🧒🩸 Vomiting Blood or Black Stools (Upper GI Bleeding) in Children: A Parent-Friendly Guide

⚠️ Upper GI bleeding means bleeding from the esophagus, stomach, or first part of the small intestine.
It may show as vomiting blood, “coffee-ground” vomit, or black/tarry stools (melena).
Some causes are minor, but upper GI bleeding should be taken seriously—especially if your child looks unwell.

1) 🧾 Quick “At-a-glance” box (top of page)

✅ Topic: Upper GI Bleeding
Common names: Vomiting blood (hematemesis), coffee-ground vomit, black tarry stool (melena)

Plain-language summary (2–3 lines):
Upper GI bleeding comes from the esophagus or stomach. It can be caused by irritation (gastritis), a tear after forceful vomiting, ulcers, swallowed blood (nosebleed), or (rarely) varices. Any significant or repeated bleeding needs medical assessment.

Who it affects (typical ages):
All ages—infants to teens.

✅ What parents should do today:

• Identify what you saw: bright red blood, coffee-ground, or black stool
• Check your child’s energy, breathing, and hydration
• Avoid ibuprofen/NSAIDs
• Seek urgent assessment if bleeding is more than a tiny streak or recurs

⚠️ Red flags needing urgent/ER care:

• Repeated vomiting blood
• Black tarry stools with weakness or pallor
• Dizziness/fainting
• Fast breathing, chest pain, severe belly pain
• Child looks very sleepy, pale, or dehydrated

🟡 When to see clinic soon:

• Single small episode but ongoing stomach pain
• Blood after forceful vomiting
• NSAID use with stomach symptoms
• Family history of ulcers or bleeding disorders

2) 🧠 What it is (plain language)

Upper GI bleeding usually comes from:

• Esophagus (food pipe)
• Stomach
• Duodenum (first part of small intestine)

How it can look:

• Bright red blood in vomit (fresh bleeding)
• Coffee-ground vomit (older blood exposed to stomach acid)
• Black tarry stool (melena) (digested blood)

What part of the body is involved? (small diagram required)

Common myths vs facts

• Myth: “Black stool always means bleeding.”
  Fact: Iron or certain foods can darken stool, but tarry black with smell is concerning.
• Myth: “A small streak of blood is never serious.”
  Fact: It might be minor, but patterns and child’s condition matter.
• Myth: “If the bleeding stops, there’s no need to assess.”
  Fact: Some causes still need evaluation, especially if melena occurred.

3) 🧩 Why it happens (causes & triggers)

Common causes

• Swallowed blood from a nosebleed (vomit looks bloody; child otherwise well)
• Gastritis (stomach lining irritation), often from illness, stress, or medications
• Mallory–Weiss tear (small tear after forceful vomiting/retching)
• Ulcers (stomach or duodenal), sometimes related to infection or NSAIDs
• Esophagitis (reflux irritation)

Less common but important causes

• Varices (enlarged veins) in children with liver/portal hypertension (medical emergency risk)
• Bleeding disorders or anticoagulant medications
• Severe infection/critical illness causing stress-related ulcers

Triggers that worsen risk

• ibuprofen/NSAIDs on an empty stomach
• severe vomiting/retching
• dehydration and stress on the stomach lining
• underlying liver disease

4) 👀 What parents might notice (symptoms)

• vomiting blood or coffee-ground material
• black tarry stool (sticky, strong odor)
• stomach pain or burning
• nausea
• weakness, pallor
• dizziness

Symptoms by age group

• Infants: swallowed maternal blood (rare), reflux irritation, infections
• Children: gastritis, tears after vomiting, ulcers
• Teens: NSAID-related gastritis/ulcers, stress, reflux; consider eating disorder-related vomiting patterns carefully

What’s normal vs what’s not

🟢 Sometimes less concerning (still call for advice):

• one small streak of blood after a known nosebleed
• tiny blood streak after single hard vomit with rapid recovery

⚠️ Concerning:

• repeated blood vomiting
• coffee-ground vomit
• black tarry stool
• weakness, dizziness, pallor

Trackers

• amount of blood (drops vs spoonfuls vs more)
• number of episodes
• stool color and consistency
• NSAID use
• hydration and urine output

5) 🏠 Home care and what helps (step-by-step)

⚠️ With suspected upper GI bleeding, home care is supportive—but don’t delay assessment if bleeding is more than minimal.

First 24–48 hours: what to do now

✅ Do this now:

• Keep child calm and upright
• Offer small sips of fluid if not actively vomiting
• Avoid NSAIDs (ibuprofen/naproxen)
• If bleeding recurs or child looks unwell → urgent assessment

What usually makes it worse

• continuing NSAIDs
• delaying care when melena occurs
• large meals immediately after vomiting episodes

6) ⛔ What NOT to do (common mistakes)

• Don’t give ibuprofen/NSAIDs.
• Don’t assume “it’s just a virus” if there is coffee-ground vomit or black stool.
• Don’t give anti-vomiting meds unless prescribed.
• Don’t ignore dizziness or fainting.

