Pediatric gastrointestinal (GI) bleeding ranges from mild and self-limited cases to severe episodes of hemorrhagic shock. A structured, age-specific approach is essential for the correct diagnostic workup and effective management. Collaboration with a multidisciplinary team, including pediatric surgery and gastroenterology specialists, may be necessary. The goal of managing pediatric patients with GI bleeding in the emergency department is to identify and treat severe cases, while avoiding unnecessary workup and admission for patients with mild or self-resolving cases.
Our recent issue Pediatric Gastrointestinal Bleeding: Identification and Management in the Emergency Department provides a comprehensive review of the definitions, causes, and management strategies for upper and lower GI bleeding in children.
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Here are a few key points:
- Pediatric patients with gastrointestinal (GI) bleeding may appear well initially, but can decompensate rapidly. Remember to keep the differential diagnosis broad.
- Evaluating GI bleeding involves assessing onset, duration, past episodes, and bleeding characteristics such as color and type of vomit or stool to pinpoint the source and severity. (See Table 2.)
- Prehospital teams should evaluate the receiving hospital’s resources, especially its pediatric GI services and endoscopic capabilities.
- For serious GI emergencies, it is advisable to coordinate early with pediatric subspecialties, including critical transport teams, pediatric gastroenterologists, and pediatric surgeons, to ensure the highest level of care.
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