Causes of Gastrointestinal Bleeding in Children: A Parent's Guide

Causes of gastrointestinal bleeding in children?

Our second child, a boy in the fourth grade (height 126 cm, weight 26 kg), usually does not complain of stomach pain, has a good appetite, and eats plenty of fruits and vegetables.
However, he occasionally experiences constipation.
Last week, for reasons unknown, he suddenly started vomiting in the evening despite being in good spirits, having a good appetite, and looking healthy.
His face and lips turned pale, and we took him to the hospital where he received IV fluids.
The doctor examined him and conducted blood tests, stating that "the condition is okay, but there is malabsorption in the gastrointestinal tract and symptoms of anemia." After the IV treatment, he stopped vomiting, fasted for about a day, and gradually regained his strength, although his complexion was still slightly poor.
The next day, we noticed that his stool was completely black, resembling tar.
When we consulted the doctor, he said that as long as our child felt fine, we should monitor the next stool.
On the third day, the latter part of his stool was yellow-brown.
Now, over a week later, his stools have returned to normal, and aside from the antacid and iron supplements prescribed by the doctor, he has not taken any other medications.
We have been following the doctor's advice to maintain a normal diet and lifestyle.

I would like to ask why a child who previously had no gastric issues would suddenly experience gastrointestinal bleeding? Additionally, he no longer has stomach pain two days later, but this could lead to a prolonged recovery from anemia.
What are the possible causes of gastrointestinal bleeding? Could it be related to acute gastritis? What should we be cautious about moving forward? Is the likelihood of recurrence high? Despite consuming more fruits and vegetables than other children, why does he still occasionally experience constipation? Also, is there a connection between the frequency of nighttime teeth grinding and constipation in children? Thank you for your assistance, doctor.

Ai Yu, 40~49 year old female. Ask Date: 2000/11/17

Dr. Li Huixiong reply Internal Medicine

Could you please tell me what color your child's vomit was? Was there any coffee ground appearance? Did they consume pig's blood soup or duck blood cake previously? In theory, gastrointestinal bleeding can occur at any age, but it is uncertain whether your child is experiencing "gastric bleeding" since this has not been confirmed by endoscopy (although this is not necessarily required).
Additionally, have you sent a stool sample for testing to check for blood or occult blood? This could provide some insight into the possibility of gastrointestinal bleeding.
As for your child's condition, it is unlikely that anemia could develop in just two days.
It would be advisable to first check for more common types of anemia, such as G6PD deficiency, thalassemia, iron deficiency anemia, or pernicious anemia, before deciding on a treatment approach.
Regarding constipation and bruxism, the two are likely unrelated.

Reply Date: 2000/11/17

More Info

Gastrointestinal bleeding in children can be alarming for parents, especially when it occurs suddenly without any prior symptoms. In your case, your child experienced vomiting, pale skin, and subsequently passed black, tarry stools, which are indicative of upper gastrointestinal bleeding. The black color of the stools suggests that the blood has been digested, which typically occurs when there is bleeding from the stomach or the upper part of the small intestine.

Possible Causes of Gastrointestinal Bleeding
1. Infections: Gastroenteritis, often caused by viral or bacterial infections, can lead to inflammation of the stomach lining (acute gastritis) and result in bleeding.
2. Acute Gastritis: This condition can arise from various factors, including stress, certain medications (like NSAIDs), or dietary indiscretions. It can cause inflammation and bleeding in the stomach.

3. Peptic Ulcers: Although less common in children, ulcers can develop in the stomach or duodenum and lead to bleeding.

4. Vascular Abnormalities: Conditions like arteriovenous malformations or other congenital vascular issues can lead to gastrointestinal bleeding.

5. Food Allergies or Intolerances: In some cases, allergies to certain foods (like cow's milk protein) can cause gastrointestinal bleeding.

6. Constipation and Anal Fissures: Chronic constipation can lead to straining during bowel movements, resulting in anal fissures, which can cause bright red blood on the stool or toilet paper.

Relation to Acute Gastritis
Your child's sudden onset of symptoms could indeed be related to acute gastritis, especially if there was a recent change in diet, stress, or exposure to infections. The absence of pain after the initial episode may indicate that the acute phase has resolved, but it is crucial to monitor for any recurrence of symptoms.

Monitoring and Follow-Up
Given that your child’s stools have returned to normal and he is feeling better, it is essential to continue monitoring his condition. Here are some recommendations:
- Dietary Adjustments: Ensure a balanced diet rich in fiber to help with constipation. Encourage hydration and regular meals.

- Observation: Keep an eye on any changes in stool color or consistency, and watch for any signs of pain, vomiting, or fatigue.

- Follow-Up Visits: Regular check-ups with a pediatric gastroenterologist may be beneficial, especially if symptoms recur.

Recurrence Risk
The risk of recurrence depends on the underlying cause. If the bleeding was due to an acute, self-limiting condition like gastritis or a mild infection, the risk may be low. However, if there are underlying issues such as ulcers or vascular malformations, further evaluation may be necessary.

Constipation and Other Symptoms
Regarding your concerns about constipation and nighttime teeth grinding (bruxism), these can be related. Constipation can cause discomfort, leading to teeth grinding as a stress response. Additionally, dietary habits play a significant role in bowel regularity, and even with a good intake of fruits and vegetables, some children may still experience constipation due to other factors, such as fluid intake or activity levels.

Conclusion
In summary, gastrointestinal bleeding in children can arise from various causes, and while your child seems to be recovering well, it is essential to remain vigilant. Regular follow-ups with healthcare providers, maintaining a healthy diet, and monitoring for any new symptoms are crucial steps in ensuring your child's continued health. If any concerning symptoms arise, do not hesitate to seek medical attention promptly.

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