Contrast Enema for Children

What is a barium enema?

A barium enema (or contrast enema) is a test done by a pediatric radiologist. It uses contrast material and X-rays to look for issues in your colon (large intestine). It uses an imaging test called fluoroscopy.

Why does my child need a barium enema?

Your healthcare provider may recommend a pediatric barium enema to see the shape, form and position of your child’s colon. This test helps look at things that your provider can’t see during a routine physical exam.

The most common reason for a contrast enema is to find out why your child has trouble pooping. This test can help diagnose or get more information about issues like:

• Constipation
• Chronic diarrhea
• Hirschsprung disease
• Unexplained weight loss

How does a contrast enema work?

A contrast enema is an X-ray of your child’s GI tract with one important addition: Before taking the X-ray, a healthcare provider will give your child a barium enema through a device placed in their anus (butthole).

Barium is a silvery, chalky chemical element that providers use as contrast material. It shows up white on an X-ray, so when it coats the walls of your GI tract, your provider can see how your intestines and colon function.

Pediatric barium enema preparation

Unless your healthcare provider tells you otherwise, you don’t need special preparation before your child’s barium enema. Typically, your child can eat and drink normally prior to their procedure.

Depending on the age of your child, it’s a good idea to talk to them beforehand. Tell them, in simple terms, what to expect. If you’d like, you can bring a favorite blanket or stuffed animal to your child’s appointment.

Pediatric barium enema procedure

When you arrive, a provider will bring you and your child into an X-ray room. They’ll have your child change into a gown and lie down on an exam table.

Your child will be awake during the barium enema procedure. The entire process usually takes between 30 and 45 minutes.

You’ll be able to stay with your child during the procedure. A provider will give you a lead vest to wear for protection. If you’re pregnant, you should limit your exposure to X-rays. In these cases, be sure to bring another trusted family member who can stay with your child during the test.

Once you and your child are ready, a radiologist will:

• Take an X-ray of your child’s abdomen
• Ask your child to lie on their side and raise their knees up toward their chest
• Carefully insert a small enema tube into your child’s rectum (the other end of the tube connects to an enema bag containing a barium solution)
• Secure the tube to your child’s bottom with tape
• Use the enema bag to move the barium contrast into your child’s rectum and through their colon (it’s totally normal for your child to feel like they need to poop during this part)
• Take X-rays of your child’s colon (they may ask your child to roll from side to side so they can take pictures from different angles)

Once your provider finishes taking X-rays, they’ll:

• Remove the tube from your child’s rectum
• Allow your child to go to the restroom so they can poop
• Take one last X-ray of your child’s abdomen (once they’ve returned from the restroom)

What should I expect after my child’s contrast enema?

Typically, your child can resume normal activities and eating habits immediately after the procedure. Here are some things to keep in mind:

• Encourage your child to drink plenty of fluids after the procedure. This helps flush the barium out of their system.
• Your child’s stool (poop) may look white for a couple of days. This is normal.
• Your child may need to poop more frequently for a few days.

What are the risks or side effects of a barium enema?

Contrast enemas are generally safe. There’s minimal radiation exposure from the X-ray. As with any procedure, there are potential risks.

Complications may include:

• Bloating
• Constipation
• Diarrhea
• Headaches
• Nausea
• Allergic reaction (rare)
• A small tear in your child’s bowel, or gastrointestinal perforation (very rare)

What do my child’s test results mean?

Generally, a barium enema test comes back either positive or negative:

• A negative result means that your healthcare provider didn’t find any issues or abnormalities in your child’s colon.
• A positive result means your provider detects some type of issue, like a blockage. In some cases, your child might need additional tests.

When will I know the results?

The radiologist who did your child’s test will write up a report and send the images to your child’s pediatrician. This may take one to several days, depending on your situation.

When should I call my child’s pediatrician?

Let your healthcare provider know if your child develops:

• Abdominal swelling
• Blood in their poop (rectal bleeding)
• Dizziness
• Fever
• Severe abdominal pain
• The inability to poop for more than two days

How can I help keep my child comfortable during the procedure?

A barium enema isn’t fun for anyone, adults included. But when it’s your child, there may be an added layer of worry or unease. Here are some things you can do to calm your child’s nerves during their barium enema procedure:

• Bring a favorite toy, blanket or stuffed animal for your child to hold.
• Older children can bring a book or handheld video game.
• Stay close to your child during the procedure. Hold their hand or offer them words of comfort.
• Practice breathing or relaxation techniques with your child.
• If you have other children, arrange for someone to care for them while you’re at the appointment.
• If you’re pregnant, please arrange for another trusted, comforting adult to be with your child during the test. Pregnant people should avoid radiation as much as possible.