This time of year, we pediatricians are inundated with all sorts of sick kids. Colds, influenza and a host of other respiratory illnesses fill our waiting rooms with mucus and coughs. We also tend to see lots of intestinal viruses, and nothing is less fun for a parent than caring for a child with constant vomiting and diarrhea.
What about stomach flu?
First and foremost, stomach flu is not really flu. We reserve the term “flu” for cases of influenza virus, which tends to show up in Oregon right about now. It involves high fevers, muscle aches and bad respiratory symptoms — think of it as a cold on steroids.
What lots of folks call “stomach flu” we call viral gastroenteritis, or inflammation of the stomach and intestinal tract. It is generally caused by a host of different viruses.
What does viral gastroenteritis look like?
The most important thing to pay attention to when your child is vomiting and has diarrhea is preventing dehydration. If kids are losing lots of fluid, and not able to keep their tanks full, they can get pretty sick, and the younger the kid, the more risky it can be. However, if you can help your child keep up with their losses, then everything will be fine.
Most gastroenteritis starts with vomiting. Usually, it is just the stomach contents, but sometimes it includes mucus, or even some yellowish-looking stuff. As long as there is no blood or bright green substance, the child will likely be OK.
What can parents do?
The hardest part about managing vomiting is giving your child fluids that keep coming right back up. The trick is to offer lots of fluids (I’ll explain what kind further along in the post). Give him/her a little bit at a time. We recommend starting with 1 to 2 tablespoons of fluid every 5 to 15 minutes (2 tablespoons = 1 ounce). If that stays down, then slowly increase the amount.
If the child drinks too much too fast, vomiting is likely to occur. In general, the vomiting will last one to three days. If it lasts any longer than that, you should call your health care provider.
Can medicines help?
There is no magic medicine for viral gastroenteritis. And there are no over-the counter remedies that parents can safely give their child. Sometimes, we will give a child with severe vomiting a prescription medication called “ondansetron” to lessen the symptoms and discomfort. Sometimes, we will prescribe anti-vomiting meds like Phenergan or Compazine, but most pediatricians don’t use these drug because of some very well-recognized, and common, bad side effects.
Diarrhea can follow vomiting, or it can start all on its own. In general, the stool will be loose and watery. If you see frankly bloody or mucus-y stools, or your child has a high fever (greater than 102 degrees), it is worth a phone call to your provider. Diarrhea is a bit easier to treat than vomiting because you can give your child as much as she wants to drink without worrying about her vomiting!
Viral diarrhea usually is bad for a couple of days, but it would be fair to expect it to take a week or so for your child’s stool to get back to normal. As with vomiting, there is no magic bullet for viral diarrhea. Again, over-the-counter stuff is not a good choice, as it can be dangerous for little ones.
Now let’s talk fluids
What can you give a child with gastroenteritis? The easy answer is whatever they will drink, with a few caveats. If the child is breast- or bottle-feeding, the best thing to give him/her is breast milk (or formula if that is what they take). Solutions like Pedialyte are specifically designed to rehydrate kids and replenish some of the salts they lose. It is always a reasonable choice, but is not always necessary. Some kids like it, and some do not — they taste pretty salty.
Water, milk, diluted juices, herbal teas and sodas can all be used, and it is a good general rule to give a variety of different liquids. Juice has a lot of sugar and can sometimes make diarrhea worse, so dilute it down to half-strength. Sports drinks have a good amount of sugar as well, so use them with caution.
Some kids will have worse diarrhea with milk, but it is fine to try it. Caffeine can worsen diarrhea as well, so be careful with sodas and teas.
What about food?
As far as eating goes, it is pretty normal for kids who do not feel well to not want to eat much. This drives parents nuts, but it is fine for a child to go a day or two without eating much, as long as she is drinking. If she is hungry, give her what she wants to eat. We used to talk about the BRAT diet (Banana, Rice, Applesauce and Toast). Bland starchy foods are fine, but it turns out that they do not make much of a difference. Just hang tight for a couple of days, and your child will eat again when she feels better.
Dehydration is the biggest worry for us pediatricians. Decreased urine output, lack of tears when crying, dry, tacky mucus membranes (in the mouth, for example) and just feeling cruddy and listless are all signs that your child’s tank could be a bit low. Try and push the fluids as described above, and if you are worried, call your health care provider. Usually, we can get by with fluids by mouth, but sometimes, we need to use more aggressive measures like intravenous therapy.
Remember to practice good hand hygiene
Finally, gastroenteritis is pretty contagious, so be sure to wash hands often, and keep things as clean as you can to prevent a mini-epidemic in your home!
With a few simple tricks, you can keep your kids hydrated and safe if they get hit with a gastrointestinal bug. And remember, your pediatrician is always ready to help when needed!
Ben Hoffman, M.D.
Medical Director, OHSU Doernbecher Tom Sargent Children’s Safety Center
Assistant Professor of Pediatrics, OHSU Doernbecher Children’s Hospital