Persistent blood in nappies - so far unexplained. Any ideas?

[Flora1985]

Hi everyone,

I'm wondering whether anyone else has any experience of persistent blood in their baby's poo, and what turned out to be the cause in your situation? Our DD is 4 months old and has had small amounts of bright red or pinkish blood in her poo on and off for around six weeks now. Generally without mucus. She's EBF. We have of course been to our GP about it several times, and we've seen a pediatrician at A&E, so I don't think it's an urgent/emergency issue, for now anyway; just wondering whether anyone else has experienced blood in nappies that's gone on for so long and is (so far) unexplained?

Our GP and the A&E paed both thought it unlikely to be a cow's milk protein allergy since we have no history of allergies on either side of the family and DD has no other signs of allergies (eczema, for example); after running some tests and stool samples they concluded it was most likely to be a small tear/graze near the anus that would heal within a week or two following liberal application of nappy cream (which we have been doing). But that was six weeks ago and it's still happening once or twice a week, so I'm fairly sure now it can't be a tear/graze...

We're going to make another appointment to see our GP (if we can even get an appointment, that is; it's madness out there...) and we might try to see a private paed in the new year, but so far they don't seem to know what's causing it and the A&E paed we saw didn't seem overly concerned. Has anyone else experienced anything similar with their DCs? What turned out to be the cause for you?

I should say that other than blood in her poo from time to time DD seems her usual happy and alert self - it doesn't seem to be troubling her at all, from what we and the GP & paed can see.

Thank you in advance for any experiences shared...

Does she strain when she poops? Maybe piles from straining - not even sure if babies can get piles

Thanks for the reply @Kona84. She does strain sometimes, but not all the time; and even when she strains her poos are very runny (the standard EBF poo really - korma yellow, seedy and loose) and regular, so I guess I find it hard to imagine she's constipated in any way

I had something similar with my DS, only about 4-5 separate times, like little streaks - same as you no one was concerned.

The only correlation I made was when I’d had coffee, strangely enough.

I honestly wouldn’t rule out CMPA or some kind of allergy just because you or your partner don’t have allergies. Have you tried cutting out dairy for 2 weeks? From what I know CMPA is much more common in formula fed babies because of the much greater amount of CMP in the milk but of course if t’ouvre ingesting it then some will go into your milk and even though it’s minor it may still be enough to cause this. I’d probably try the elimination diet of no dairy, eggs or soy for 2 weeks and then slowly introduce one by one. I know it’s not much fun especially at this time of year… I was in the same boat last year

Also, babies when they are so little (pre weaning) have really soft stools, especially when ebf) so I can’t imagine what would cause a tear. She’s not suffering from any constipation right?

Conversely, if she’s ebf then her stools might be very runny as the milk passes through them so quickly and I know that that can sometimes cause mucus in nappies, possibly a bit of blood too? I’m not sure about that?

Unfortunately because it’s fresh blood they’re probably not overly concerned but I, like you, would definitely want to get to the bottom of it considering the length of time it’s gone on for.

Best of luck and hope you find the right answers soon x

I agree with the above poster - I’d want to trial dairy free for a while to actually rule it out as a cause, rather than just thinking it’s unlikely. There’s a good Facebook group for breastfeeding with cmpa if you need support

Thanks @CelloYouveGotABass, glad to hear it didn't persist too long for your DS. I have one decaf coffee every morning so doubt it's this but may just cut it out anyway to see if anything changes.

Thanks @Latinorapida, so useful to hear how it played out for you. Hope your DC is all better now? I did start cutting out dairy just to be on the safe side but the A&E pediatrician actually suggested I didn't, as he was so sure it wasn't an allergy...but I might just cut it out again and see what happens perhaps. She's definitely not constipated (ebf, usually pretty wet poos) but I think I probably have quite a fast letdown and perhaps a bit of an oversupply so I sometimes wonder if it's that, and sheer volume of milk passing through her system, as you say. Not sure how to fix that one though!

Most doctors are a bit crap about CMPA. My son was ebf and reacted through breast milk - try dairy free for six weeks and see if it gets better (it takes that long to get out of both of your systems). Mine is also allergic to soya, so I cut that out too after going dairy free, and the different was astounding. Also recommend the Dilan and Me fb group / website mentioned above

Yes my little one is all good now - despite the daily tantrums . If oversupply were an issue you’d likely be noticing Green stools or frothy stools. Have you ever noticed anything like that?