7) 🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• fainting, confusion, severe weakness
• fast breathing, chest pain
• large-volume blood vomiting
• suspected variceal bleed (known liver disease + bleeding)

🟠 Same-day urgent visit

• repeated vomiting blood
• coffee-ground vomit
• black tarry stool
• belly pain + bleeding
• dehydration signs

🟡 Book a routine appointment

• single tiny streak with clear cause (nosebleed) but recurring stomach pain
• mild symptoms after NSAID exposure without recurrence

🟢 Watch at home (only if clinician agrees)

• one tiny streak after a single vomit + child fully well + no recurrence + no melena

8) 🩺 How doctors diagnose it (what to expect)

What the clinician will ask

• what you saw (red vs coffee-ground vs melena)
• amount and frequency
• nosebleed history
• medications (NSAIDs, steroids, anticoagulants)
• stomach pain, reflux symptoms
• liver disease history

Physical exam basics

• hydration status
• vital signs (heart rate, blood pressure)
• belly exam
• signs of anemia (pallor)

Possible tests (and why)

• blood count (anemia)
• clotting tests if indicated
• stool testing for blood (sometimes)
• endoscopy if bleeding significant or recurrent
• imaging if specific causes suspected

What tests are usually not needed

• broad testing for a single tiny streak clearly from swallowed blood and no recurrence (case-by-case)

9) 🧰 Treatment options

First-line treatment

Depends on cause, but commonly includes:

• stopping NSAIDs
• acid suppression medications (clinician prescribed)
• hydration support
• treating underlying vomiting illness

If not improving (next steps)

• endoscopy to identify/treat source
• treatment for ulcer causes (if suspected)

Severe cases (hospital care)

• IV fluids or blood transfusion if needed
• endoscopic therapy for active bleeding
• urgent specialist management for varices

10) ⏳ Expected course & prognosis

• minor gastritis or tear often improves once vomiting stops and stomach heals (days)
• ulcers require treatment and follow-up
• variceal bleeding is serious but treatable with urgent specialist care

Return to school/sports

• depends on cause and recovery; avoid strenuous activity if anemic or recently bled significantly

11) ⚠️ Complications (brief but clear)

• anemia
• dehydration
• recurrent bleeding if cause untreated

12) 🛡️ Prevention and reducing future episodes

• avoid unnecessary NSAIDs; use alternatives if advised
• take stomach-irritating meds with food when appropriate
• treat reflux and vomiting early
• follow liver disease care plans closely

13) 🌟 Special situations

Infants

Swallowed blood from nosebleed or cracked nipples (breastfeeding) can mimic GI bleeding—still needs assessment.

Teens

NSAID use and vaping/smoking (if present) can worsen gastritis; screen for restrictive eating/vomiting patterns sensitively.

Kids with liver disease

Any GI bleeding is urgent due to variceal risk.

Travel considerations

Seek urgent care if black stools or repeated bleeding occur.

School/daycare notes

If recent bleed: note fatigue, need for hydration, and emergency plan.

14) 📅 Follow-up plan

• follow up with your clinician after any confirmed bleed
• bring:
  • photos (if available)
  • medication list
  • details of episodes
• earlier follow-up if recurrent pain, new melena, or fatigue occurs

15) ❓ Parent FAQs (Upper GI Bleeding-Specific)

“What’s the difference between coffee-ground vomit and bright red blood?”

Bright red suggests fresh bleeding; coffee-ground means blood has been in the stomach and partly digested—both need assessment if more than minimal.

“Can a nosebleed cause vomiting blood?”

Yes—swallowed blood can irritate the stomach and be vomited. Still, if you’re unsure or it repeats, get assessed.

“How can I tell melena from dark stool caused by iron?”

Melena is often black, sticky/tarry, and very smelly. Iron stool can be dark but usually not tarry—ask a clinician if unsure.

“Do ulcers happen in kids?”

Yes, though less common than adults. NSAIDs and certain infections/conditions can contribute.

“If my child vomited blood once and is now fine, do we still need to be seen?”

Often yes—especially if it wasn’t clearly from swallowed blood, or if there was stomach pain, NSAID use, or any black stool.

16) 🧾 Printable tools (high-value add-ons)

🧾 Printable: Upper GI Bleeding One-Page Action Plan

1. What did you see? red blood / coffee-ground / black stool
2. How much? streak / spoonful / more
3. How does child look? well / pale / sleepy / dizzy
4. NSAIDs used? yes/no
5. Red flags → urgent care

🧾 Printable: Episode Tracker

Date/time: ______
Type: vomit blood / coffee-ground / black stool
Amount: ______
Pain: yes/no
NSAIDs: yes/no
Notes: ______________________

🧾 Printable: “No NSAIDs” Reminder Sheet

⛔ Avoid ibuprofen/naproxen until clinician clears it after a bleed.

17) 📚 Credible sources + last updated date

Trusted references:

• Children’s hospital GI bleeding education pages
• Pediatric gastroenterology society patient resources

Last reviewed/updated on: 2025-12-31
Local evaluation pathways differ—follow your clinician’s advice.

🧡 Safety disclaimer

This guide supports—not replaces—medical care. If you are worried about your child, trust your instincts and seek urgent medical assessment.

This guide was fully developed & reviewed by Dr. Mohammad Hussein, MD, FRCPC ROYAL COLLEGE–CERTIFIED PEDIATRICIAN & PEDIATRIC GASTROENTEROLOGIST Board-certified pediatrician and pediatric gastroenterologist (Royal College of Physicians and Surgeons of Canada) with expertise in inflammatory bowel disease, eosinophilic gastrointestinal disorders, motility and functional testing, and complex nutrition across diverse international practice settings.

To book an online assessment Email Dr. Hussein’s Assistant Elizabeth Gray at: Elizabeth.Gray@pedsgimind.ca
In the email subject, please write: New Assessment Appointment with Dr. Hussein

Important: This appointment is completely online as Dr. Hussein is currently working overseas. This service is not covered by OHIP