Initial work-up

• Rule out fissure (NB: causes of fissures in children include constipation, Crohn's etc)
• Stool MC&S
• Stool for clostridium difficile toxin
• FBE with diff, ESR or CRP
• LFTs
• Family history of Crohn's Disease, Ulcerative Colitis, GI polyps etc.

When to refer

• If not due to acute infection which is settling within a week, refer for further evaluation.
• IMMEDIATE REFERRAL within a day or via the Emergency Department if in an infant and associated with significant abdominal pain (suspect intussception). 
• If associated with significant weight loss, refer within one week (suspect inflammatory bowel disease).

Resources

• Make a referral:Specialist Clinics
• Contacts
• RCH Primary Care Liaison (GP website)
• Kids HealthInfo (Parent information website)  

References and more reading

• Paediatric Handbook (2009). Gastrointestinal Conditions, Chapter 24 (pp369389) Mark Oliver and Lionel Lubitz. Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

Guideline developed by RCH Gastroenterology. First published Jan 2008. Reviewed August 2009. Please read  Copyright and Disclaimer