Author: Anna Pickens, MD (@AnnaEMin5, Creator of EMin5) // Reviewed by: Alex Koyfman, MD (@EMHighAK), Brit Long, MD (@long_brit), and Manpreet Singh, MD (@MprizzleER)
Welcome to this week’s edition of EMin5 by Dr. Anna Pickens. Today we’ll review what to do when a parent shows up to the ED stating that their baby has blood in the diaper!
So let’s start out with a case:
Mom brings in a 6 month old baby, otherwise healthy, non-toxic, complaining of blood in the diaper the last 2 days. He is not vomiting, his abdomen is soft, he’s well hydrated, and doesn’t have a fever.
Before panicking that you have a volvulus on your hands, let’s think through how to approach the differential for bloody stools in pediatric patients.
- Blood or Not Blood?
- Sick or Not Sick?
- Then think through the differential by age.
First, let’s make sure this is actually blood.
There are many mimics of blood that can turn stool red.
EXAMPLES:
Any guesses?
Yep, spicy hot cheetos!
Other foods:
Beets:
Jello:
Kool-aid / Popsicles / Juice:
Markers:
Frosting:
How do we find out? Hemoccult the sample if the diaper was brought in:
Also ask about other medications the child might be on:
(Pepto-Bismol and iron also turns stool melanotic / black in color)
If blood is confirmed, now start thinking about the differential based on if the child is sick or not sick:
Then break it down by age:
SICK:
NOT SICK:
Then rely on other clues in your history and physical.
Here’s some scenarios:
So to review:
- Confirm that the stool is actually bloody (or that the blood is not coming from somewhere else)
- Is the child sick or not sick?
- Then break down the differential diagnosis by age
Suggested/Further Reading:
PEM Playbook – GI Bleeding in Children – emDOCs.net – Emergency Medicine Education
Wayne Wolfram. March 7, 2013. Pediatric Gastrointestinal Bleeding: Background, Etiology, Epidemiology
