This page contains descriptions of common gastrointestinal (GI) tests, as well as other tests that may be performed in children with eating or feeding problems. Click on the plus sign to open up detailed information on each test.
If you or your doctors suspect that your child might be aspirating (allowing fluids to enter into the lungs), your child should have a swallow study. Infants especially are prone to silent aspiration, meaning they will not cough when something “goes down the wrong way.” Swallow studies are performed by Speech Language Pathologists and Radiologists. The test will show if your child is aspirating or swallowing correctly, and helps identify a safe thickness or texture for your child to eat and drink.
Your child will need to have barium mixed with different thicknesses of liquid or solid food during the test, and you may be requested to bring food or drink your child likes. You or a caregiver will ideally feed your child during the test while they run X-ray video of how your child swallows. The barium sounds scary, but it is safe. Your child will have white stool after the test, often for several days, which is normal.
If your child is aspirating, the doctor may recommend thickening liquids, or may say it is not safe to take anything by mouth for now (NPO). Often subsequent swallow studies are not completed for several months or even longer. Many infants and children will grow out of aspiration; however, time needs to pass to allow a child to grow and for swallow skills to improve before another test should be conducted. Moreover, no one wants to expose young children to any unnecessary radiation.
TIP: Bring all your child’s feeding equipment with you including bottles, nipples, spoons, bowls and typical foods. Request that you be the one to feed your child, since that will set your child at ease. The goal is to simulate your child’s typical eating experience. You should also consider bringing your feeding therapist with you to the exam if possible. If not, the results of the test should be shared with him or her.
Oftentimes, the upper GI series will accompany the first swallow study. The upper GI series is done in radiology with the use of X-rays. The child must drink barium, or if they have a tube already, it can be inserted into the tube. Intermittent X-rays or continuous video fluoroscopy is used to determine if there are any structural abnormalities in the esophagus, stomach and duodenum, such as pyloric stenosis, strictures, or other abnormalities. This test is also often used to help determine if a child is experiencing gastroesophageal reflux, but it is not diagnostic for this condition, since it only evaluates a small period of time.
Sometimes this test includes a portion called a Small Bowel Follow-Through. In this situation, additional X-rays or more video fluoroscopy will be done once the formula has left the stomach and entered the small intestine. This test can help identify anatomical abnormalities in the small intestine, and may help diagnosis a motility disorder of the stomach or small intestine.
This test typically uses a flexible camera to look at your child’s esophagus, stomach, and the beginning of the small intestine. Your child will likely be anesthetized for this procedure. Once asleep, the endoscope will be passed into the child’s throat with real-time video.
Your child’s doctor can see damage from reflux, gastritis, or ulcers, as well as physical abnormalities. In addition, biopsies can be taken to rule out food allergies, Celiac disease, Eosinophilic Disorders, and inflammatory bowel disease.
Older children may have the option of having a capsule endoscopy, which is either swallowed or placed in the gut with a traditional endoscope. The advantage of this version of the test is that the entire intestinal tract, including all of the small intestine that cannot be seen on regular endoscopy, can be visualized as the capsule passes through. Capsule endoscopy is not an option for children with severe dysmotility or young infants who may not be able to pass the capsule.
A lower GI series usually includes a barium enema followed by video fluoroscopy to look for intestinal obstructions, structural abnormalities, and diseases like inflammatory bowel disease and Hirschsprung disease.
Your child will need to have his or her bowel cleaned out a day before the procedure. Once cleaned out, barium will be inserted into the large intestine through the anus as an enema. Your child will then be brought to radiology for imaging. This test may also be done in conjunction with a colonoscopy.
TIP: If your child is prone to dehydration, the bowel clean out prep for the lower GI series or the colonoscopy may be very challenging. Moreover, if your child has gastric motility issues, the prep agents used to clean out the bowel may take longer to work through the system and react. Giving the child additional dosing may lead to dehydration when it does kick in. In these cases, your child may need to do the prep in the hospital with an IV running.
A colonoscopy is similar to an endoscopy, except it is from the bottom up. It is used to visualize and take biopsies from the large intestine and the very end of the small intestine. The child is typically sedated or put under anesthesia, and a flexible tube is passed through the anus into the large intestine. Conditions such as anatomic abnormalities of the large intestine, Hirschsprung disease, inflammatory bowel disease, polyps, and other conditions can be detected by this test.
Like a lower GI series, a colonoscopy requires your child to have a bowel clean out before the procedure.
pH probes and impedance probes are used to check for gastroesophageal reflux over a period of 24 or more hours. In a pH probe, a thin probe is run down the nostril into the esophagus. It records each episode of acid reflux over a period of time by measuring the pH levels in the esophagus.
The impedance probe is a similar test that uses multiple probes to detect acid reflux, nonacid reflux, and the passage of gas from the stomach to the esophagus. It can be useful in children who have airway problems that may be due to reflux, since these are often nonacid reflux events that do not show up on pH probe. Children with vomiting or spitting up that does not show up on a pH probe may also get more accurate results from an impedance probe. For more information, see Impedance Probe Monitoring to Diagnose Reflux from Complex Child.
