Blood in the Diaper

The 4 Most Common Causes of Blood in Diaper * Urinary crystals* Will be guaiac negative* Common in first few weeks of life* Vaginal bleeding* Common in newborn females as they withdraw from maternal estrogen* Maternal blood* Swallowed during birthing process* Breastfeeding with cracked/bleeding nipples* Anal fissures* Common and will improve on its own Basic Approach * Step 1: Check if guaiac positive* If negative, it’s not blood* Urinary crystals, food coloring, etc* Step 2: Consider vaginal bleeding* Step 3: Perform apt test* Diagnoses maternal blood* Step 4: Check for anal fissure* Self resolve* Step 5: Expand the differential diagnosis* Necrotizing enterocolitis* Intussusception* Cow’s milk allergy* Colitis* Red Food Dye Additional Reading * Neonate With Bloody Stool (Pediatric EM Morsels)