Management of a Child Vomiting Mucous Blood
A child vomiting blood with mucus requires immediate assessment for severe, life-threatening bleeding and should be hospitalized if there is hematemesis with signs of significant blood loss, regardless of the underlying cause. 1
Immediate Assessment and Stabilization
Evaluate for shock or near-shock state immediately by assessing:
- Pulse quality and rate 1
- Capillary refill time (most reliable predictor of perfusion status) 2
- Mental status and level of consciousness 1
- Skin perfusion and temperature 2
If the child shows signs of severe bleeding with hemodynamic instability, this constitutes a medical emergency requiring immediate intervention with conventional critical care measures already underway. 1
Emergency Treatment for Life-Threatening Bleeding
For severe, life-threatening bleeding, immediately administer:
- Platelet transfusions 1
- High-dose parenteral glucocorticoid (e.g., 30 mg/kg methylprednisolone daily for 3 days) 1
- Intravenous immunoglobulin (IVIg), either alone or in combination 1
These interventions are justified given the serious consequences of severe hemorrhage, even though published data on efficacy for this specific presentation are limited. 1
Hospitalization Criteria
Hospitalize the child if:
- Severe, life-threatening bleeding is present, regardless of platelet count 1
- Mucous membrane bleeding requires clinical intervention 1
- Hematemesis is present as a complication requiring evaluation 1
Diagnostic Evaluation
Upper endoscopy with esophageal biopsy is indicated when hematemesis exists, as this allows:
- Direct visualization of esophageal mucosa to determine presence and severity of injury 1
- Evaluation of microscopic anatomy through biopsies 1
- Assessment of other causes of vomiting blood, such as eosinophilic esophagitis 1
- Exclusion of conditions that mimic gastroesophageal reflux disease 1
The diagnostic benefits must be weighed against minimal but not negligible procedural and sedation risks. 1
Concurrent Supportive Management
If vomiting is ongoing, provide oral rehydration with small, frequent volumes:
- Administer 5 mL every minute using a spoon or syringe with close supervision 1
- Gradual progression in amount taken helps guarantee tolerance 1
- Simultaneous correction of any dehydration often lessens the frequency of vomiting 1
Critical Pitfalls to Avoid
Do not:
- Delay hospitalization if significant hematemesis is present 1
- Pursue conservative measures alone without considering invasive testing when hematemesis exists 1
- Allow the child to drink large volumes rapidly, as this may worsen vomiting 3, 4
- Use antimotility agents (loperamide), which are absolutely contraindicated in all children <18 years 3, 2
Monitoring and Follow-Up
Instruct caregivers to return immediately if:
- The child becomes irritable or lethargic 1
- Decreased urine output develops 1
- Intractable vomiting persists 1
- Bloody vomiting continues or worsens 2
The presence of blood in vomitus, particularly with mucus, suggests mucosal injury requiring thorough evaluation to determine the underlying cause and appropriate definitive treatment beyond supportive care alone. 1