If the clinical evidence for reflux is so strong, especially in infants, these tests may not be necessary. Attempting treatment first may be a simpler way to determine if a child has reflux.
This test is performed to see if the G-, GJ-, or J-tube is placed correctly. It is performed by radiology and typically includes administration of contrast through the tube. X-ray or video fluoroscopy is used to ensure the tube is placed correctly and is functional.
This test is performed when it is suspected that the stomach is not emptying at a normal rate. During this test, a small amount of radioactive material is ingested with a volume of food.
While most hospitals prefer the child to eat the radioactive isotope in eggs, children who are tube fed may be able to have the isotope mixed with their formula. The child is then monitored for how much radioactive material remains in the stomach after specific periods of time.
Different hospitals perform this test in different ways. Most hospitals have your child lie on the table in a scanner for the first 30 minutes to an hour. Periodic images will be taken to track the progression of the food through the stomach. After the first set of images has been completed, additional images will be taken every 15 to 30 minutes for one to five additional hours.
Some hospitals require the child to remain lying in the scanner during the entire test, while others allow your child to walk around between images. This test will not be painful for your child, and you can be with your child through it. However, making a child lie still on the table for that long can be challenging.
TIP: If at all possible, schedule the scan during your child’s nap time. Sometimes the hospital has a DVD player for your child to watch during the scan, or you can bring a portable player. Your child will be able to move his/her arms during the scan, so you can bring small toys or books to play with during the test. If your child has a favorite stuffed animal or blanket, bring that along for comfort.
Children with suspected severe motility problems of any part of the digestive tract may require manometry or motility testing. This test is much less common and is only performed if there is a serious problem with dysmotility. It is not available at many children’s hospitals, and is typically only performed at specialized motility centers.
Separate manometry tests are available for the esophagus, stomach/duodenum, colon, and anus/rectum, all of which detect pressure within the GI tract to determine how appropriate a child’s motility is. Manometry tests are used to measure the strength, frequency, and coordination of contractions throughout the GI tract. They can help to diagnose disorders ranging from dysphagia to intestinal dysmotility or chronic constipation.
Esophageal manometry uses a catheter threaded through the nose to evaluate the motility of the esophagus. Children are asked to swallow liquids with the catheter in place. This test is commonly done together with fluoroscopy, like a video swallow study.
Antroduodenal manometry also uses a catheter through the nose or a G-tube to measure the contractions within the stomach and duodenum. Children are often sedated during the placement of the catheter. Once placed, the child remains in bed for several hours while the contractions in the lower stomach and upper part of the small intestine are recorded. In some cases, medications that affect motility may be administered to see if motility changes.
Colonic manometry is used to measure contractions within the colon. The catheter is placed through the rectum using a colonoscopy or by a radiologist. Children may be sedated during placement. The catheter remains in place for several hours to monitor activity within the colon.
Anorectal manometry tracks the function of the rectum and anus. A catheter with a balloon on the end is inserted into the rectum and the balloon is inflated to mimic stool. The response of the rectum and particularly the anus is noted during the exam.
One Parent’s Experience: We had to submit his whole chart for review and then they “accepted” him for the testing. We met with the motility specialist in office the day before the test and he discussed all the details of my son’s presentation and how the test would work. The test is done using manometry. Essentially it is a long tube with sensors that measures the muscle movements. In our case, the tubing was placed from the stoma to 40cm into the intestines. The test took between 8 and 9 hours. My son had 8 sensors from his stomach to the intestines. It looked like a big EKG on the screen.
The first part of the test is fasting. It is a lot of sitting around and waiting and keeping your child occupied–you can’t pick him up and he needs to stay pretty stationary because manometry reads muscle movement. You have to try to keep him from crying because that also messes up the readings. During the tests they trialed different medications to see the impact on the muscles. We also fed our child during the test to see the impact of food. It took several weeks to get results.
Children with chronic constipation may have a Sitz Marker Study performed. This test requires the child to swallow a capsule filled with 24 small rings called markers. The child then undergoes imaging about four to five days later to see if the markers have been passed out of the body in stool, or if they remain in the body. Additional images at later intervals may also be required if the child has not passed a large number of the markers by the five-day point. In some cases, children may be asked to swallow two or three different sets of markers on consecutive days (with different patterns on them) to evaluate if motility changes on a day-to-day basis.
This test can help identify areas of dysmotility in the large intestine, especially if many markers are “stuck” in the same place. It can also help to characterize how fast things move through the larger intestine.
An abdominal ultrasound is performed for children who may have problems with their gall bladder, pancreas, spleen, kidneys or liver. It is a very simple procedure. Your child is placed on a table, gel is applied to a transducer wand, and the internal organs in the abdomen are examined. The radiologist will use the ultrasound to measure the size of organs, characterize their appearance, and will use doppler ultrasound to examine blood flow.