I don’t think an oversupply/strong let down would cause her to poo all the time. Formula fed babies (volume wise) receive much larger quantities of milk but it is common for them to go once a day or every other day. Because your breast milk is perfectly tailored to your baby it is very easily digestible and as a result some ebf babies produce 5 plus runny stools a day x

Hi all, bit of an update here: I've now been cutting out the 14 main allergens (including dairy, wheat, soy, fish, nuts, eggs) for nearly six weeks, and if anything the blood in DD's poo has become more frequent, not less... So I'm 99% sure it's not being caused by allergies - though we are now seeing an NHS consultant and dietician, so we'll rule out allergies as the cause with them (they agree it's very unlikely given there's been no improvement with such a restricted diet).

So, I'm wondering whether anyone else on here has been through a similar experience, and what it turned out to be that caused their DCs' gastro issues (if it wasn't allergies)?

Thanks so much in advance for any experiences that could be shared! Just feeling so helpless and upset that DD is going through this and I feel powerless to help her (obvs we're in the NHS route and our paeds gastro consultant is running tests etc, but it's all taking such a long time and in the meantime my heart just breaks a bit more every time I change her nappy and see blood :-()

Hi,

My daughter is 16 months old now but when she was 5 months old she had this happen but she had so much blood it actually leaked through her clothes :( she was pooing around 10 times a day and every one had lots of blood in. Was admitted to hospital twice. Couldn’t find any bacteria in her samples or bloods and just ended up putting it down to a virus. Couldn’t give any antibiotics though as didn’t know what to treat for with it showing nothing. Lasted 6 weeks, was really frightening so I understand your concerns. It hasn’t happened again since luckily. Hope you get some answers.

Thanks so much for sharing @leadust92. I'm so sorry you and your daughter had to go through that, sounds awful :-( Very glad to hear she's all better now!

Thanks for sharing your story though, it's really interesting to hear that it was just put down to a virus...one of the stool samples we had done back in November indicated DD had a virus but then a different stool sample at A&E in early December came back clear, so we thought she'd cleared it...but the blood has just got more frequent since then, so maybe it's lingered or affected her gut in some longer-term way.

Argh, so horrible not knowing what's causing it. Thanks for sharing and yes, I really hope we get some answers soon, it's driving me crazy not knowing how I can help DD :-(

@Flora1985 have you heard any more on this?
I’m experiencing very similar with my son.
Nearly 5 weeks of streaky and spotting blood in 50% of hits stools. 3 months old, cut out dairy but not much improvement. Trying to get referred to paediatricians now.

Hi op
Bit late to the thread but just to say my ds had the same with no obvious cause. I also cut out every allergen known to man and eventually say a paed gastro at around 5 months. He said it was deeply unlikely to have been an allergy as such tiny amounts ever get into breast milk (also ebf). They ran allergy tests and all were negative. It never got any worse but then cleared up at around 7 months so 🤷‍♀️

Ds is fine now no ongoing issues and he’s in school so guess it was just one of those things!

Hope you get it sorted or it stops soon xx

This isn't normal and should be investigated, glad you are seeing a paediatric gastroenterologist. With no improvement after a trial exclusion of common allergens, first thought that comes to my mind is meckel's diverticulum. I think the gastroenterologist is very likely to have thought of this also and will order investigations in due course (not urgent if your baby is generally well). Blood in stools may be the only symptom and many people live with Meckel's diverticulum for several decades or even a lifetime with no significant issues. Great Ormond Street Hospital (GOSH) have produced some good info for parents that you can find online. Hope this helps, it obviously isn't "official" medical advice when given anonymously via an internet forum!

Just to add to what I've mentioned above re meckel's diverticulum, sometimes if investigations have been done that prove that despite the symptom / problem, a child is well, safe and developing normally then it is okay to wait and observe. And perhaps though meckel's diverticulum seems a strong possibility and there are special tests that can be done to look for it, doing those tests might not be the best approach right away. Exhaustive investigations to find out "why" might do more harm than good for the present. This is a decision you have to reach with the specialist actually seeing your child. Important to feel you have had a full discussion with the specialist and that your questions have been answered. Good luck.

Has she been tested for celiac disease? Try cutting out gluten from your diet for a few weeks and see if the problem resolves

Don’t rely too much on GPs NHS is on its knees and was rubbish at spotting food intolerances in the best of times.

