Introduction

This guideline relates to gastrointestinal bleeding in paediatric patients. For more information please see: Clinical Practice Guidelines: Abdominal pain - acute or Clinical Practice Guidelines: Abdominal pain - chronic 

When to refer

• Patients aged 0-16 years
• Persistent haematemesis, melaena or rectal bleeding (non-urgent)
• Persistent haematemesis, melaena or rectal bleeding with any of the following features (urgent):
  • Faltering growth (weight loss of > 2 weight centiles)
  • Iron deficiency anaemia
  • Persistent diarrhoea (bloody or non-bloody) > 2 weeks
  • Elevated inflammatory markers (raised platelet count, C-reactive protein, erythrocyte sedimentation rate and/or reduced albumin)
  • Suspected colonic polyp with minimal rectal bleeding

If any of the following are present or suspected, please direct the patient to the Emergency Department (no referral required):

• Acute haematemesis or melaena
  
• Acute lower gastrointestinal bleeding in large volume or with haemodynamic compromise

Services available closer to home

Other hospitals with public paediatric general medicine/gastroenterology services include:

• Austin Hospital
• Box Hill Hospital (Eastern Health)
• Monash Medical Centre
• The Northern Hospital
• Sunshine Hospital (Western Health)

Referral criteria/required information

• Detailed history and assessment, including duration of symptoms
• Provisional diagnosis and current management to date  
• Growth charts: including current weight, weight loss (amount and timeframe)
• Blood tests:
  • C-reactive protein (CRP)
  • Erythrocyte sedimentation rate (ESR)
  • Full blood count (FBC)
  • Iron studies
  • Liver function test results
  • Coagulation studies
• Stool sample (if available)
  • Faecal multiplex PCR results
  • Faecal helicobacter pylori antigen
  • Faecal calprotectin result if diarrhoea > 6 weeks (in children aged > 4 years)
• Any previous investigations e.g., x-ray, ultrasound

How to refer

RCH Specialist Clinics Referral.pdf

Please complete the above and submit via:

• Fax (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query call ED admitting officer or Gastroenterology Outpatient Consult Fellow on (03) 9345 5522. If after hours ask for Gastroenterology fellow on call 

Information for families

Kids Health Info : Abdominal pain

Resources and links

• Clinical Practice Guidelines : Abdominal pain - acute
• Clinical Practice Guidelines : Abdominal pain - chronic

Acknowledgements

The development of this guideline was coordinated by the Department of Gastroenterology (A/Prof. George Alex). Guideline reviewed in July 2025.