When blood appears in the feces of a baby, parents begin to sound the alarm. Indeed: normal feces should not be bloody. Blood in the feces of a child appears for a variety of reasons and can be a symptom of a serious illness that cannot be ignored.
Causes of blood in the stool
Blood impurities can stain stool black (if it is bleeding from the esophagus, stomach and duodenum). If it is not enough, it can look like blood streaks, strings or droplets on a diaper. Why does an infant have bloody diarrhea or blood streaks in the stool?
The appearance of blood in the feces of an infant has the following reasons:
- Mother’s bleeding cracked nipples. In a breastfed baby, the mother’s blood is swallowed along with milk. For diagnosis, a reaction to occult blood and the Apt-Downer test are used.
- Persistent constipation, which produces hard stools. Defecation is difficult, the child needs to strain, and as a result, rectal cracks appear. At the same time, the blood is not mixed with feces and has a bright color. If constipation occurs 3 months ago or more, it is called chronic.
- Allergic reaction in an infant (when feeding unadapted formulas and cow’s milk, which contains a foreign protein, or when a food allergy occurs).
- Intestinal dysbiosis (often occurs after taking antibiotics). With dysbiosis, there is a foamy, sometimes liquid, blood-streaked stool.
- Inflammatory diseases of the digestive tract (eg, colitis). Specks and traces of blood do not mix with feces. Mucus often appears in the stool.
- Hemorrhagic disease of the newborn. Blood in the stool can be caused by a vitamin K deficiency in infants, which affects blood clotting.
- Juvenile intestinal polyps. Rarely formed in a one-year-old child, more often occur after 5 years. The main symptom is scarlet blood in the feces of a newborn without fever. To confirm the diagnosis, sigmoidoscopy or colonoscopy under anesthesia is performed.
- Intestinal intussusception. They often occur in infants because their intestines are relatively longer and more mobile than in adults. At the site of intussusception, a site of venous stasis is formed. As a result, some of the blood seeps into the intestinal lumen. On the baby’s diaper, you can see discharge in the form of “raspberry jelly”.
- Acute intestinal infection (shigellosis, salmonellosis, rotavirus gastroenteritis). The temperature rises, vomiting occurs, loss of appetite, diarrhea. In this case, mucus with blood is formed in the liquid feces of the baby. Also, green stools are common.
- Helminthic invasions. Often they occur with trichocephalosis, when helminths attach to the intestinal mucosa, and then disappear, which is accompanied by bleeding from the points of their attachment. In this case, there is a stool with mucus and blood in the child.
- Lactase deficiency. It occurs when the content of the lactase enzyme is less than the norm. Children have frothy diarrhea streaked with blood and mucus in the stool.
- When teething. The milk tooth erupts with a drop of blood, which, after swallowing, can be found in the feces.
- With the introduction of complementary foods earlier than six months of age.
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You need to immediately show the child to a specialist if you have the following symptoms:
- loss of body weight,
- diarrhea with blood in infants,
- green chair,
- pallor of the skin (a sign of anemia).
Among the harmless reasons for the appearance of dark feces in a baby, one can name: taking iron preparations, feeding the mother with foods that can color the feces and the introduction of the first complementary foods. The red threads from the diaper can be mistaken for blood streaks.
What to do if streaks of blood in the baby’s feces are found in large quantities, there are large clots of clotted blood, or, conversely, there is a little liquid scarlet blood on the diapers? We urgently need to take the baby to the pediatrician! Blood in dark, liquid feces in an infant may indicate internal bleeding, and its scarlet color indicates problems in the lower digestive tract (such as a bleeding polyp).
Hemorrhagic disease of the newborn
It occurs with a deficiency of vitamin K, which contributes to the formation of blood coagulation factors. It is observed in about 2 out of 100 children, if vitamin K has not been administered in the maternity hospital after childbirth. The classic form of the disease occurs when the child is breastfeeding. Symptoms begin at 3–5 days of life and include bloody vomiting, bloody feces (melena), cutaneous hemorrhages, cephalohematoma, and bleeding when the umbilical remains fall off.
The cause of bloody diarrhea is the formation of small ulcers on the mucous membrane of the stomach and duodenum. The main mechanism of their occurrence is an excess of glucocorticoids (during stress during childbirth), hypoxic damage to the stomach and intestines. Also, blood in the stool and vomiting in an infant can be triggered by peptic esophagitis (inflammation of the esophagus) and reflux of stomach contents into the esophagus.
Late hemorrhagic disease occurs before the 10th week of a child’s life. If bleeding occurs later (in a 3 month old or in a 4 month old baby), then this disease can be excluded.
Coprogram. The main research method that is carried out in all medical institutions. Allows you to determine whether there is mucus, an admixture of red blood cells and particles of undigested food in the feces of a baby, as well as many other indicators. Based on the results of the coprogram, the doctor can correctly diagnose.
Coagulogram. Blood from the digestive tract of infants in the feces sometimes indicates the appearance of congenital disorders of the blood coagulation system. When conducting a coagulogram, prothrombin and thrombin time, fibrinogen are determined.
The Apt-Downer test is used to differentiate bleeding in a child under one year old with a syndrome of ingestion of maternal blood from nipple cracks. For this purpose, take bloody vomit or baby stool. They are diluted with water and a solution is obtained that contains hemoglobin. Hemoglobin in a newborn child differs in structure from an adult. The resulting mixture is centrifuged and mixed with sodium hydroxide solution. The appearance of a yellow-brown color indicates the presence of hemoglobin A (mother), and the preservation of pink color indicates the presence of hemoglobin of the newborn (alkaline-resistant Hb F).
Gregersen’s reaction or fecal occult blood test. It is used when there is a suspicion of bleeding from the digestive tract, when no blood is visually detected in the feces. Meat products are excluded before testing.
A possible number of results are classified by the amount of hemoglobin in the stool: negative reaction (no occult blood in the stool), weakly positive (+), positive (++, +++), sharply positive reaction (++++).
The reaction to Gregersen’s blood is widespread only in the CIS countries; in other countries, stool analysis is used to determine human hemoglobin by enzyme immunoassay.
Tests for lactase deficiency. What to do if you suspect this pathology? A quantitative determination of carbohydrates in feces, a breath test (hydrogen content in exhaled air after ingestion of lactose), a D-xylose absorption test, and others are carried out.
Also, feces are analyzed for dysbiosis, stool examination for helminth eggs and general blood and urine tests.
Blood or bloody streaks in an infant in the feces require additional diagnostic methods. The need for these examinations is determined after consultation with the following doctors: pediatrician, gastroenterologist, allergist and hematologist.
General therapeutic principles for the treatment of diseases that lead to the appearance of blood in infants in the feces:
- If a baby on mixed or artificial feeding is suffering from constipation, it is necessary to replace the mixture or use laxatives in the form of syrup.
- Intestinal obstruction is treated with surgical intervention using manual expansion of invaginate.
- Acute intestinal infection has two lines of therapy: rehydration and antibacterial.
- If you are allergic to cow’s milk protein, such feeding should be replaced with a highly adapted formula.
- Lactase deficiency is treated with lactose-free mixtures (Nutrilon Lactose-free, Enfamil Lactofree).
- Hemorrhagic disease of the blood coagulation system in infants is treated with the introduction of a synthetic analogue of vitamin K (vicasol).
Blood in the stool of a baby child should not cause panic in parents. It is best to consult a pediatrician. If blotches or blood streaks in the feces are repeated for a long time, the child does not gain weight or loses his appetite, it is necessary to go to the hospital for a wide range of diagnostic or therapeutic procedures.