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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.
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.
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.
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.
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.
Advise the parent that the child might suffer constipation and have white stool.
Page last modified on 29/3/2017.
RANZCR® is not aware that any person intends to act or rely upon the opinions, advices or information contained in this publication or of the manner in which it might be possible to do so. It issues no invitation to any person to act or rely upon such opinions, advices or information or any of them and it accepts no responsibility for any of them.
RANZCR® intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers.
RANZCR® recommends that any specific questions regarding any procedure be discussed with a person's family doctor or medical specialist. Whilst every effort is made to ensure the accuracy of the information contained in this publication, RANZCR®, its Board, officers and employees assume no responsibility for its content, use, or interpretation. Each person should rely on their own inquires before making decisions that touch their own interests.