🩸💩 Blood in Stool in Children (Newborn → Teens)

Common causes by age, red flags, and what to do today

Seeing blood in your child’s stool is scary—but many causes are treatable and not dangerous. The key is to quickly sort out:

• How much blood
• What it looks like
• Your child’s age
• Whether there are red flags

✅ Quick note: If your child looks unwell, is very sleepy, has severe belly pain, is vomiting repeatedly, or the bleeding is large—seek urgent assessment.

🧾 Quick “At-a-glance” box

✅ Topic: Blood in stool / rectal bleeding in children
Common parent terms: “Blood on the poop,” “blood when wiping,” “red streaks,” “dark stool,” “black tarry stool”

What it is (2–3 lines): Blood in stool can come from a small tear at the anus (very common with constipation) or from inflammation/infection inside the intestine. The color and amount of blood, plus age and symptoms, help determine whether this is mild vs urgent.

Who it affects (typical ages): Any age. The most likely cause changes with age (newborn vs toddler vs teen).

✅ What parents should do today:

• Check red flags first.
• Look at the color (bright red vs dark red vs black/tarry).
• Check stool pattern (hard stools? diarrhea?).
• Take notes (and a photo if possible) for your clinician.

⚠️ Red flags that need urgent / ER care:

• Large amount of blood, clots, continuous bleeding
• Black, tarry stool (melena)
• Pale, weak, dizzy, fainting, very sleepy
• Severe abdominal pain, belly swelling, or persistent vomiting
• Fever with very unwell appearance
• Bloody diarrhea with dehydration
• Baby < 3 months with significant bleeding or poor feeding
• Suspected swallowed foreign body, caustic ingestion, or trauma

🟡 When to see the family doctor/clinic soon:

• Small bleeding that repeats
• Blood mixed into the stool (not just on the outside)
• Ongoing constipation or painful stooling
• Chronic diarrhea, fatigue, weight loss, poor growth
• Family history of inflammatory bowel disease (IBD)

🧠 What it is (plain language)

“Blood in stool” can come from:

• Right at the exit (anus/rectum): usually small bright red streaks from a fissure
• Inside the bowel (colon or small intestine): bleeding may mix with stool, come with diarrhea, pain, fevers, or other symptoms
• Higher up (stomach/upper intestine): can appear as black, tarry stool

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

Common myths vs facts

• Myth: “Any blood means something dangerous.”
  Fact: The most common cause in kids is a small tear (fissure) from hard stool.
• Myth: “If it’s bright red, it’s always minor.”
  Fact: Bright red can still be significant if there’s a lot, if it’s mixed in stool repeatedly, or if your child is unwell.
• Myth: “Black stool is from chocolate or blueberries.”
  Fact: Some foods/iron can darken stool, but black tarry stool (sticky, foul, “tarry”) can signal bleeding and should be assessed urgently.

🧩 Why it happens (causes & triggers)

Common causes

• Constipation → anal fissure (most common overall)
• Infectious colitis (infection causing diarrhea + blood)
• Polyps (often painless bright red bleeding)
• Inflammatory bowel disease (IBD)
• Milk protein allergy (especially infants; blood + mucus)

Less common but important causes (brief)

• Intussusception (telescoping bowel; episodic pain, pallor; can have blood/mucus)
• Meckel’s diverticulum (can cause painless significant bleeding)
• Upper GI bleeding (black/tarry stool)
• Trauma/foreign body ingestion
• In teens: proctitis/infections (needs private, respectful assessment)

Triggers that worsen bleeding

• Ongoing hard stools and straining
• Diarrhea and irritation
• Delayed assessment when red flags are present

👀 What parents might notice (symptoms)

Typical clues that help you narrow the cause

• Bright red on toilet paper / outside of stool → fissure is likely
• Blood mixed in stool → inflammation/infection/polyp/IBD needs evaluation
• Dark red/maroon → can be more significant lower-bowel bleeding
• Black tarry stool → possible upper GI bleeding (urgent)

Symptoms by age group (common patterns)

Newborns (0–28 days)

Common possibilities

• Swallowed maternal blood (delivery or cracked nipples)
• Anal fissure (less common but possible)
• Milk protein allergy (small streaks + mucus possible)

More serious possibilities (urgent if unwell)

• Infection
• Intestinal problems (especially if vomiting, distended belly, poor feeding)

Infants (1–12 months)

Common

• Anal fissure from hard stool/constipation
• Milk protein allergy (blood + mucus; may have eczema/irritability)

Important

• Infectious colitis (diarrhea, fever)
• Intussusception (episodic pain, pallor; sometimes blood/mucus)

Toddlers & preschool (1–4 years)

Common

• Constipation → fissure
• Infectious diarrhea

Important

• Polyps (often painless bleeding)
• Intussusception
• Meckel’s diverticulum (painless significant bleeding)

School-age (5–12 years)

Common

• Constipation with fissure
• Infectious colitis

Important

• Polyps
• IBD, especially with weight loss, poor growth, chronic diarrhea, nocturnal stooling, fatigue/anemia, perianal symptoms

Teens (13+ years)

Common

• Constipation/fissure
• Infectious colitis

Important

• IBD
• Hemorrhoids (especially with straining; less common than fissures)
• In sexually active adolescents: proctitis/infections may be relevant and should be assessed privately and respectfully

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

✅ Do this now (if NO red flags and bleeding is small): Focus on stool softness and comfort, and document what you see.

