FOREWORD: We have recently revised our approach to the preparation of children for pyelography, barium studies, and other fluoroscopic and contrast examinations. These directions (distributed to attending physicians, house staff, and hospital and clinic nurses) follow, slightly abbreviated. Perhaps they will be of interest to pediatricians and radiologists, especially those practicing in institutions where large numbers of children are not seen or where children make up only a small part of the x-ray work load. The protocol is based primarily on our own experience, although we have consulted the systems used in several other general and children's hospitals. Since this revision was only recently introduced, it is not yet time tested and will doubtless be modified as circumstances and thinking change. It is presented only as the approach to patient preparation used locally at this time.
All such systems inevitably represent compromises between the ideal and the reasonably attainable; diagnostic zeal must sometimes bow to practicality. The footnotes will point out some of our compromises. The footnotes also include comments on examination technique. At other centers or in other patient populations, these compromises might be neither necessary nor desirable. But, we are trying to care for children by getting studies of diagnostic quality and not trying to accumulate pretty pictures or fit infants into adult stereotypes. The comfort of the child cannot be ignored when rigorous preparation maneuvers such as repeated enemas and strong cathartics are being considered, and preparation must often be individualized. Since most x-ray departments deal largely with adults, often elderly adults, adult routines sometimes tend to be applied unquestioningly to children.
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