
It can be distressing for parents to see their newborn spit up blood. While it is natural to panic, there are several reasons why this may be happening and when to seek medical advice.
Characteristics | Values |
---|---|
Reasons for newborn to spit up blood | Ingesting maternal blood during birth, forceful spitting up, cracked nipples, trauma, irritation, clotting disorder, milk protein allergy |
Colour of blood-stained breast milk | Red, pink, orange, brown |
When to call a doctor | If the baby has a fever, swollen belly, lethargy, colic, constipation, abdominal distension, diarrhoea, seizures, fussiness, or is inconsolably upset |
What You'll Learn
Rusty pipe syndrome
If you see your newborn spitting up blood, it is understandable to feel scared and want to call a healthcare provider. However, in most cases, the blood is likely swallowed maternal blood, and this is sometimes called "rusty pipe syndrome". Rusty pipe syndrome refers to the presence of blood in colostrum and breast milk, which may appear reddish or brown. This occurs during late pregnancy and the first few days postpartum due to increased vascularity in the alveolar and ductal tissue, as well as the growth and development of blood vessels around the glandular tissue. While it may look alarming, rusty pipe syndrome is generally harmless and usually resolves within a few days as more milk flows through the breasts. It is important to distinguish this condition from other potential causes of bleeding, such as nipple sores or lesions, by seeking evaluation from a healthcare provider.
- Timing: It typically occurs during late pregnancy or immediately after birth, starting within the first few hours of birth.
- Appearance: The colostrum and breast milk may appear reddish, brown, or have a mild tinge of colour, resembling rusty water from old pipes.
- Occurrence: It usually occurs in both breasts but may also occur in only one. It is more common in first-time mothers, and some mothers experience it with each baby.
- Harmless: Rusty pipe syndrome is typically harmless to the mother and the baby. The discoloured colostrum and milk are generally safe for the baby to ingest.
- Resolution: The condition usually resolves within a few days as the milk production increases and flows through the breasts.
- Breastfeeding: Mothers with rusty pipe syndrome can continue breastfeeding. Exclusive breastfeeding may be challenging due to the discolouration, but proper counselling and support can help overcome this barrier.
- Diagnosis: To rule out other pathologies, a thorough evaluation is necessary. This includes interviews, physical assessments, ultrasounds, and cytological analysis to exclude malignant cells.
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Trauma to the mother's nipples
To prevent nipple trauma, it is important to ensure correct positioning and attachment of the baby during feeding. This may involve seeking assistance from a midwife, lactation consultant, or breastfeeding counsellor to ensure proper latching and positioning. It is also recommended to avoid soaps and shampoos on the nipples during showering, as well as avoiding nipple ointments, powders, and tinctures, as these can increase nipple problems. Leaving milk or colostrum to dry on the nipples after breastfeeding can also help, as they contain anti-infective agents. Additionally, it is important to change breast pads frequently and avoid using pads that hold moisture against the skin.
If nipple pain or trauma persists, it is important to seek help from a healthcare professional, such as a doctor, lactation consultant, or breastfeeding counsellor. They can provide guidance on proper latching and positioning, as well as recommend treatments such as nipple shields or breast shells to protect the nipples and allow them to heal.
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Gastro-oesophageal reflux disease (GERD)
GERD is more common in premature infants and those with certain health conditions. It is diagnosed by reviewing symptoms and medical history, and if necessary, medical tests may be recommended. Treatment options include medicine and lifestyle changes such as not smoking around the baby, burping them more often, and holding them upright for 20-30 minutes after feeding.
GERD can cause heartburn, chest pain, and trouble swallowing. If left untreated, it may lead to weight gain issues and irritability in infants. In rare cases, forceful vomiting due to GERD can cause tears in the tiny blood vessels in a baby's oesophagus, resulting in blood in their spit-up or vomit.
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Allergic reaction to cow's milk
It is not normal for a newborn to spit up blood, and you should seek medical attention if this occurs. While there are several possible causes, one of them is an allergic reaction to cow's milk.
Cow's milk allergy (CMA) is one of the most common food allergies in the UK, affecting about 7% of infants fed formula or both formula and breast milk. CMA can occur when a breastfeeding baby's mother consumes cow's milk or when cow's milk is used in formula for bottle-fed babies. CMA usually appears in the first year of a baby's life, with babies showing their first symptoms days to weeks after they first ingest cow's milk. CMA is uncommon, with only about 1% of babies actually having the allergy despite a higher rate of diagnosis.
