Neonates
Anal fissures (the most common cause of GI bleeding in infants); Rectal fissures
Swallowed maternal blood
Milk protein allergies; Milk or soy enterocolitis, or allergic colitis
Necrotizing enterocolitis; Bacterial enteritis,
Malrotation with midgut volvulus
Intussusception,
Hirschsprung disease with enterocolitis
Coagulopathy
Brisk upper gastrointestinal (GI) bleeding
Vascular malformations
Gastric or duodenal ulcer
Gastrointestinal duplication cyst
Lymphonodular hyperplasia.
Erosions of the esophageal, gastric, and duodenal mucosa (2/2 gastric acid secretion and laxity of gastric sphincters in infants) are also a frequent cause of true neonatal GI bleeding.
Drugs: NSAIDs, heparin, and tolazoline given to the mother.
Children aged 1 month to 2 year – Infants and toddlers
Anal fissures (especially around the introduction of solid food or cow’s milk)
Milk or soy protein-induced colitis (allergic colitis)
Intussusception
Infectious colitis
Meckel’s diverticulum
Lymphonodular hyperplasia
Gastrointestinal duplication cyst
Coagulopathy
Eosinophilic gastrointestinal disease (EGID)
Infantile and very early onset inflammatory bowel disease (VEO-IBD)
Children aged 2-5 years
Anal fissures (especially around toilet training)
Intussusception
Meckel’s diverticulum
Infectious colitis: Bacteria – Salmonella, Shigella, Campylobacter, E. coli 0157:H7, C. diff, etc. Parasites e.g.(Entamoeba histolytica) and viruses e.g. adenovirus, CMV, and HSV.
Hemolytic-uremic syndrome (HUS)
Immunoglobulin A vasculitis (IgAV; Henoch-Schönlein purpura [HSP])
Juvenile polyps
Very early onset inflammatory bowel disease (VEO-IBD)
Solitary rectal ulcer syndrome (SRUS)
Children 5-17 years, School-aged children and adolescents
Anal fissures
IgAV (HSP)
Meckel’s diverticulum
Infectious colitis
Juvenile polyps
Hemorrhoids (primarily in older adolescents)
Inflammatory bowel disease
Solitary rectal ulcer syndrome (SRUS)
Further Reading
uptodate.com/contents/lower-gastrointestinal-bleeding-in-children-causes-and-diagnostic-approach
https://emedicine.medscape.com/article/1955984-overview#a5
Gastroenterol Nurs. 1989 Fall;12(2):100-3. Bloody diarrhea in children.
BMJ. 2008 May 3; 336(7651): 1010–1015. Management of bloody diarrhea in children in primary care
Pediatrics. 2017 Sep;140(3). Bloody Stools in a 3-Day-Old Term Infant.