What can I expect when my toddler needs a Barium X-Ray?

barium-swallowbarium swallow x-ray.jpg

Barium can be used to help soft tissue show up on x-rays. It works by coating the inside of the esophagus, stomach, or small intestines which allows them to be seen more clearly on a CT scan or x-ray. This can be useful for doctors to check that everything is where it should be and to look for any abnormalities in the structure or lining. Sometimes it’s a less invasive pre-cursor in deciding whether an endoscopy is required.

My two year-old daughter needed one because of persistent Gastric Reflux Disease (GERDS). Let me be straight up and say that for us, this was not a successful experience. I’m sharing our story because I went looking beforehand to try and find out more details on what to expect and I wish I’d known more specifics going in! Don’t be disheartened by our experience though – I’ve also seen stories online where their toddlers breezed through it! On the other hand, if your wee one also struggles – know that you are not alone!

Before we went

We got a basic information pamphlet from the hospital and I also spoke with the Booking Co-ordinator to ask them a few questions. We read our picture books about going to the doctor and talked about how she was going to get an x-ray (just like in her ABC books).

The test requires fasting for up to 4 hours (not easy with a toddler!). We got permission to just do 3 hours; this means no food or liquids of any kind apart from water (formula and breast milk are not permitted). The difficulty I faced was that at age 2 she doesn’t understand the idea of filling up now because she won’t be able to eat later. I needed to wake both of us up quite early so that I could try and get some food into her before the fasting window began (ditto with myself – it would have been impossible to eat in front of her later but tell her she wasn’t allowed!).

Going In

We’re familiar with our local Children’s Hospital so getting there wasn’t a problem and finding Radiology was fine. I went prepared with any and all comforts that I could offer her (the pram – exciting for her as normally now she just walks), Bunny, a book, Peppa Pig on tablet, her dummy (normally only allowed at bedtime), and treats/food for afterwards. I also took in one of her cups from home (NOTE: the liquid is thin enough that you can also choose to bring in a formula bottle).

We were introduced to a friendly nurse and given a choice of flavours: Vanilla, Chocolate, or Strawberry. I chose Vanilla because her formula is vanilla flavoured and she hasn’t had flavoured milks.

The Procedure

Let me say straight up that the procedure and equipment may differ from hospital to hospital. I’ve googled images of barium swallow x-rays and some of them look quite different from what we encountered.

For us, the lovely nurses all wore radiation aprons decorated in cool patterns (like flowers or butterflies) and they put one on me as well. Definitely a good thing that I could stay with her. Unfortunately, that was the first thing that upset her as she didn’t like seeing me in a strange costume.

The x-ray machine was VERY DIFFERENT to the one used to x-ray her foot when they checking (just in case) for a fracture after she tripped and fell up a concrete step.

Imagine a flat plastic bed like you’d lie on as an adult for an x-ray. On top of this was…kind of like a small rectangle of cushioning with hard plastic down the long sides. They lay her on this and then used soft strapping across her legs, hips, and to secure her arms above her head. The x-ray machine itself looked more like an MRI machine – it was lowered down to maybe a foot above her face and covered her from forehead to toes (like a big plastic cocoon). They had stickers on it (inside and out) to make it more cheerful and there’s no loud scary noises like an MRI machine. What they needed was for her to sip the chalky barium solution while she was inside the machine being scanned so that they could watch it traverse through her. The whole process takes about 15-25 minutes.  They had a stash of lollipops so that, in an ideal situation, she could even alternate between sipping the barium and licking the lollipop.

I was able to be positioned at the top of the bed and could hold her hands or kiss her forehead or hold the tablet playing Peppa Pig above her face.

What went wrong for us?

She’s 2. She was hungry, tired, out of routine, and we were at a strange scary place with a strange scary machine trapping her while wide awake and strangers were trying to get her to drink a strange yucky drink. She wanted OUT! She wanted her Mummy! She wanted everyone to listen and accept that she was screaming NO!

She is, by personality, very sensitive to change and to her environments and this absolutely terrified her. No amount of telling her that she was in a special cave, or trying to point out stickers, or offering her lollipops was going to change her mind on this. Kissing her, holding her hand, singing our special calm down songs, and doing breathing exercises kept her from a full on panic-attack / hour long meltdown but she stayed at DEFCON 2 terrified.

We got her out and she cuddled desperately on my lap while staff conferred. We tried offering her the barium in a formula bottle, and tried syringing it into the corner of her mouth while she sucked her dummy but she just chipmunked it and spat it out (thankfully the nurse anticipated this and had a cloth ready).  Everyone in the room agreed that it would be highly traumatic for her to be awake and have a feeding tube forced down her nose or throat into her stomach and that this would not be a good idea.

The nurses and doctor were all kind, caring, competent professionals. They explained that they were going to cancel the procedure on medical grounds as the process was proving highly traumatic for her. The likelihood of them finding something wrong in her case was low, the medical need was not critical, and the risk of emotional/psychological trauma was high. They noted that they’ve seen patients come back to the hospital after 8-10 years and be utterly terrified of being in a hospital because of a deep-seated fear stemming back to a bad experience as a young child. They noted that she’s at an age where it is a difficult procedure to undertake. They encouraged me to help her form other positive memories that day to help mitigate her overall impressions of the day.

They won’t be rebooking as they advised she’s likely to have an even stronger aversion on a second visit and it’s not worth the risk of creating a permanent negative association (and impacting future visits where it’s more medically critical).

Things I wish I’d known

I wish I’d known what the x-ray machine was going to look like. I would have told them straight out that I had grave concerns my child would tolerate it (unless sedated) and if we were going to give it a shot then I’d have tried roleplaying it at home under the table and in her toy pop-up tunnel etc. and tried to prepare her better. They told me they don’t tell parents because they don’t want them being really anxious/fearful beforehand and the kids coming in having already picked up on that tension.

I also would have asked them if there was any chance of having her drink the solution in the waiting room while she was calmly sitting on my lap (and so that we could have offered her the other flavours if she refused the first). It might not have helped them get all the pictures they needed but it would have given them a chance of getting any.

What to expect if it’s a success

If your child is excited by the stickery tiger cave of awesomeness and happy to comply then the nurses will turn them (i.e. onto their side) and change their position a few times during the scans.

Afterwards, there’s a small risk of nausea or stomach cramps so plan a quiet day. The barium can also impact their poop as it harmlessly passes out.You might find that bowel motions are a different colour (i.e. chalky) and they may have mild constipation or looser poo. Encourage them to drink lots of fluid and you might want to try stewed apple and prunes. Floradix Liquid Magnesium Tonic as well as being generally good as a supplement can also have a mild laxative effect.

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