Blood in baby stool is one of the most common causes of pediatric gastroenterologist visits (1). You may notice red streaks or blood on diapers. Although it is not an emergency, a pediatric consultation is recommended to identify the cause. Rectal bleeding can be a symptom of some self-limiting conditions or digestive disorders. Some babies may have accompanying symptoms or crying, while a few may not have any symptoms.
Read on to know the causes, diagnosis, treatments, and preventive measures for rectal bleeding in babies.
When Is Blood In Baby’s Stool Not Normal?
For babies younger than 12 weeks, blood in the stool should be treated as an emergency. Whereas for older babies, if the baby looks healthy and happy, you do not have to worry much. A planned pediatric consultation is wise to avoid any complications. However, consult the doctor immediately if the baby shows signs that indicate at something serious (2):
- Inconsolable crying or crankiness or fussiness
- Refusal to eat or drink anything
- Abdominal pain
- Significant bleeding in the stool, diarrhea, vomiting
- Persistent or increasing blood in the stool
- Blood mixed with mucus
What Causes Blood In Baby Stool?
Blood can appear in the baby’s stool in two forms: visible blood that you see in the form of red stains, and occult blood which is discernible through laboratory testing of the stool. If the bleeding happens inside the stomach (due to stomach infection or allergy), the blood may get digested and give the stool a blackish appearance. So, the form in which the blood appears in the stool could be used as an indicator of the probable cause.
Here are a few reasons why there might be blood in an infant’s stool:
1. Anal fissures
Anal fissure, a tear in the inner mucous lining of the anus, bleeds a bit, leading to blood in the stool and the nappy (3). Passing blood in the stool is not normal. So, if it persists, a doctor must be seen. A baby that is exclusively breastfed passes a softer, runny stool. If this is frequent, it could abrade the sensitive mucous lining of the baby’s anus. A baby who has ongoing diarrhea is unlikely but may develop an anal fissure that may lead to blood in the stool.
Babies may get constipated, making them pass a hard stool in the form of pellets. Chronic constipation in babies could lead to blood in the stool due to the overstretching of the anal sphincter muscle for the passage of the tough stool (4). Harder stools that are also abrasive may aggravate an existing anal fissure.
Treatment: Just like any other abrasion in the body, anal fissures heal on their own. But in case the condition is severe, the doctor may prescribe a topical ointment.
Babies are vulnerable to gastrointestinal infections, but not all infections lead to bloody stool. A host of gastrointestinal infections could lead to blood in the baby’s poop, making it case-specific. If the blood is accompanied by diarrhea, then it can be an intestinal infection by bacteria such as shigella, salmonella, or campylobacter (5). These bacteria cause inflammation in the intestines, leading to tiny ruptures that drain blood into the stool. Streptococcus bacteria can infect the skin around the anal opening, causing inflammation. This can lead to a fissure and, eventually, blood in the infant’s stool.
Sometimes, due to infection-induced diarrhea, the stool of the baby may appear green with bloodstains. The blood could be a result of infection, whereas the green color is due to the improper breakdown of the bile juice. Green poop in diarrhea generally happens with breastfed babies.
Treatment: A scheduled dosage of antibiotics prescribed by the doctor could help your baby get relief from the infection and its discomforting symptoms.
Colitis or ulcerative colitis is not common. It is an inflammation of the inner lining of the colon, also referred to as the large intestine. In infants and newborns, this condition is called pediatric ulcerative colitis (6). If a baby is diagnosed with colitis, the diagnosis could find small sores within the large intestine that may or may not be painful but can cause bleeding in the baby’s stool. The reasons for pediatric ulcerative colitis are not known, but genetics is said to play a major role.
Necrotizing enterocolitis is a condition that can cause blood in a premature baby’s stool (7). Premature babies have an underdeveloped immune system, which makes their organs vulnerable to infection. In this condition, the intestinal walls are invaded by bacteria, and the bacterial degeneration leads to inflammation, which ultimately causes blood in the stool of the premature baby.
Treatment: The doctor might prescribe a course of anti-inflammatory drugs and antibiotics to regulate the immune response.
4. Crohn’s disease
Crohn’s disease is an uncommon inflammatory disease of the large intestine, nearly identical to colitis yet differing in its physiology and pathology. In babies, this condition is called pediatric Crohn’s disease (8). Just like in the case of colitis, there is no clear explanation for the condition and primarily seems to be caused by genetic mutations. If someone in the family, including a direct relative, has been diagnosed with Crohn’s disease, the probability of the little one developing this disease might exist.
Treatment: There is no cure for Crohn’s disease. A doctor will prescribe a host of medicines to manage the condition, and the nature of the medication depends on the intensity of the problem. In some cases, surgery might help in easing long-term symptoms.
Certain food allergies may also cause blood in the stool, accompanied by mucus. The baby can develop an allergy to milk (cow’s milk and formula), wheat, barley, rye, and oats. This can be a major concern for babies who have allergies and started feeding on solid food, and those who take supplements that may contain gluten as an ingredient. For example, vitamin supplements often contain barley malt, which has gluten (9). Therefore, a baby can get blood in stools after consuming vitamin supplements, and the bleeding stops once you stop the dosage.
Food allergies might lead to conditions such as allergic colitis and food protein-induced enterocolitis syndrome, which are both caused by allergic reactions to the protein in the food. Both these conditions can result in vomiting and blood-laden diarrhea in babies (10).
Treatment: Allergy can be a life-long condition but can be managed through various precautionary measures suggested by a medical practitioner.
Note that there is a difference between the bleeding caused by food allergies and the red-colored stool that results from the consumption of certain foods such as beetroot.