CMPA. Push for a trial 9f prescription formula. I think GPs are on targets now to minimise cmpa diagnosises like they were for cesarean #moneyoveradequatehealthcare

Cesareans*

Mixed fed DD had terrible problems with wind, colic and constipation. HV, GP and consultant paediatrician said it was nothing to do with cows milk. She is 7 years old now and still gets constipated if she has more than a tiny amount of milk. I really wish I’d ignored Drs and cut milk out when she was tiny.

Thanks all for your replies. We've seen several paeds gastroenterologists now and their thoughts on what might be causing it have been mixed; the consensus is still allergies - despite me now having cut out gluten, dairy, soy, fish, nuts, etc for over 11 weeks now with no improvement (it's got worse, if anything) - though Meckel's Diverticulum has been mentioned as a possibility @KidsDr. We're currently waiting for a follow-up from one doctor to another (have to wait for one's secretary to type up a letter to the other's secretary before any sensible next steps can happen - it's c21 ffs ) but one of the doc's we're seeing seems really good and has given me his email address for follow-up so at least he seems genuinely committed to helping work out what's causing this. Meanwhile the blood has got more frequent (nearly every day now) despite me barely eating anything at all (chicken and veg is pretty much all I can eat now I've cut out most food groups!), but reassuringly all the doctors think DD is thriving (her weight gain etc. is on track and she's always seemed well and happy in herself despite the blood) and don't seem to be too concerned, therefore; they've all seen photos of the bloody nappies and none have seemed particularly worried, so I'm taking that as reassuring (whilst obviously still pursuing it with the specialists). As @KidsDr suggested they might, the docs have indicated that invasive testing (such as endoscopy) to work out the cause may do more harm than good, since DD seems to be well and happy aside from this issue, so for now we're not taking that forward...that would of course change though if DD shows any signs of pain or her weight starts to drop off, etc.

@Paydle123, really sorry to hear your son is going through similar; really hope you can get referred to a good paed asap. Let me know how you get on?

@babypeach v glad to hear your DS is fine now. Did the blood in stools continue for the whole 7 months, fairly regularly (a couple of times a week or so)?

We had this. My DD had cmpa and she'd been very unhappy but DS was happy but had blood in the nappy. I had to go on a total exclusion diet to get to baseline nappies then intro foods one at a time. In the end he was allergic to lots of the top 14 but also some others that I wouldn't have suspected. Once they were cut out the blood stopped.

My son had the same but also a miserable baby, colicky, breastfed. Looking back we suspected dairy and/or wheat.... Totally fine now by the way and no food issues

Flora I was down to chicken, veg, olive oil and oats too at one point! I had started trying to remove irritants to help with his bad silent reflux and then the blood started too so I kept going!

For my ds it was about once/twice a week sometimes more. The odd thing was that once I started to re-introduce foods to my diet on the paed advice, it didn’t get any worse and within a few weeks had almost stopped. And completely went away as solids were introduced (all usual food groups given) so yes by the 7 month mark.

So for us I can only assume paed was right it wasn’t an allergy. Through all of this he was happy and weight ok (although he had dropped centile around 3 month mark)

Glad they are continuing to investigate for you and hope you get answers xx

I've had two bf babies with CMPA and they never had that symptom. In fact I've never heard of it - is it common?

When I cut out dairy the effect was instant on DD - literally within a week. If I were you (assuming the consultant hasn't advised otherwise) I'd reintroduce all those foods now as you've given it a good test and it's not working. You need to look after yourself too

I hope you get some answers soon, or better still it stops happening!

I just wanted to update on here for anyone reading this in the future and worrying about their babies. Obviously everyone's situation will be different, but in our case the blood in DD's poo stopped literally overnight as soon as we started introducing solids at 6.5 months. She's now nearly 10 months and we've not had any blood in her stools at all since she started eating (even very small amounts of) solid food. She's also had a skin prick test to check for allergies and it came back negative on everything, including dairy, so we're fairly sure now it wasn't an allergy causing the blood in her poo. The docs don't really know what it was tbh but they say it might've been a reaction to so much breastmilk going through her gut and irritating the gut lining when she was EBF, and introducing solids (alongside breastmilk - I'm still breastfeeding her 6-8 times a day at 10 months even though she's eating three solid meals a day now. Hungry girl!) has balanced that out a bit to the extent the bleeding just resolved on its own. Anyway, I hope this is useful (and potentially reassuring, though every situation will be different) for anyone reading in future.