Vomiting and Diarrhea

Vomiting and diarrhea (gastroenteritis) are common in children; sometimes this is called the stomach flu. This is not the same as influenza that causes chest olds and we vaccinate for the illness.   Usually vomiting and diarrhea are caused by a viral infection in the stomach and intestines. For the most part, antibiotics are not helpful for the stomach flu and can even make vomiting and diarrhea worse in some cases. People lose a lot of water and salts from their bodies when they have vomiting and diarrhea, and with time, people can become dehydrated if they aren’t able to take in enough fluids to replace what they lose in the vomit and diarrhea.  It is very difficult to dehydrate if there is only vomiting or only diarrhea.   Usually there is both vomiting and diarrhea when a child gets dehydrated. 

Signs of dehydration are mainly limp weak muscles and the child is like a rag doll.   Or the eyes and eye lids sink to the back of the eye socket and look like the children starving on TV in third world countries.  Most children decrease their urine output then they do not have as much fluids in their body as normal.  To keep from dehydration, they decrease the urine to conserve fluids in their body so they do not dehydrate.  So kids who are dehydrated do not urinate much but just because they are not urinating much does not mean they are dehydrated.  Less urination does not help you tell if your child is dehydrated.  Also tearing and saliva output generally does not help.   Watch for limp muscles and sunken eye balls.  Sometimes doughy feeling skin but that is late in dehydration.

Treatment Of Vomiting and Diarrhea

The most important thing your child needs is plenty of fluids to try and prevent dehydration. Children with the stomach flu may not feel like eating solid foods. It is all right if your child does not want to eat solid foods for a day or two. When they are feeling better, they will start eating better and catch up in their weight.

When your child has frequent vomiting, clear fluids are easier on the stomach. DO NOT give your child plain water that does not have electrolytes in order to try and prevent dehydration as this can be dangerous, especially for babies. You can give babies and young children Pedialyte or generic electrolyte replacement solution (available in your grocery store or pharmacy) when they are vomiting. Babies who are breast-fed can continue to take breast milk. Older children over 1 can take clear liquids like gatoraide, sportdrinks, flat 7-up. Straight fruit juice can cause more diarrhea. Do not use soup or boiled rice water.

When children are vomiting, it is better to give small amounts of fluid frequently. If your child takes too much at one time, he/she is more likely to vomit up what they took. It is better to give small amounts of fluids (for example, a tablespoon) every five to ten minutes. If your child is breast-fed, offer the breast frequently but only for about five minutes so that your baby does not take too much at one time.

Call the office for suppositories or tablets that dissolve in the mouth for vomiting if needed. Do NOT use anti-diarrhea medications till 10yr or more in age.  Most of the over the counter meds do not help diarrhea much and if they stop the diarrhea, the germs increase in the intestines and can cause worse troubles or rare deaths.  Push a lot of fluids to "flush" the germs out and keep them hydrated. 

When your child stops vomiting, he or she may still have diarrhea for a few more days. You should change from Pedialyte and clear fluids back to your child’s normal formula or milk and some bland food (cereal, bananas, bread) when your child’s vomiting improves, even if your child still has diarrhea.

Go to the ER if signs of dehydration.  

Call Your Doctor If:

• Your child cannot keep down any liquid or food or is too weak or tired to drink enough fluids.
• The vomiting and diarrhea do not improve in 1-2 days.
• Your child has not urinated in more than 24 hours.
• Your child has severe constant abdominal pain.
• You notice blood in your child’s vomit or there is blood in your child’s stool.
• Your child has a fever of more than 103 and blood in stools.
• Your child starts to look dehydrated (his/her eyes look sunken, the skin feels doughy when squeezed, his/her soft spot feels sunken).
• The diarrhea lasts more than 7 days. (there is an antibiotic to kill the germs or tests may need to be run to see what germ is in there.)

Prevent spread in the family by washing hands with soap or using dilute bleach to clean hands and surfaces.  Alcohol sanitizing solutions do not kill Norovirus which is the most common cause of gastroenteritis in kids. 

http://www.cdc.gov/norovirus/