Red Stools in Children: Common Causes

By: Rian C. Calo, DO, FAAP & Patrick T. Reeves, MD, FAAP

Children can sometimes have different colored stools (poops). The most common, normal color of stool is brown, tan, yellow or green.

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Red poops can be caused by many different things, including a variety of foods, medicine or other factors. Less commonly, children can have red or dark-colored poop that is caused by bleeding or diseases of the digestive tract or gut.

But it is important to note: the most common reasons for children to have red poops are notbecause of blood.

Causes of red stools that are not blood

Foods

Even when it’s caused by something they ate or drank, seeing red- or purple-tinged poop in your child’s diaper or toilet can be unsettling since it can look like blood. The passage of poop through the gut can be very fast in infants or young children. So, their poop can come out the same color of the food or fluid that they have eaten (such as bright red after watermelon).

Food coloring that is added to many drinks, breakfast cereals, gelatin desserts—or from the coloring of different foods like tomato skins, beets, red peppers, rhubarb, paprika or peach skins—can all cause poop to take on a red color. In addition, foods like spinach, licorice, chocolate sandwich cookies such as Oreos, dark chocolate, dark purple grapes, dark juices, blueberries or cranberries can also cause black poop.

Medicine

Many medications can cause poop to be red or dark-reddish or black in color.

• Bismuth. Common over-the-counter medications with brand names including Pepto-Bismol, Maalox and Kaopectate contain a medicine called bismuth. Bismuth can color the stools black or dark red.

• Iron supplements or medications that contain bright red dyes (such as cherry syrup flavored antibiotics or laxatives) can cause dark or red tints to the poop.

• Certain antibiotics such as rifampin can cause orange/red discoloration of both urine and the stools in children.

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  Many other medications can cause orange/red or pink/red colorations of stools, too, including phenothiazines, rifabutin, senna or tetracyclines.

If you notice a change in the color of your child’s poops, review this list and ask your child’s doctor about it.

When there is blood in the stool

Swallowed blood during birth or breastfeeding

Sometimes there is blood in the poop, but not from bleeding in the child’s digestive tract. Babies can develop red poops after swallowing the birth parent’s blood during delivery, for example, or blood from a cracked, bleeding nipple during breastfeeding.

Swallowed blood from nosebleeds or other sources

Swallowed blood can also be from recent procedures, such as if your child had a tonsillectomy, or even from a recent nosebleed.

Sometimes bleeding in the urine can also be confused with blood in the stool, especially in young girls. Female infants can also pass blood into their diaper from the vagina due to a “mini-period” (false menses) that can occur after delivery. This is common and nothing to be alarmed about. It simply suggests the child has a healthy uterus.

Blood from diaper rash or anal fissures

Oftentimes, infants can have blood in their diaper around the anus because of diaper rash. In older children, especially during toilet training, children can have small skin tears around the anus from constipation called anal fissures.

For either diaper rash or anal fissures, use a zinc oxide topical treatment with every diaper change to help prevent further irritation to the skin.

Blood from infection or bleeding in the gut

Rarely, the red or dark poop is caused by an infectious disease or bleeding from the digestive tract.

Infections from travel, food or other people can sometimes cause bleeding. Food allergies, autoimmune diseases, or other problems of the digestive tract can also lead to blood in the stool. If you are concerned that your child has blood in the poop, don’t hesitate to talk with your child’s primary care physician.

What you can do at home

Stop foods or drinks that you think could be causing the red or dark poops. This should clear up the red and/or dark color from the poops in about 48 hours.

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Take a picture of unusual stools so that if they continue you can show your doctor. Try to confirm that the red substance (blood) is coming from the poop by using the towel method described above. If these red poops continue for more than 2 weeks, then please seek medical attention from your child’s primary care provider.

When to see your doctor

If your child is having red stools and a fever, bring them to see your doctor or go to the emergency room if they are acting sick or becoming worse. You should also see your doctor if you see that the red poops are continuing, even after stopping the suspected foods for more than 48 hours.

Tests & procedures to check for blood in stools

There are different tests that your doctor can order to determine if it is really blood in the poop.

A stool guaiac test is a simple test that your doctor can order determine whether the red substance in the poop is blood. A sample of the poop can also be sent off to test for things like infection or inflammation.

Your child’s doctor may consider other options to help determine the cause of red poops. These may include imaging with radiology, blood tests or a specialty referral to a pediatric gastroenterologist.

Sometimes a special procedure called a colonoscopy or endoscopy can be performed by a pediatric gastroenterologist. These allow the doctor to look directly into your child’s digestive tract and help identify causes of blood in the stool. Visit the “CartoonGI” website created by pediatric gastroenterologist Diana Lerner, MD, FAAP, to learn more about these procedures.

More information

• The Many Colors of Baby Poop

• Constipation in Children

• Baby’s First Days: Bowel Movements & Urination

• Poop: What’s Normal & When to Worry (HealthyChildren Podcast)

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