Abdomen radiograph (pediatric)

The abdomen radiograph is a commonly requested examination in the pediatric patient. Children that present for abdominal x-rays are often very unwell, therefore specialized techniques and appropriate communication are essential for gaining the child's cooperation. 

Indications

Performing abdominal radiography on pediatric patients may be requested for the following indications ^1,2:

• swallowed foreign body

• bowel perforation

• bowel obstruction

• abdominal hernia

• pneumoperitoneum

• intussusception

• appendicitis

• inflammatory bowel disease

• hematuria

• necrotizing enterocolitis

• typhlitis - thumbprinting

• constipation

• MRI screening

• anal atresia

Projections

Standard projections

• AP supine view

• AP supine (neonate) view

• PA erect view

  • ideal for demonstrating gas-fluid levels and free gas under the diaphragm ¹

Additional projections

• lateral decubitus view

  • ideal for demonstrating free abdominal gas ¹

• supine cross-table lateral view (neonate)

• invertogram view ³

  • ideal for demonstrating anal atresia

• prone cross-table lateral view (neonate) ³

  • alternative to the invertogram view, less traumatic for neonates ⁴

Patient preparation

Patients should remove any clothing or jewelry overlying the abdominal area; including pants, t-shirts and underwire bras. In particular, clothing with metal or shiny decorative material must be removed. Wet diapers are also known to create artifact on the radiograph, therefore should be removed ⁵.

Tips for pediatric abdominal radiography

• pediatric patients may feel uncomfortable when bony landmarks are felt for, therefore an appropriate explanation to the patient beforehand is ideal for improving patient comfort

Immobilization techniques

Immobilization techniques will vary from department to department. Since blankets or immobilization devices can often obscure the abdominal area, distraction techniques might be the most ideal form of immobilization. Some distraction techniques that can be used are:

• using toys, games or conversation

• using child-appropriate language (e.g. 'stand still like a soldier' and 'breathe in, you are about to go diving underwater!')

• for younger babies, asking the parents to sing the child's favorite song

Otherwise, a radiographer or parent being in the room with the patient holding them still has been cited as a commonly used technique ⁶ in the Australian context, however with this method, the parent or staff will receive some scattered radiation dose.