Blood in an infant's vomit: what parents should do

Contact the baby's paediatric clinician or an urgent medical service now for advice. A newborn or young infant can become unwell quickly, so do not wait for the symptom to repeat before seeking guidance.

A breastfed baby may swallow blood from a cracked or bleeding nipple. A newborn can also bring up blood swallowed around birth. Other possibilities include irritation in the mouth, nose, throat, oesophagus, or stomach, forceful vomiting, a clotting problem, or bleeding within the digestive tract.

The colour and texture offer clues but cannot establish the source: fresh blood may appear red, while blood exposed to stomach contents may look dark or granular. Oesophageal and stomach cancers belong to adult-focused differential discussions and are not conclusions to draw from this infant symptom.

Keep the baby with a responsible adult and note the blood's appearance, approximate amount, timing relative to feeding, and whether vomiting was forceful or green. Check for bleeding in the baby's mouth or nose. If breastfeeding, look for nipple cracks or active bleeding, but do not assume this explains the episode without clinical advice.

Tell the clinician about prematurity, birth events, medicines or supplements, feeding changes, wet nappies, stool colour, fever, and unusual bruising. Save a photo or stained cloth if practical. Do not give over-the-counter remedies, water, or altered formula mixtures unless the baby's clinician instructs you.

Call emergency services for more than a small streak of blood, repeated bloody vomiting, green vomit, a swollen or very tender abdomen, breathing difficulty, unusual sleepiness, limpness, pale or mottled skin, poor responsiveness, black stool, fever in a young infant, or signs of dehydration such as markedly fewer wet nappies or a dry mouth.

Emergency evaluation is also appropriate when the baby cannot keep feeds down or the caregiver feels the infant is rapidly worsening. Keep the baby positioned safely and follow the emergency dispatcher's feeding instructions while help is arranged.

Ask whether the blood appears swallowed or produced by the baby's digestive tract, whether feeding can continue, which tests are appropriate, and which stool, feeding, behaviour, or nappy changes should trigger immediate reassessment.