Blood in the Poop
What to do when there is blood in your kid’s poop. A lot of children at one time or another will have blood in their stool, and most causes will go away on their own. But regardless, when wiping a booty or checking a diaper and you see some red spots your mind always goes to the worst, am I right? So before we all start freaking out, let’s ask ourselves some questions:
How old is the kiddo?
Shortly after birth, usually in the first 5-7 days, I will have families let me know that they noticed some blood in their baby’s diaper. Oftentimes, it is not blood at all but rather uric acid crystals. When a baby is born, it may take mom’s milk a few days to come in. So babies are born with a lot of extra fluid in their body/skin to help with this delay in fluid intake. But at a certain point, the kidneys will start super-concentrating urine to hold on to fluid. When you super-concentrate urine, you can get these orange to pink to brick dust–looking remnants known as uric acid crystals in the diaper. If I see this in clinic, and a kiddo has lost close to 10% of their birthweight, it is a signal to me that we need to hydrate the baby a bit more.
Another common cause of blood in the diaper of babies is that female babies will often have discharge or small amounts of blood from the vaginal opening after birth as their bodies get used to not having mom’s hormones around—very normal and will clear up on its own.
Within the first 2 months, we sometimes see blood spots or mucus in a baby’s diaper. Parents will also tell us that the kiddo’s stools are always painful. We can also often see that after 6 weeks (when we expect all baby rashes to start clearing up), body rashes worsen. If this is the case, we may have a milk protein or other protein sensitivity in baby, where their gut is reacting to something in the milk. Your pediatrician will usually test the poop to see if there is microscopic blood. If there is, we will have the families try a dairy-free diet for a breastfeeding mom or change the formula to one that breaks down the dairy proteins to less irritating amino acids.
A rare cause of bloody-looking stools in children ages 6 months to 36 months is something called intussusception. Intussusception is when the intestine can sort of telescope in on itself. This causes bouts of inconsolable crying in infants and kids with their legs pulling up into their abdomen to help relieve the pain. It can then be followed by a classic finding that has been drilled into pediatricians’ heads so as to not miss it. It is this odd-looking stool described as currant or grape jelly stool. This is more of a medical emergency and should be investigated in the emergency room due to the fact that the imaging technique we use to identify it is also commonly how we treat it: a water-soluble contrast or air enema that will show us the spot of intussusception and also allow us to expand the intestine so it will elongate out of its telescoped state.
Are there any other symptoms?
Now if we have a potty training or older kiddo with blood in the toilet or on the toilet paper, we need to investigate a little further. Is this an isolated incident? Are there any other symptoms such as fever, diarrhea, or constipation? The most common cause of bright red blood in the toilet or on toilet paper at this age is a few days of constipation and big/hard-to-pass stools. Kiddos (and adults) can get an anal tear due to large-caliber poops. A small tear here can bleed a lot when pooping and cause a lot of discomfort for kiddos. Oftentimes there will be a streak of blood around the poop and/or small drops of blood in the toilet water after the pooping has commenced. The way to treat these is by making sure the poop is guacamole or softer for a couple of weeks to allow the anus to heal itself. If it is really itchy or sore, you can apply some over-the-counter 1% hydrocortisone to the anus a few times a day to take the sting away.
More concerning blood in the stool happens when it is recurrent, associated with pain and/or fevers, or if there is lots of blood and mucus mixed together. If this occurs, we need to figure out what inflammatory process is going on. Chronic conditions like Crohn’s disease or ulcerative colitis can have these bouts of diarrhea with blood and mucus, associated with abdominal pain and fevers. There are some bacterial and viral gastroenteritis infections (stomach bugs) that can also cause a brief bout of blood in the stool. Regardless, your pediatrician should help to investigate these possible causes of recurrent bloody stools.