination of the large intestine through X-rays taken after a barium enema.

Accurate test results depend on the child’s cooperation with prescribed dietary restrictions and bowel preparation.

Common bowel preparation includes restricted intake of dairy products and maintenance of a liquid diet for 24 hours before the test. The child is encouraged to drink five 8-oz glasses of water or clear liquids 12 to 24 hours before the test.

A polyethylene glycol and electrolyte solution (GoLYTELY) preparation isn’t recommended because it leaves the bowel too wet for the barium to coat the walls of the bowel.

The child should receive enemas until the return is clear.

Tell the child and his parents that he shouldn’t eat breakfast before the procedure; if the test is scheduled for late afternoon, he may have clear liquids.

The child may experience cramping pains or the urge to defecate as the barium or air is introduced into the intestine. Instruct him to breathe deeply and slowly through his mouth to ease the discomfort.

The child must contract his anal sphincter tightly against the rectal tube.

Stress the importance of retaining the barium.

After securing the child in a supine position on the X-ray table, the table is tilted until the patient is erect, and the heart, lungs, and abdomen are examined fluoroscopically.

The child is then instructed to take several swallows of the barium suspension; its passage through the esophagus is observed.

Occasionally, the child is given a thick barium suspension, especially when esophageal pathology is strongly suspected.

During fluoroscopic examination, spot films of the esophagus are taken from lateral angles and from right and left posteroanterior angles.

When barium enters the stomach, the child’s abdomen is palpated or compressed to ensure adequate coating of the gastric mucosa with barium.

To perform a double-contrast examination, the child is instructed to sip the barium through a perforated straw. As he does so, a small amount of air is also introduced into the stomach to allow detailed examination of the gastric rugae, and spot films of significant findings are taken.