Children’s (Paediatric) Barium Meal

Author: Dr Timothy Cain*

What are the generally accepted indications for a paediatric barium meal?

The main indication for referring a child for paediatric barium meal is to investigate upper abdominal pain or vomiting, especially when there is bile-stained vomiting that raises the possibility of duodenal obstruction. Less common indications are duodenal malrotation and gastric hernias.

If the symptoms are acute, a mid-gut volvulus due to duodenal malrotation should be considered. This can be a medical emergency. An urgent opaque meal can be carried out for diagnosis. Gastric hernias are uncommon in children, but a barium meal study will show any abnormal position of the stomach.

A barium follow-through examination is only needed if there is suspicion of small bowel pathology distal to the duodenojejunal junction.

What are the prerequisites for having a paediatric barium meal done?

Suspicion of duodenal obstruction or malrotation.

Radiologists require a clearly written (legible) request with sufficient clinical information to ensure that the most appropriate examination is carried out. Not only does this enable the correct study to be carried out, it also enables provision of a meaningful report.

What are the absolute contraindications for a paediatric barium meal?

Suspicion of oesophageal, gastric or intestinal perforation.

Although barium will not damage the lungs if aspirated, it can cause granulomas if it enters the peritoneal cavity or mediastinum. If there is suspicion of oesophageal, gastric or intestinal perforation, this information should be specifically mentioned on the imaging request, as the radiologist might use water-soluble contrast media for at least the first part of the study.

What are the relative contraindications for a paediatric barium meal?

If a computed tomography scan or ultrasound is also necessary as part of the investigation of the patient’s symptoms, they should be carried out first, as the barium ingested as part of a barium meal will interfere with interpretation of these other studies. The radiologist should be consulted to determine which study should come first and whether barium or another contrast agent should be used.

What are the adverse effects of a paediatric barium meal?

It is common for the patient’s bowel motions to be white after a Barium Meal and it can cause relative constipation so the patient should be encouraged to increase oral fluid and fibre intake.

Is there any specific post procedural care required following a paediatric barium meal?

Advise the parent that the child might suffer constipation and have white stool.

Are there alternative imaging tests, interventions or surgical procedures to a paediatric barium meal?

• It is sometimes preferable to use an iodine-based contrast agent instead of a barium study to investigate the orientation/position, extrinsic compression or obstruction of the proximal gastrointestinal tract. This medium is indicated when there is concern about penetration or perforation of the proximal gastrointestinal tract, as iodine-based contrast agents are easily absorbed from the peritoneum and mediastinum, and do not cause as much inflammation as barium. Importantly, the mucosal detail is not as good as with barium and the dilution that occurs in the small intestines makes iodine media less suitable for follow-through examinations.
• Nuclear medicine gastro-oesophageal reflux studies and pH manometry are better investigative techniques to quantify gastro-oesophageal reflux.
• Ultrasound is a better test for hypertrophic pyloric stenosis than a barium meal in neonates, provided it is carried out by an experienced operator who is proficient at acquiring the correct images for measurement of the pyloric muscle and channel.
• A barium swallow should be requested if the patient has difficulty swallowing. This should be in consultation with speech pathologists.
• Endoscopy should be carried out if there is suspicion of a mucosal abnormality, as these might not be seen on routine barium meal examinations in children.
• Nuclear medicine gastric emptying studies can quantify delayed gastric emptying once normal anatomy has been confirmed on a barium meal study.

*The author has no conflict of interest with this topic.

Page last modified on 29/3/2017.