I don't really have a protocol for this but can review what I do.

I confirm its blood with a hemocult test
Take a good feeding history, has the baby had anything else?
I think I remember one breastfeeder with blood in the stool who never had abm.
Check a CBC with diff looking for elevated white count as infection maker, hemoglobin to check for anemia , eosinophils as allergy marker.
Stool culture to rule out infection. 
Discuss with mom a trail of eliminating cows milk and possibly cows milk protein from her from her diet.
Often the baby is getting supplement and just stopping the supplement stops the bleeding w/out mom changing her diet.

If none of this works I refer the baby for colonoscopy to look for pathology changes of allergy or in rare cases a lymphoid hyperplasia that bleeds but self resolves.

Rob





Robert Cordes, D.O.
general pediatrician
Wilkes Barre, PA
mailto:[log in to unmask]

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