What to do in the first 24–48 hours (safe, practical steps)

• Check whether stools are hard, large, painful, and whether your child is withholding
• Increase water intake
• Increase fiber gradually (fruit/vegetables/whole grains)
• Start a calm toileting routine after meals with feet supported
• If your child has constipation: talk to your clinician about a stool-softening plan (often needed)

What usually makes it worse

• Ongoing hard stools/straining
• Stopping constipation treatment too soon
• Ignoring diarrhea + blood + fever/dehydration

⛔ What NOT to do (common mistakes)

• Do not assume repeated bleeding is “fine” without a plan
• Do not stop constipation care as soon as things improve
• Do not delay urgent evaluation if bleeding is large or your child is unwell
• Do not give “anti-diarrhea” medications without clinician guidance when blood is present

🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• Collapse, severe weakness, hard to wake
• Severe breathing difficulty

Example: “My child looks extremely pale and is fainting.”

🟠 Same-day urgent visit / Emergency Department

• Large bleeding, clots, continuous bleeding
• Black, tarry stool
• Bloody diarrhea with dehydration
• Severe belly pain, belly swelling, or persistent vomiting
• Fever with very unwell appearance
• Baby < 3 months with significant bleeding or poor feeding
• Suspected foreign body/caustic ingestion/trauma

Example: “There’s a lot of blood in the toilet and my child looks weak.”

🟡 Book a routine appointment soon

• Small bleeding that repeats
• Blood mixed within stool (not just on paper)
• Ongoing constipation, pain, withholding, or soiling
• Any growth concerns, weight loss, fatigue, chronic diarrhea
• Family history of IBD or celiac disease

Example: “We see blood weekly and stools are often hard and painful.”

🟢 Watch at home (briefly) if reassuring

• A small streak of bright red blood on paper with a hard painful stool
• Child otherwise well, no fever, no belly pain, no diarrhea
• Plan is in place to soften stools and reduce straining

Example: “One painful hard stool with a small streak of blood—now improving.”

🩺 How doctors diagnose it (what to expect)

What the clinician will ask

• Amount of blood (streaks vs spoonfuls/clots)
• Color (bright red vs dark red vs black)
• Where it appears (paper/on stool/mixed in stool)
• Stool pattern (hard vs diarrhea)
• Pain with stooling or withholding behaviors
• Fever, vomiting, belly pain, weight loss, fatigue
• Travel, sick contacts, new foods
• Medications (antibiotics, ibuprofen/NSAIDs, iron)
• Family history (IBD, polyps syndromes, celiac)

Physical exam basics

• Growth check and hydration
• Belly exam
• Anal exam for fissure (when appropriate)
• Skin/mouth signs that can suggest systemic inflammation (in selected cases)

Possible tests (and why)

• Stool tests if infectious diarrhea is suspected
• Blood tests if anemia, inflammation, or systemic illness is a concern
• Imaging if intussusception is suspected
• Endoscopy/colonoscopy if polyps, IBD, or unexplained bleeding is suspected

What tests are usually not needed

• Extensive testing after a single obvious fissure episode that resolves with stool-softening and no red flags

What results might mean (simple interpretation)

• Fissure: treat constipation/strain, bleeding resolves
• Infection: supportive care or targeted treatment depending on cause
• Polyps: may require removal during colonoscopy
• IBD: needs specialist care and long-term plan

🧰 Treatment options

First-line treatment (common scenarios)

• Fissure/constipation-related bleeding: stool-softening plan + routine + time
• Infectious diarrhea: hydration first; specific treatment only when indicated
• Polyps/IBD suspicion: specialist evaluation

If not improving (next steps)

• Reassess constipation plan intensity and duration
• Evaluate for infection, polyps, or IBD depending on pattern
• Consider referral to pediatric gastroenterology

Severe cases (hospital care)

• Large bleeding, dehydration, severe pain, systemic illness, or concerning infant symptoms

⏳ Expected course & prognosis

Typical timeline

• Fissure bleeding often improves quickly once stools become soft
• Infectious colitis usually improves in days but needs monitoring
• Polyps and IBD require targeted evaluation; many children do very well once diagnosed and treated

What “getting better” looks like

• Less pain with stooling
• Soft stools
• No further blood
• Normal energy and appetite

What “getting worse” looks like

• Increasing blood amount
• New fever, worsening belly pain, vomiting
• Child becomes pale, weak, dizzy
• Ongoing diarrhea and dehydration
• Weight loss or fatigue

