My baby is thriving but has blood in their poo – should I be worried?

The answer is always check with your GP, but it depends on whether your baby is otherwise thriving!

Proctocolitis means inflammation of the rectum and colon, which can show itself as blood or mucus in the baby’s stool. If is found in well breastfed infants and usually resolves on its own within a few months, without causing harm to the baby. It is not always due to food allergy.

It is not unreasonable to tolerate some blood in stool in happy babies and mum doesn’t always have to exclude foods from their diet. In these babies, there is no strong evidence that the maternal diet is the cause of blood in stool or that eliminating certain foods will help.

Therefore, if your breastfed baby is well but has a little blood or mucus in their stool, after evaluation by your GP for other causes, it can be considered safe to ignore it, as it will likely resolve on its own. This is also important as there is evidence that excluding foods from a baby’s diet can increase the risk of food allergy.

What other causes of blood in my baby’s stool will my GP check for?

Here are some important causes:

1. Cows Milk Protein Allergy: This is a condition where the baby’s immune system reacts to certain proteins in the mother’s milk (less common) or formula(more common). It can cause troubling symptoms compared with benign proctocolitis, including bloody stools with other symptoms such as eczema, weight loss and being extremely unsettled. There is no test for this condition: instead the diagnosis is made when the baby’s symptoms improve after a trial of specialised formula for a few weeks and worsen on reintroduction of formula. Similarly in breast fed babies, maternal dairy exclusion and reintroduction may be tried.
2. Infection: In some cases, blood or mucus in the stool can be a sign of an infection, such as a gastrointestinal infection. If your baby is unwell it is important to seek medical attention.
3. Intestinal obstruction: Although rare, an intestinal obstruction can also show itself with blood in the stool. If your baby has signs of abdominal pain, vomiting, or a distended abdomen, seek immediate medical attention.
4. Anal fissures: These are small tears or cracks in the lining of the anus and can cause blood in the stool. Anal fissures can be seen in infants and can be related to passing hard stools or straining during bowel movements.
5. Disorders of Bleeding: This is rare. Your GP will ask if your baby had vitamin K after birth as babies who haven’t are at slightly increased risk of severe bleeding due to vitamin K deficiency. They will also ask about a bleeding disorders in the family such as haemophilia and whether there is bleeding in other sites such as the umbilical cord.