Rectal suction biopsy is the first step in evaluating suspected Hirschsprung's disease before a full thickness rectal biopsy is planned. It has an excellent safety profile and generally good yield. However, there have been rare reports of serious complications with this procedure and at least one death, mostly in the neonatal period and under one year of age, at the time of diagnosis. We report a case of a 2 year old child with suspected Hirschsprung's disease who underwent rectal suction biopsy and developed delayed bleeding requiring a blood transfusion. To the best of our knowledge, this is the first report of an older child, greater than one year of age, developing this serious complication at the time of rectal suction biopsy. Discussion of the technique as well as the patient's presentation and his outcome are provided. Pediatric gastroenterologists and pediatric surgeons performing rectal suction biopsy may need to be aware of this risk even with older children.