Return to school/daycare/sports guidance

• Usually fine if child is well and hydrated
• Keep bathroom access easy
• Ensure hydration during diarrhea illnesses

⚠️ Complications (brief but clear)

Common complications

• Ongoing fissure pain → more withholding → worse constipation cycle
• Anemia if bleeding is persistent or significant
• Dehydration if bleeding is part of severe diarrhea illness

Rare serious complications (red-flag reminder)

• Significant GI bleeding
• Intussusception complications
• Severe inflammatory disease complications

🛡️ Prevention and reducing future episodes

• Prevent constipation relapse (fluids, fiber gradually, toilet routine, treat long enough)
• Hand hygiene to reduce infectious diarrhea
• Seek early evaluation for repeated mixed-in-stool bleeding or systemic symptoms

🌟 Special situations

Infants (especially < 3 months)

• Lower threshold for assessment
• Fever, lethargy, poor feeding, vomiting, or significant bleeding needs urgent review

Teens

• Offer private time with clinician when appropriate
• Respectful assessment for possible proctitis/infections if relevant

Kids with chronic conditions or immunosuppression

• Lower threshold for evaluation of blood in stool (infection and inflammation risk may be higher)

Neurodevelopmental differences/autism

• Constipation may be more common and harder to recognize
• Use visual stool charts and predictable toileting routines

Travel considerations

• Watch for infectious diarrhea risks
• Seek care promptly for bloody diarrhea with dehydration

School/daycare notes

• Ensure bathroom access
• Encourage hydration
• Notify parents if repeated diarrhea/bleeding occurs

📅 Follow-up plan

When to follow up and with whom

• Family doctor/clinic for most first episodes (especially constipation-related)
• Pediatric gastroenterology if recurrent bleeding, mixed blood, suspected polyps/IBD, or growth concerns

What would trigger earlier follow-up

• Repeated bleeding
• Blood mixed in stool
• New fever, belly pain, vomiting
• Weight loss, fatigue, poor growth
• Pale appearance or dizziness

What to bring to the appointment

• Symptom notes (amount/color/pattern)
• Stool diary (hard vs diarrhea)
• Medication list
• Photo of stool if possible (awkward—but extremely helpful)

❓ Parent FAQs

“Is it contagious?”

Sometimes. If bleeding is from infectious diarrhea, the illness can be contagious. Fissures and constipation are not contagious.

“Can my child eat ___?”

Usually yes. If constipation is involved, focus on fluids and fiber gradually. During bloody diarrhea, prioritize hydration and gentle foods.

“Can they bathe/swim/exercise?”

Yes if your child is otherwise well and hydrated. Avoid strenuous activity if dizzy, weak, or dehydrated.

“Will they outgrow it?”

Constipation-related fissures often improve with a consistent plan. Other causes depend on diagnosis (polyps can be treated; IBD requires long-term care).

“When can we stop treatment?”

For constipation-related bleeding: once stools are soft and painless consistently—and your clinician helps you taper slowly so it doesn’t relapse.

🧾 Printable tools

🧾 Printable: One-Page Action Plan (Blood in Stool)

Step 1: Check danger signs

• Large bleeding, clots, continuous bleeding
• Black, tarry stool
• Pale/weak/dizzy/fainting/very sleepy
• Severe belly pain or swelling, persistent vomiting
• Fever and very unwell child
• Bloody diarrhea with dehydration
• Baby < 3 months with significant bleeding or poor feeding
• Foreign body/caustic ingestion/trauma suspected

➡️ If any checked: urgent care now.

Step 2: If small bleeding and child is well

• Note the color and amount
• Check stool: hard vs diarrhea
• Start constipation support if hard/painful stool
• Book clinic visit if it repeats

🧾 Printable: Symptom Diary / Tracker

Date: _______

• Amount: streaks / drops / spoonfuls / clots
• Color: bright red / dark red / maroon / black-tarry
• Location: on paper / on stool / mixed in stool
• Stool type: hard / normal / diarrhea
• Pain with stooling: yes / no
• Fever: yes / no Temp: _____
• Belly pain: none / mild / severe
• Vomiting: yes / no
• Energy: normal / tired / very sleepy
• Notes (travel, sick contacts, meds): ____________________________

🧾 Printable: “Red flags” fridge sheet

⚠️ Urgent care if: large bleeding/clots, black tarry stool, pale/weak/dizzy, severe belly pain or swelling, persistent vomiting, bloody diarrhea with dehydration, baby < 3 months with significant bleeding/poor feeding, or suspected ingestion/trauma.

🧾 Printable: School/Daycare Instructions Page

Blood in stool support

• Ensure easy bathroom access
• Encourage water intake
• Notify parents for repeated diarrhea/bleeding or belly pain
• If child becomes pale, dizzy, very sleepy, or has severe pain: urgent medical assessment

🧡 Safety disclaimer

This guide supports—not replaces—medical advice. 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

Free Printable for Parents

Get our pediatrician-approved Constipation Action Plan (PDF) by email.