Upper Gastrointestinal Bleeding in Children: What to do

Upper gastrointestinal bleeding (UGIB) is bleeding that occurs in your child’s upper gastrointestinal tract. The bleeding occurs in the esophagus, stomach or duodenum (first part of the small intestine). If you suspect your child may have UGIB, consult a physician immediately.

Some of the causes of UGIB in children are as follows:

• Stress ulcers or gastritis as a result of the child suffering from a severe illness. When a child’s body is put under stress due to illness, it releases an acid that can lead to bleeding in the stomach. Stress ulcers as the cause for UGIB is common among children in the Neonatal Intensive Care Unit (NICU) or the Pediatric Care Unit (PICU)  
• Peptic ulcer, especially in older children. Symptoms of peptic ulcer include abdominal pain and vomiting up blood
• Multiple episodes of severe vomiting which can cause a tear or an inflammation in the esophagus
• Food allergies – it is important to check your family history for any cases of allergies
• Hemorrhagic diseases
• Liver dysfunction and variceal bleeding
• Vitamin K deficiency – this is no longer one of the most common causes of UGIB due to vitamin injections every newborn must receive
• Vascular malformation

Let it be noted, that sometimes it may appear as though a child has UGIB, but other factors are at play. For example, a child may swallow some of their mother’s blood during breastfeeding, causing the child to have a bloody mouth. Mothers will often be alarmed, thinking the blood is coming from the child. The mother should check if her nipples are cracked and/ or bleeding before rushing to the hospital.   

One obvious symptom of gastrointestinal bleeding is vomiting blood. Other symptoms may include fatigue, pale skin, shortness of breath, and abdominal pain that is more painful than usual. Some children may show no signs of UGIB. In severe cases, one of the signs of UGIB is black stool. UGIB can be detected through a blood test showing whether or not someone has a low level of hemoconcentration.  If left untreated, gastrointestinal bleeding can be fatal, so detecting it as early as possible is of utmost importance.

Take your child to the doctor immediately if they are vomiting blood or black material that looks like coffee grounds, or if they have black and tarry or maroon stools. Early detection is key; the sooner gastrointestinal bleeding is diagnosed or ruled out, the sooner your child’s condition can improve rapidly, allowing for a happy, healthy life.

Most commonly, a physical exam will be performed.  In some cases, the doctor may perform a gastroscopy in which a small tube inserted through the mouth to determine the source of the bleeding and evaluate its severity. An abdominal and rectal examination may also be performed to determine the cause of the bleeding. Other tests are carried out to determine the complete blood count, the patient’s liver function, and the blood’s ability to clot (coagulation test).

Treatments depends on the condition your child has, and how much bleeding has taken place. The following are types of treatments which your child’s doctor may perform:

• Administering medicine to reduce stomach acid in the cases of peptic ulcers or stress ulcers
• Removing certain foods from your child if he or she has food allergies
• Therapeutic endoscope to stop the bleeding in more severe cases
• Vitamin injections
• Direct treatment of the wounds inside the child’s stomach

Resource:

1. Pediatrics Clerkship: upper GI bleeding. Available from https://pedclerk.bsd.uchicago.edu/page/upper-gi-bleeding. Accessed on October 27, 2015.
2. Medscape: upper gastrointestinal bleeding. Available from http://emedicine.medscape.com/article/187857-overview. Accessed on October 27, 2015.

Photo Credit: arielfs via Compfight cc