Pediatric Emergency Playbook

Blood in the vomit. Blood in the stool. Blood in the diaper. How far do I go in my investigation? What do I really have to worry about?   The differential diagnosis of GI bleeding in children is broad. (Here is the complete differential diagnosis) In the ED, we can simplify by categorizing by age and appearance.     Neonates GI bleeding in the neonate (less than one month of age) is serious until proven otherwise. Well appearing? If this in obvious anal fissure, then no further work-up is necessary.  Counsel on proper feeding and follow-up. Evaluate for potential swallowed maternal blood by examining mother with a chaperone, then perform the Apt test. Consider allergic proctocolitis if the child is well.  Counsel the breastfeeding mother on diet modification.  If formula fed, the child should feed through thus until the primary care physician decides whether to start the sticky process of changing up formulas. If unclear, consider a complete blood count and/or further work-up and admission if unwell. Ill