ABSTRACT
Gastrointestinal haemorrhage is always a worrying symptom, but the commonest presentation in childhood is rectal bleeding due to an anal fissure, which is benign and easily treated. However, less common and more serious causes should be excluded, e.g. intussusception, necrotizing enterocolitis, inflammatory bowel disease. Bleeding may arise from a localized lesion any where along the GI tract or it may occur as part of a generalized bleeding disorder (e.g. haemorrhagic disease of the newborn, thrombocytopenia). Occasionally the bleeding is artefactual, e.g. Münchausen syndrome by proxy, swallowed maternal blood from cracked nipples. Common causes of blood-streaked vomitus include swallowed blood or a Mallory-Weiss tear. More significant haematemesis or melaena in childhood is uncommon.
