What is colonoscopy in children? How is colonoscopy performed in children?

Fast Facts About Colonoscopy

• A colonoscopy is a test to see the large intestine, lower part of the rectum, colon, and lower end of the small intestine.
• Home preparation and diet restrictions are required prior to your child's procedure.
• Your child will be asleep for the test.
• The test takes 45–90 minutes.

What Is a Colonoscopy?

A colonoscopy (cole-en-AH-sco-pee) is a test that allows your doctors to see the inside of the lower part of the rectum, colon and lower end of the small intestine.

• A high-quality video chip works as a camera to send pictures through a thin, ­bendable tube called an ­endoscope (EN-doe-scope).
• If your doctor decides to look at the top few inches of the large intestines, this procedure is called a sigmoidoscopy (sig-moyd-AH-sco-pee). 
• Both the colonoscopy and ­sigmoidscopy are done by passing the scope through the anus into the large ­intestine. 
• The pictures sent by the video chip show information about your child’s colon and intestinal tract that cannot be determined from a physical examination or other kinds of tests.
• The pictures may show swelling, ulcers, bleeding, polyps (PAW-lips) or small growths, and other changes that may not show up on other tests. With the endoscope, your child’s doctor also can test for infection, and possibly determine the cause of swelling or irritation.  

Fast Facts About Anesthesia

Most colonoscopies are done while your child is under general anesthesia, meaning that they are sound asleep during the test.

• An anesthesiologist — a doctor who specializes in anesthesia — will give the medications that will make your child sleep during the test. 
• Under general anesthesia, your child will not feel any pain or have any memory of the test.

Occasionally, the colonoscopy may be done while your child is under sedation, meaning that your child will be given medication to make him or her very drowsy and relaxed during the test. When sedation has been used, your child may not even remember having had the test. If your child receives sedation, the doctor doing your child’s test will give the sedation medication. Your child’s doctor will decide if your child should have general anesthesia or sedation. 

Home Preparation

Your doctor will give colon prep instructions, specific for your child, at the time the colonoscopy is recommended. Please read these instructions closely. The success of this test to diagnose your child's condition depends on the complete clean-out of your child's colon.

Additionally, you will be contacted by a GI nurse the week before your scheduled procedure to review and clarify these instructions with you.

On the day before your appointment, you will receive a phone call informing you when to arrive at the hospital for your child's procedure by a Same Day Surgery nurse. These calls are made in the afternoon and evening hours. If you are not at home, a message can be left on an answering machine with these instructions.

The nurse will instruct you on when your child must stop taking anything by mouth, and which medications, if any, are allowed the morning of your child's procedure.

Please have a pen and paper ready to write down these instructions, as it is very important that you understand and follow all directions to avoid cancellation or delay of your child's test.

If your child is on an antibiotic, or becomes ill with a fever or cough within three days of the scheduled test, please call us at 412-692-5944. In some cases, the test may need to be rescheduled. 

What is allowed on a clear liquid diet:Beverages: Apple, grape, cranberry, cranapple juices; fruit-­flavored drinks; sports drinks, Gatorade^®, PowerAde^®, clear tea, carbonated drinks (soda or pop)
Desserts: Popsicles^® or frozen fruit-flavored bars with no pulp, plain Jello^®, water ices
Soups: Fat-free broth, fat-free bouillon
Other: Salt, sugar, jelly, honey, plain hard sugar candy in small amounts 

Do not be alarmed if your child has diarrhea. Diarrhea is normal with a clear liquid diet and is necessary to clean out the bowels in order for your child’s doctor to see the colon clearly during the test.

If Your Child Is Having General Anesthesia

Once your child has been registered for the test, a member of the anesthesia staff will meet with you to take your child’s vital signs, weight and medical history. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.

• The anesthesiologist will meet with you and your child to review your child’s medical information and decide which kind of sleep ­medication your child should be given. 
• If your child is very scared or upset, the doctor may give a special medication to help him or her relax. This medication is flavored and takes effect in about 10 to 15 minutes.
• If you wish, you may go with your child to the room where the test will be done and stay as the sleep medication is given. 
• Younger children will get their sleep medication through a mask that will carry air mixed with medication. Your child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while your child is still awake. 
• Older children may choose between getting their medication through the mask or directly into a vein through an intravenous (IV) line. 
• When your child has fallen asleep, you will be taken to the waiting room. If it has not already been done, an IV will be started so that medication can be given to keep your child sleeping throughout the test. While your child is asleep, his or her heart rate, blood pressure, temperature and blood oxygen level will be checked continuously.
• Depending on the test being done, your child may have a breathing tube placed while he or she is asleep. If a breathing tube is used, your child may have a sore throat after the test.
• To keep your child asleep during the test, he or she may be given anesthetic medication by mask, through the IV tube or both. When the test is over, the medications will be stopped and your child will begin to wake up.

If Your Child Is Having Sedation

Once your child has been registered for the test, a nurse will meet with you to take your child’s vital signs, weight and medical history.  As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.

• Your child’s doctor will decide which type of sedation medication is right for your child, depending on your child’s age, medical history and the type of test being done. 
• Sedation medication may be given by mouth, through the nose, into the rectum, or directly into a vein through an intravenous (IV) line.  There are no inhaled medications given.  
• The medication will work in one of two ways:  In one dose that takes effect slowly and lasts throughout the test, or in a continuous dose throughout the test.  
• You may stay with your child until he or she is very drowsy.  You will be taken to the waiting room when the test is ready to begin.
• During the test, your child’s heart rate, blood pressure, temperature and blood oxygen level will be checked continuously.  

The Test

Your child’s colonoscopy will be scheduled at either Children’s Hospital of Pittsburgh of UPMC in Lawrenceville, Children's South in Bethel Park, or Children’s North in Wexford. Your doctor will decide which facility is best for your child’s procedure.

• Once your child is asleep, the endoscope is passed through the anus through to the end of the colon. Usually the doctor also will pass the scope into the last part of the small intestine.
• Each area is looked at by the doctor, and pictures are taken for your child’s records. You will get a copy of the pictures.
• The doctor may take tiny samples of tissue from each area. 
• Tissue samples will be sent to a laboratory and looked at under a microscope to check for infections or other changes in the tissues that were not seen with the endoscope.
• Several days later, your doctor will call you with the results of the test.  

A Parent’s/Guardian’s Role During the Test

We welcome your help and support during this test. One of the most important roles of a parent and/or guardian is to help your child stay calm and relaxed before and after the procedure. The easiest way to do this is for you to stay calm.