Pediatric Colonoscopy

What you need to know about a colonoscopy: A colonoscopy uses a scope to look at the inside of your child's colon (intestine). This scope is a long, flexible tube with a light and a camera on the end. The camera attaches to a monitor that allows your child's healthcare provider to see inside the colon.

Your child may need a colonoscopy to look for inflammatory bowel disease or to remove tissue growths. Your child may also need a colonoscopy if he or she has chronic diarrhea or abdominal pain. 

Your child may have this procedure to find the cause of conditions, such as:

• Lower gastrointestinal bleeding 
• Chronic diarrhea 
• Chronic abdominal pain
• Suspected colon polyps 
• Suspected inflammatory bowel disease 
• Follow-up of inflammatory bowel disease 
• Removal of foreign body 
• Dilation of stricture 
• Decompression of obstructed colon 

Risks of a colonoscopy

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• A tear or hole (perforation) in the lower small intestine or colon. He or she may need surgery to repair the hole.

What happens before the procedure?

How to prepare your child for a colonoscopy

• Your healthcare provider will talk to you about how to prepare your child. Your child will have to drink liquid that contains medicine to help empty his or her colon. This is called a bowel prep. Bowel prep helps the healthcare provider see clearly inside your child's colon. When your child is done with prep, his or her bowel movements should not contain solids. It is okay if they are brown or yellow liquid with tiny solid pieces. Ask your healthcare provider how to give your child the medicine.

Call your child's healthcare provider if your child cannot drink all of the medicine. Call if the bowel movements are solid after your child finishes. 

• Your child will be on a clear liquid diet for 1 to 2 days before the procedure. Clear liquids include water, apple juice, lemonade, gelatin, and broths. Do not give your child clear liquids that are blue, red, or purple. Give your child plenty of clear liquids to prevent dehydration. Ask your healthcare provider how much liquid your child should have and which liquids are okay. Your child's healthcare provider may tell you not to let your child eat or drink anything after midnight on the day of the procedure. He or she will tell you what medicines your child should take or not take on the day of the procedure.

What will happen during the colonoscopy: 

• Your child may receive IV sedation or general anesthesia. IV sedation will make your child feel sleepy and help him or her relax during the procedure. General anesthesia may be given to keep your child asleep and free from pain during the procedure. Your child's healthcare provider may lay your child on his or her left side with knees bent to chest.
• Your child's healthcare provider will put gel on the scope and gently place it into your child's anus. He or she will pass the scope through your child's colon and up into the small intestine. The provider may take pictures. He or she may inject air and water into your child's colon to clean and expand it. This will help your child's healthcare provider see inside the colon more clearly. 
• Tissue samples may be taken from the walls of your child's bowel and sent to a lab for tests. The healthcare provider will pass a small catheter with teeth or a wire loop through the scope and remove tissues or growths. He or she may use electricity to burn a growth off or prevent bleeding.

What will happen after the colonoscopy

• Healthcare providers will monitor your child until he or she is awake. They will feel your child's stomach and listen to his or her bowel sounds with a stethoscope. Your child's healthcare provider will talk to you about what he or she saw or found during the procedure. 
• Before your child can eat or drink, he or she may need to pass the air put into the colon during the procedure. Your child may need to walk around or lie on his or her left side to help move the air out. Once your child has passed gas and is able to drink, he or she can go home. 
• Your child may feel bloated or have stomach cramps. If tissue or growths were removed, your child may have a small amount of blood in his or her bowel movements for 1 to 2 days after the procedure.

Seek care immediately if: 

• Your child has a large amount of bright red blood coming from his or her rectum or in bowel movements. 
• Your child's stomach is very painful, feels hard, and is larger than usual. 
• Your child does not have a bowel movement for 3 days after the procedure.

Contact your child's healthcare provider if: 

• Your child has a fever or chills.
• Your child is nauseated or is vomiting. 
• Your child's skin is itchy, swollen, or has a rash.
• You have questions or concerns about your child's condition or care.

Follow up with your child's healthcare provider as directed:  Ask your child's healthcare provider when and how you will get the test results. Write down your questions so you remember to ask them during your child's visits.

Care for your child

• Limit your child's activity to prevent bleeding.  He or she should not play sports or do vigorous activity after the procedure. Ask your healthcare provider when your child can return to normal activities. 
• Relieve your child's gas and discomfort.  Have your child lie on his or her left side. Your child may need to take short walks to help move the gas out. Give your child small meals until the bloating improves. Start with clear liquids such as juice. If your child does okay with clear liquids, start giving his or her usual foods. Ask your child's healthcare provider if your child needs to be on a special diet.

FREQUENTLY ASKED QUESTIONS 

The following questions may help answer questions you have regarding the colonoscopy: 

Q: Is a colonoscopy a safe procedure to do in children? 

A: A colonoscopy is a safe procedure in children and can be performed safely even in infants. Complications are extremely rare. The complications naturally vary and depend on: 

• The type of procedure performed. A routine diagnostic colonoscopy with biopsies is extremely safe. A therapeutic colonoscopy performed to attempt to control bleeding or involving a polypectomy entails slightly more risk. 
• The clinical state of the patient. An otherwise well child has very little risk from the sedation or procedure. A child with a severe illness or who is critically ill will have a greater risk of complications. 

Your physician will review the risks and benefits of the procedure as well as alternatives to the procedure with you. If you have any questions about the procedure, please ask your physician. 

Q: Will my child be asleep during the procedure? Will he or she remember the procedure? 

A: IV medications will be used to keep your child asleep during the procedure. Your child will be monitored during the entire procedure to be sure that he or she is safe and not having any pain. One of the medications given before the procedure affects short-term memory. This means that the child will not remember the procedure. The medications also help the child to relax. 

Q: When and what can my child eat after the procedure? 

A: In general, we allow the child to take sips when he or she is awake. If this is tolerated, then the diet can be advanced as tolerated (in an age-appropriate manner). The nurses or Endoscopy Unit team will give you more specific instructions after the procedure. 

Q: Can I watch the procedure? 

A: Parents are NOT allowed to stay in the room during the colonoscopy procedure. (Please see the section titled “Preparing Your Child for a Colonoscopy.”) We are able to take pictures of what we see during the procedure and will be able to review these with you. 

Q: When will I get the results of the procedure? 

A: After the procedure, the physician will review the results with you.