Foods That May Cause Reddish Stool
Some foods may lead to a stool that ranges from red to black, thereby giving a false impression of blood in the baby’s stool. It is the color from the food that one sees in the stool, and there is no visible or occult blood in the stool. Here are the foods that may cause reddish stools:
- Red gelatin
Iron supplements may cause the stool to appear reddish-black to tar black. For example, medicines such as Cefdinir used for the medical condition otitis media can result in the red stool (12).
Note that in some babies, gastric issues are diagnosed with occult blood. So, there is no certainty that all the babies suffering from gastric issues will have visible blood in their stool.
How Are These Conditions Diagnosed?
Blood in the stool, be visible or occult, is not normal for your baby and mandates a medical checkup. The condition is diagnosed through the following methods that can accurately determine the quantity of blood in the stool:
- Stool analysis: Your doctor will recommend a pathological analysis of your baby’s stool. This will help determine the presence of bacteria, viruses, mucus, and the exact amount of blood in the stool of your baby. This test will also detect the presence of occult blood.
- Blood test: Blood test is a second obligatory test to determine if an infection is causing the baby’s blood-stained stool.
- Symptomatic diagnosis: A medical practitioner will make an affirmative diagnosis of the condition after analyzing the various other symptoms that your baby may show, apart from blood in the stool. A colonoscopy with biopsy may be conducted in the cases of chronic rectal bleeding, where a sample of tissue is surgically collected to determine the exact nature of the medical problem (1).
There are certain medical anomalies the little one may face if a serious condition is detected.
Are There Any Complications Of Blood In Baby’s Stool?
If the blood in the baby’s stool is left untreated and the condition gets aggravated, then the baby runs a risk of developing the following medical complications:
- Scarring around anal opening: Repeated anal fissures can lead to permanent scarring around the anal opening, which will lead to more abrasion due to friction with the stool.
- Topical infections: Fissures can get infected with skin bacteria, causing inflammation and severe discomfort in passing the stool. Furthermore, the skin infection will spread to the genitals making things worse.
- Bowel obstruction: Conditions such as colitis and Crohn’s disease can inflame the linings of the intestines so severely that food contents fail to move smoothly. This drastically slows down the process of digestion, thus hampering the feeding routine of the baby.
- Malnutrition: Since your baby is unable to digest the food properly, he is prone to malnutrition because nutrients from food are poorly absorbed by the inflamed walls of the intestines. Moreover, the baby is losing blood through stool, thus increasing the risk of anemia.
- Ulcers: Those suffering from Crohn’s disease are susceptible to lesion-like ulcers anywhere in their digestive tract, including the mouth (13). These ulcers are again prone to infection.
You need not worry about the complications if you are following the remedy guidelines prescribed by the doctor. Also, you can take some precautions to reduce and prevent the chances of blood appearing in the stool of your baby.
Precautions To Prevent Blood In The Baby’s Stool
Here are simple steps to follow to mitigate the chances of seeing the baby’s blood in his stool:
- Breastmilk is the best food: Feed your baby only breast milk for the first six months. Breast milk is best for your baby’s gastrointestinal tract and is laden with antibodies that will help keep infections at bay. It improves the efficiency of his immune system.
- Do periodic inspections: Periodically check your baby’s anal opening for any signs of tears or infections. If you find something perturbing and feel that it deserves medical attention, then do not hesitate to take him to the doctor.
- Be cautious about allergies: When the doctor diagnoses an allergy, make sure your little one stays away from those allergens. Do not attend to a baby after consuming any of those foods. Food allergies can be managed through epinephrine auto-injector that your doctor will prescribe.
It could be worrisome to spot blood in a baby’s stool for most parents. Infections, inflammation, anal tears, food allergies, and other medical conditions could be the possible causes. Following simple measures and being watchful for allergies and infections could help lower the chances of seeing blood in the baby’s stools. You may seek immediate medical care for babies younger than three months. However, for older babies, you may plan a doctor’s visit only if they display increased blood loss in stool, accompanied by mucus and other signs such as pain, fever, and loss of appetite.
Infographic: Hematochezia (Rectal Bleeding): Differential Diagnosis
Hematochezia or rectal bleeding in the pediatric population could be mild to severe. Identifying the etiologies and timely evaluation could help prevent adverse outcomes. This infographic demonstrates the differential diagnosis of hematochezia.
2. Stools – Blood In; Seattle Children’s Hospital
3. Anal fissure; Medical Encyclopedia; National Institute of Health; U.S National Library of Medicine
4. Anal fissure; National Health Service, UK (2012)
5. Lori R. Holtz et al.; Acute Bloody Diarrhea: A Medical Emergency for Patients of All Ages; Journal of Gastroenterology
6. Gia M Bradley and Maria Oliva-Hemker; Pediatric ulcerative colitis: current treatment approaches including the role of infliximab; National Center For Biotechnology Information (2012)
7. Necrotizing Enterocolitis; Children’s Hospital Los Angeles
8. Crohn’s Disease in Children; Stanford Children’s Health
9. Gluten In Medications, Vitamins, And Supplements; Celiac Disease Foundation; Semantic Scholars
10. Food Protein-Induced Enterocolitis Syndrome (FPIES); American College of Allergy, Asthma, and Immunology (2019)
11. Norane Shehab, et al.; Copious amount of bloody stool in a newborn shortly after birth; SAGE Open Medical Case Reports (2021)
12. Meredith C. Roath and Jack A. Di Palma; Correspondence: Cefdinir and Red Stool; National Center For Biotechnology Information (2013)
13. Pediatric Crohn’s Disease; National Organization For Rare Disorders (2019)