Children with severe constipation may have an X-ray taken of the abdomen. This is a simple X-ray that will show whether stool or gas has accumulated in the lower GI tract, and where the stool is located.
If you or your doctor suspects your child may have allergies (food or environmental), your child should be tested. There are a number of ways to test for allergies.
Skin prick testing. This is the most common way to diagnose allergies. With skin tests, small amounts of allergens are pricked or scratched into your child’s skin with a needle, which can be uncomfortable. After about 15-20 minutes, the doctor will check the site for redness, swelling or itching. These are signs that your child may be allergic to a particular substance.
Blood Test – RAST (short for radioallergosorbent test). This is a blood test to detect specific IgE antibodies to suspected or known food or environmental allergens. The doctor will take a sample of your child’s blood and send it to a laboratory. This test may produce false positives, and is not used as often as the skin test since it is less definitive.
Patch testing or atopy patch testing. This test is used to detect non-IgE-mediated reactions. These reactions are often delayed, occurring hours to days after ingestion of the food or exposure to an allergen. For patch testing, fresh food is prepared into a soft consistency and placed on aluminum chambers on the patient’s back and covered with an adhesive patch. The child will wear the patches for 48-72 hours. The patches are then removed and the doctor will look for redness and swelling. Many doctors will re-read the results by examining your child’s back again 24 hours later for delayed responses. Any type of reaction your child has to patch testing can be painful or irritating, even including a reaction to the tape. If your child is having a reaction, her mood may fluctuate, she may not sleep well, her back may be extremely itchy or she may cry because she is uncomfortable. If your child sweats a lot, it is recommended to have extra tape on hand so you can add tape to the patches. Make sure to have topical anti-itch cream available after the test to apply to itch spots.
There are four types of hypersensitivity allergic reactions that may be seen, depending on how soon they are seen:
Type I – Immediate or anaphylactic hypersensitivity. Response time is 15-30 minutes. Antibody is IgE.
Type II – Cytotoxic hypersensitivity. Response time is minutes to hours. Antibody is IgG and IgM.
Type III – Immune complex hypersensitivity. Response time is 3-8 hours. Antibody is IgG and IgM.
Type IV – Cell mediated or delayed type hypersensitivity. Response time is 48-72 hours. No antibody response.
Children with chronic GI problems sometimes are diagnosed with cystic fibrosis, a genetic condition that causes respiratory and GI issues.
To test for cystic fibrosis, your child will have sweat collected. The arm is washed and dried. A disc with electrodes is placed on the arm with a medication to stimulate sweat. Then, a small collection device is placed on the arm under plastic wrap.
Larger children’s hospitals and cystic fibrosis centers typically perform this test. If the test is inconclusive or cannot be performed, genetic blood testing can also be performed.
A bronchoscopy is a scope of the airways and lungs, typically performed by a pulmonologist or ENT under anesthesia. Your child will be sedated for the procedure, usually under general anesthesia if a rigid bronchoscopy is used. If a flexible scope is used, the procedure can be performed with minimal or no sedation. The doctor will thread the scope down into the airway through the mouth, nose, or a tracheostomy, examining the lungs and airway for anatomic abnormalities, damage from reflux or aspiration, and other anomalies. Biopsies or other specimens may be taken during the procedure.
Some children who are not growing well may have underlying heart problems. There are three standard tests to evaluate cardiac function: echocardiogram, EKG, and Holter monitor.
An echocardiogram is an ultrasound of the heart that checks for abnormalities in cardiac valve function and abnormal communication between the right and left sides of the heart. It is a simple and painless test, but your child will need to remain quiet and still.
An EKG measures the electrical activity of the heart through a series of leads that are attached to the chest. It is also painless, but requires the child to remain still for about two minutes.
A Holter monitor is an EKG recorder that continuously monitors the electrical activity of the heart over a longer period of time, usually one to 30 days.
Your child may be referred to a geneticist if he or she has multiple medical problems that may be part of a genetic syndrome. You will likely need to submit your child’s medical file for review, and it may be a few months before you get an appointment.
Before your appointment, you may need to fill out a long questionnaire about medical problems in your extended family. During the appointment, the geneticists will ask many questions and examine your child in detail.
They may draw blood and urine for labs, including running a FISH test or microarray test, which detects very small genetic imperfections. Genetic testing is changing and improving on a yearly basis, and often children must be tested frequently before a diagnosis is found. Some children may remain undiagnosed.
A relatively new test is called Whole Exome Sequencing. This test looks at your child’s entire genome for any patterns that are not typical. The results are often difficult to understand, because scientists don’t always know what the patterns mean. As it is expensive and still considered experimental, it can be difficult to get insurance to pay for this test.
Sometimes feeding problems result from abnormalities in the brain. In this case, an MRI of the brain is performed. This test will likely require sedation or general anesthesia, as your child must lay very still for a period of time, often about an hour. For children with problems of the pancreas, liver, or gall bladder, an MRI of these organs may also be performed.