Noticing blood in your child's stool is alarming even for the most unflappable parent. Although you should never ignore this symptom, it doesn't necessarily indicate a serious medical problem. Bloody stool usually -- not always -- signals bleeding from the lower digestive tract, which is often mild and transient. Many conditions can cause digestive tract bleeding.
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Something Other Than Blood
Red stool flecks or streaks aren't always blood. Beets, tomatoes and red food coloring from flavored gelatin, ice pops, drinks or candies can potentially cause red stool coloration. Even if you suspect your child's diet might be responsible, check with your doctor. A simple stool test can determine whether blood is present.
An anal fissure is a small tear in the anal canal, the tissue through which stool passes as it's eliminated. These tears are a leading cause of bloody stool in the first 2 years of life and are relatively common in older children as well. Anal fissures usually occur due to constipation and hard stools but can also develop with persistent diarrhea. The blood characteristically appears as a few red streaks or flecks on the outside of the stool. Blood loss is usually minimal and the tear typically heals quickly with home treatment.
Perianal Strep Dermatitis
Perianal strep dermatitis is a skin infection around the anus caused by group A strep bacteria. Symptom include an itchy red rash around the anus, rectal pain with bowel movements and anal fissures, which often lead to bloody stools. This condition typically affects children aged 6 months to 10 years; most cases occur in preschoolers. A short course of antibiotics usually clears this infection within a few days.
Allergic, digestive tract food reactions are a consideration for infants with bloody diarrhea.
Food Protein-Induced Enterocolitis Syndrome (FPIES)
FPIES almost exclusively affects formula-fed babies during the first year of life and is usually caused by an allergic reaction to cow's milk or soy proteins. Older children might develop FPIES as solid foods are introduced due to a reaction to rice, oats, eggs, poultry, fish, nuts or other foods. Symptoms include severe vomiting and bloody diarrhea. Dehydration, failure to gain weight and anemia are serious risks. Treatment involves strick avoidance of triggering food(s). Most children outgrow FPIES.
Food Protein-Induced Allergic Proctocolitis (FPIAP)
A reaction to cow's milk and/or soy proteins is the leading causes of FPIAP, which occurs in breastfed and formula-fed babies and usually presents in the first 6 months. Eggs and wheat might also trigger a reaction. In exclusively breastfed babies, the proteins come from the mother's diet and are passed in the breast milk. Babies with FPIAP are typically well other than occassional blood in the stool. Treatment involves avoidance of the triggering food(s) in the diet of the baby and mother if breastfeeding. Most children with FPIAP outgrow the condition by age 2.
Intestinal infections can cause bloody diarrhea in children of all ages. Bacterial infections are most often to blame, with culprits such as Campylobacter, Shigella, E. coli and Salmonella. Infection usually occurs due to ingestion of contaminated food, water or other beverages. These infections can also spread when good hygiene practices -- handwashing after using the bathroom or changing diapers -- are not followed. In addition to diarrhea, other symptoms may include fever, stomach upset and reduced appetite.
A lengthy list of other medical conditions can potentially cause bloody stools in children. Some of the leading considerations include:
Juvenile polyps are growths that protrude into the interior of the large intestine. They are nearly always noncancerous but often cause episodic, painless bleeding. Most juvenile polyps are diagnosed in children younger than10 and removal with a scope inserted into the colon typically resolves the condition.
With intussusception, part of the intestine slides within the following portion in a telescoping manner similar to the pieces of a collapsible cup or antenna. This potentially life-threatening condition obstructs the bowel and robs the affected portion of blood flow. This condition is a medical emergency and primarily affects children younger than 2.
Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) includes Crohn disease and ulcerative colitis. Up to 25 percent of cases are diagnosed in people younger than 20, as reported in a November 2015 "JAMA Pediatrics" review article. IBD is most frequently diagnosed in adolescents but can occur in younger children. Bloody diarrhea is a common symptom along with weight loss, poor appetite and possibly fever.
Meckel diverticulum is a abnormality present from birth in which a pouch protrudes outward from the small intestine. This condition sometimes causes episodic, painless bloody stools particularly among children younger than 5, although older children are sometimes affected. Surgical removal of the diverticulum resolves the problem.
Next Steps, Warnings and Precautions
Call your doctor right away or seek immediate medical evaluation if your child has what appears to be bloody stool and is younger than 3 months or has one or more of the following:
- Stomach pain
- Inconsolable crying in infants
- Fever or chills
- Unexplained skin bruises
- Decreased urination
- Child seems very sick, based on appearance or abnormal behavior
- Bleeding appears to be more than a few drops
If your child has none of these signs or symptoms and seems otherwise well, call your doctor within no more than 24 hours.
Call 911 if your child experiences:
- Dizziness, lightheadedness, faints or loses consciousness
- Inattention, confusion or agitation
- Rapid or difficult breathing, or chest pain
- Pale, bluish or mottled skin
Reviewed and revised by: Tina M. St. John, M.D.
- EB Medicine: The Young Child With Lower Gastrointestinal Bleeding Or Intussusception
- Pediatric Review: Gastrointestinal Bleeding in Infants and Children
- Journal of the American Board of Family Medicine: Diagnosis and Management of Upper Gastrointestinal Bleeding in Children
- Textbook of Pediatric Emergency Medicine, 6th Edition; Gary R. Fleisher and Stephen Ludwig
- American Family Physician: Perianal Streptococcal Dermatitis
- Allergy and Asthma Proceedings: Food Protein-Induced Enterocolitis Syndrome and Allergic Proctocolitis
- Pediatric Allergy and Immunology: Non-Ige-Mediated Gastrointestinal Food Allergies in Children
- Merck Manual Professional Version: Meckel Diverticulum
- JAMA Pediatrics: Inflammatory Bowel Disease in Children and Adolescents
- Gastrointestinal Disease: An Endoscopic Approach; Anthony J. DiMarino
- Seattle Children's Hospital: Blood in Stools