Parenting is a journey during which you encounter things you weren't prepared for, especially when your child is sick. One of the scariest situations for parents is when a child has blood in their stool or vomit, which is known as gastrointestinal (GI) bleeding.
About six in 100 pediatric gastroenterology patients experience GI bleeding, and the causes can range from generally harmless situations such as swallowing blood after a nosebleed to more serious conditions such as ulcers in the GI tract.
Signs include traces of blood in the stool, appearing pale, and vomiting blood, which can be bright red or look like coffee grounds. Left untreated, GI bleeding can lead to shock, anemia, and even death in the most severe cases.
Quick diagnosis is key, so the UT Southwestern and Children's Health pediatric gastroenterology team are creating a new, collaborative database with other medical centers to improve the accuracy of diagnosis and help more kids feel better faster.
The first step is to talk with your child and their doctor about symptoms to pinpoint where the bleeding started and why.
What are the symptoms of a GI bleed?
The lower GI tract consists of the anus, rectum, and colon. The upper tract includes the esophagus, stomach, and duodenum. While symptoms can be similar from bleeds in either location, upper GI bleeds tend to be more severe.
Schedule a visit with the doctor if your child has any of these symptoms:
- Abdominal cramping
- Bright red vomit
- Dark brown or black vomit that looks like coffee grounds
- Paleness, which can suggest iron-deficiency anemia
- Shortness of breath
- Stools that are red, black, dark brown, or tar-like in consistency
If the child has any of the symptoms above paired with one or more of the following more serious symptoms, call the doctor right away:
- Being inconsolable
- Bleeding from the mouth or anus that won't stop
- Fever higher than 100.4 degrees Fahrenheit
- Dehydration symptoms, such as dry mouth, extreme thirst, crying without shedding tears, decreased urination (not going for hours or having fewer than six wet diapers in a day)
- Dizziness or lightheadedness
- Unresponsiveness or extreme lethargy
7 common causes of pediatric GI bleeding
Based on the child's symptoms, a physical exam, and additional information from the parent, we often can diagnose the underlying issue without much additional testing. For example, we’ll ask about:
- Bowel habits
- Food aversions (they suddenly avoid or "don't like" a certain food)
- Symptom frequency
- What makes them feel better
The information we gather typically points to one of seven common conditions that can cause GI bleeding in children.
The most common cause of pediatric lower GI bleeding, constipation, or passing hard stool, can tear the anal tissue (fissures). In the short term, laxatives or stool softeners can provide relief. Long term, increasing fiber in the diet and improving hydration can help.
Some children who have struggled with the pain and bloating of constipation for a long time develop anxiety about going to the bathroom. If that's the case, your child's doctor might suggest counseling or play therapy to help them overcome their fears.
These sores on the lining of the GI tract are the most common cause of pediatric upper gastrointestinal bleeding. They can form due to infections such as H. pylori, an organism believed to be spread through person-to-person contact and contaminated food and water.
Taking anti-inflammatories such as aspirin or ibuprofen long term can also cause ulcers by damaging the stomach’s protective mucus membrane.
Along with GI bleeding symptoms, ulcers can cause chest pain, hiccupping or burping, and a burning sensation in the center of the abdomen. Treatment can include medication to cure an underlying infection or antacid medications to neutralize stomach acid.
3. Meckel’s diverticulum
A Meckel’s diverticulum is a surprisingly common problem. It is a pouch, or leftover tissue, in the intestine that didn't properly absorb as the child’s digestive system developed during pregnancy. The pouch may have stomach tissue in it that makes acid leading to symptoms such as painless rectal bleeding. Children are typically diagnosed before age 10. Treatment includes a minor surgery to remove the culprit tissue.
4. Food allergies
Babies can suffer from colitis, an inflammatory reaction in the gut, caused by proteins in formula or breast milk. The most common offenders are cow milk protein and soy. These proteins can be present in both formula and breast milk through the mother’s diet. Other foods including nuts, wheat, fish, and egg can cause GI symptoms as well.
Aside from GI bleeding, symptoms can include nausea, vomiting, diarrhea, and food aversion. Treatment approaches range from creating a plan to avoid trigger foods to medication or other therapies to control symptoms and repair damaged GI tissue.
Gastritis occurs when the lining of your child’s stomach becomes inflamed or irritated. It can be caused by chronic stress, excessive vomiting, infections, autoimmune disorders such as diabetes or thyroid disease, or certain medicines like anti-inflammatory drugs or steroids. Toddlers might develop gastritis from swallowing toxic non-food objects such as batteries.
Symptoms might include abdominal pain, bloating, indigestion, GI bleeding, and loss of appetite. Treatment usually includes medication to reduce stomach acid, heal infections, and treat underlying conditions.
6. Inflammatory bowel disease
School-aged children and adolescents might have GI bleeding due to inflammatory bowel disease. There are two types of IBD:
- Ulcerative colitis affects the innermost lining of the colon and rectum. Any part of the colon and rectum can be involved, though only about one-third of patients have this disease affecting their entire colon.
- Crohn’s disease usually affects the end of the small intestine and the beginning of the colon (also called the cecum), but it can be found anywhere in the GI tract. In some cases, it can extend through the entire thickness of the bowel wall.
Both can cause bloody diarrhea, stomach pain, unexplained weight loss, fatigue, and nutritional issues. They can also be associated with joint pain. Treatment might include dietary changes, anti-inflammatory medication, or surgery in severe cases.
Children can also develop small clumps of cells on the lining of the colon called polyps. These formations can be genetic and usually are not serious, though they can lead to iron-deficiency anemia or GI bleeding. Fortunately, unlike in adults, colon cancer is extraordinarily rare in children. Problematic polyps can be removed without surgery through a simple colonoscopy procedure.
Advanced diagnosis of pediatric GI bleeding
Advanced examinations might be necessary to diagnose more rare or complex conditions, such as structural problems within the GI tract itself.
In these cases, we use X-ray, ultrasound, CT scan, or MRI to take pictures and find out what's going on inside the child’s digestive tract. If we need a better visual, we can perform one of these minimally invasive procedures to investigate further:
- Upper endoscopy: The doctor passes a thin, flexible tube with a light and camera on the end into the esophagus, stomach, and beginning of the small intestine to look for abnormalities.
- Colonoscopy: The doctor passes a thin, flexible tube with an attached camera into the child’s rectum to view the colon.
- Balloon enteroscopy: This procedure uses a slender balloon to gently expand and deflate sections of the child's GI tract over a thin scope tube to get a deeper look at otherwise restricted parts of the bowels. The American Society for Gastrointestinal Endoscopy likens the procedure to sliding a curtain over a rod.
- Capsule endoscopy: The child will swallow a pill-sized wireless video camera that takes pictures of the child's GI tract lining, concentrating on the small intestine, as it passes through their body.
Using data from these exams, as well as trends in our pediatric GI bleeding database, we can more quickly and precisely determine the cause of a patient's symptoms. Gastrointestinal health can affect children's mood, self-esteem, and long-term health. The faster we get to the source of an issue, the faster they can feel like themselves again.