CMA is caused by the immune system mistaking proteins in cow's milk as harmful invaders and working to fight them. This abnormal response releases chemicals that trigger allergy symptoms. CMA can cause different kinds of reactions, depending on the chemicals released, and the allergy is categorised based on these causes:
- Immunoglobulin E (IgE)-mediated reactions: The immune system releases histamine and other chemicals in response to cow's milk protein. Symptoms usually occur within 20 to 30 minutes of consumption but can appear up to 2 hours later.
- Non-immunoglobulin E-mediated reactions: T cells are thought to trigger the symptoms, which appear more gradually, from 48 hours up to a week after consuming cow's milk protein.
- Mixed IgE and non-IgE reactions: A combination of immunoglobulin E-mediated and non-immunoglobulin E-mediated reactions.
A wide range of symptoms can be triggered by CMA, usually involving the skin, gastrointestinal tract, and respiratory tract. Respiratory tract symptoms often appear along with other symptoms.
IgE-Mediated Symptoms
- Skin reactions: Itchiness, reddening of the skin, sudden itchy rash (urticaria), or swelling, most often of the lips, face, and around the eyes.
- Gastrointestinal reactions: Swelling of the lips, tongue, or palate in the mouth, itchiness in the mouth, nausea, vomiting, colicky abdominal pain, or diarrhoea.
- Respiratory reactions: Itchy nose, sneezing, runny nose, congestion, cough, wheezing, or shortness of breath.
Non-IgE-Mediated Symptoms
- Skin reactions: Itchiness, reddening of the skin, or eczema.
- Gastrointestinal reactions: Acid reflux or gastro-oesophageal reflux disease (GERD), loose or frequent stools, blood or mucus in stools, abdominal pain, colic, constipation, refusing food or aversion to food, redness in the perianal area, tiredness.
- Respiratory reactions: Cough, wheezing, or shortness of breath.
In rare cases, a child may have an anaphylactic reaction, which requires emergency medical help as it can be fatal. Call an ambulance if you think your infant is struggling to breathe or is floppy.
Diagnosis and Treatment
If you suspect CMA, make an appointment with your pediatrician, who will ask about your child's family history and symptoms. The doctor may refer you to an allergy specialist for a skin prick test and/or an IgE antibody blood test. If CMA is diagnosed, cow's milk protein will need to be eliminated from your child's diet.
For breastfeeding mothers, this means eliminating all dairy from your diet, including milk, butter, cheese, yoghurt, ice cream, and baked goods. Goats' and sheep's milk are also off-limits, as they have similar proteins to cow's milk. For bottle-fed babies, your doctor can recommend an allergy-free formula, such as extensively hydrolyzed formulas (eHFs) or amino acid formulas (AAFs).
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Intraductal papilloma
If you see your newborn spitting up blood, it is understandable to feel scared and want to call a healthcare provider. However, in most cases, the blood is coming from the birthing parent and not the baby. This is called "rusty pipe syndrome", and it occurs when the baby swallows maternal blood during the birthing process or from the breasts/nipples during breastfeeding. In the first few days after birth, it is natural for breast milk to be bloodstained due to increased blood flow and the growth of new cells and milk ducts. This type of bloodstained breast milk is perfectly safe for the baby to consume.
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Frequently asked questions
It is not normal for a newborn to spit up blood. If you notice blood in your newborn's spit-up, contact your doctor immediately.
There are several possible causes of a newborn spitting up blood, including:
- Ingesting maternal blood during birth or breastfeeding due to cracked nipples.
- Forceful spitting up or vomiting causing tears in the oesophagus.
- Trauma or irritation to the nasal pathways, throat, oesophagus, or stomach.
- Clotting disorders, more common in babies with a vitamin K deficiency.
- Allergic reaction to cow's milk or formula.
- Gastrointestinal bleeding due to oesophageal or stomach tears.
If you see blood in your newborn's spit-up, it is important to consult a healthcare provider. However, there is usually no reason to be alarmed unless your baby is showing additional symptoms such as fever, swollen belly, lethargy, abdominal distension, diarrhoea, or seizures.
To prevent your newborn from spitting up blood, you can try the following:
- Feed smaller amounts at a time and avoid overfeeding.
- Increase the time between feedings to allow the stomach to empty.
- Hold your baby in an upright position after meals.
- Consult a healthcare provider for advice on proper breastfeeding positions and latching techniques.