BMJ  2008;336:1010-1015 (3 May), doi:10.1136/bmj.39542.440417.BE

Clinical Review

Management of bloody diarrhoea in children in primary care

¹ Division of Reproductive and Child Health, Medical School, University of Birmingham, Birmingham B15 2TT, ² Birmingham Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH

The first 150 words of the full text of this article appear below.

Bloody diarrhoea is an uncommon symptom in children, and it may indicate the presence of serious disease. This review focuses on children presenting in a primary care setting. The non-specialist should be aware of the likely causes, initial management, and indications for specialist referral. The emphasis is on children in the developed world, although traveller’s diarrhoea is also considered. The epidemiology and management of this condition are different in the developing world, where infectious causes predominate. In recent years the reported incidence of inflammatory bowel disease increased greatly in the developed world and important advances have been made in its management. This diagnosis should always be considered carefully.

Sources and selection criteria I used the Medline database to search for evidence from the literature. Randomised controlled trials, meta-analyses, and Cochrane reviews were used when relevant and available. Other sources of evidence included large case series and cohort studies. I obtained information on the incidence . . . [Full text of this article]

What are the most likely causes of bloody diarrhoea in children?

Causes of bloody diarrhoea (real or apparent) in infants and children
Infants aged <1 year
Common causes
Less common or rare causes
Infants aged >1 year
Common causes
Less common or rare causes

How common is infection compared with inflammatory bowel disease?

Summary points

How should I investigate and manage bloody diarrhoea in primary care?

How should I investigate and manage intestinal infections?

When should I suspect inflammatory bowel disease?

Unanswered questions

How should I screen for inflammatory bowel disease?

How can I recognise and manage severe colitis?

Which diagnoses are most likely in infants?

Infant colitis
Necrotising enterocolitis
Hirschsprung’s disease
Tips for non-specialists

What other disorders should I consider?

Intestinal infarction—a surgical emergency
Additional educational resources
Resources for healthcare professionals
Resources for parents
Henoch-Schönlein purpura

Is it really bloody diarrhoea?

Juvenile polyps
Mucosal prolapse syndrome and solitary rectal ulcer syndrome
Factitious illness and illness induction

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