Abdomen radiograph (pediatric)

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

Indications

Performing abdominal radiography on paediatric 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
• haematuria
• necrotising enterocolitis
• typhlitis
• 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 view³
  • 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 jewellery 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 ³⁵.

Tips for paediatric abdominal radiography

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

Immobilisation techniques

Immobilisation techniques will vary from department to department. Since blankets or immobilisation devices can often obscure the abdominal area, distraction techniques might be the most ideal form of immobilisation. 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 favourite song

Otherwise, a radiographer or parent being in the room with the patient holding them still has been cited as a commonly used technique ⁴⁶ in the Australian context, however with this method, the parent or staff will receive some scattered radiation dose.