Anna Mendenhall, MD, FAAP

http://www.youtube.com/watch?v=xfl2orahmBc

One of the most prevalent illnesses we see in children is viral gastroenteritis, which is characterized by vomiting and diarrhea, also referred to as “the stomach flu”.

What are the Symptoms?

The viral illness starts with nausea and vomiting in the first 24 hours with diarrhea that follows shortly thereafter.  There is usually some degree of abdominal cramping a slight fever associated as well.  It is VERY important to be seen by your physician to rule out other more serious causes of vomiting such as an intestinal obstruction or infection with bacteria…strep throat can even cause vomiting!  Once any other reason for the vomiting has been excluded the next step is what to do to help your child feel better…

What Can We Do to Help? 

The most important thing to do when you or your child has viral vomiting and diarrhea is to maintain hydration.  If you can keep your child hydrated, you can usually get them through the illness quicker.  It is very important to remember a few things:

• Provide frequent SMALL sips of fluid (one to three teaspoons at a time every 5-15 minutes) which allows the stomach lining to absorb the fluid before another bout of emesis.
• Ensure the fluid is an electrolyte solution such as Pedialyte or Gerber electrolyte solution.
• DO NOT give the child food until s/he has kept clear liquids down for at least 6 hrs.
• If your child wants to eat, give popsicles and Jell-O (they are considered “food” to a child who wants to eat but they really count as clear liquids that will help hydrate your child).  Just remember to give small amounts slowly.
• Once the vomiting has subsided for at least 6 hours you may attempt feeding small amounts of the following foods:

1. bananas
2. rice
3. applesauce
4. toast/bread (no butter)
5. chicken broth
6. plain pasta
7. plain chicken or turkey
8. potatoes or squash (baked or steamed with no butter/milk)

• Do not give any dairy products (milk, cheese, butter) except for yogurt (preferably yogurt with added probiotics) for at least a week.
• Do not give any fried foods for at least a week.
• Adding probiotics once the vomiting has subsided may help decrease the duration of diarrhea.

Why Such Restrictions on Food Once the Vomiting Has Resolved?

The cells that line the intestinal tract are still damaged from the viral infection and if foods that are difficult to digest (such as dairy, with lactose in them or fried foods) are given, the vomiting may recur or the diarrhea may worsen.  Let the cells heal from the infection by reintroducing bland, easy to digest foods. Bananas are one of the best foods, because it will actually help firm up the diarrhea (and don’t worry, bananas do not cause constipation!)

What are Some Signs to Watch for that Point to More Serious Problems?

Dehydration is the main thing you need to be watchful for.  If you can avoid this your child will feel better and bounce back sooner.  If any symptoms of dehydration occur, you should see your physician immediately.  In some cases, medicine can be prescribed to help stop the vomiting.  Sometimes intravenous fluids need to be given as supportive care when a child has vomiting and diarrhea.  Symptoms of dehydration are:

1. Dry mouth and/or dry lips
2. Sunken eyes
3. Decreased urination
4. Lethargy
5. Decreased tears when crying
6. Rapid heartbeat
7. Feeling faint/lightheaded when standing
8. If any of these symptoms are present, see your doctor immediately!

My Child Got the Vaccine for Rotavirus; Can He/She Still Get the Stomach Flu?

Luckily, we have a safe and effective vaccine that is routinely given to all 2, 4 and 6 month old infants in this country to help prevent one of the most common causes of death worldwide.  This vaccine has been in routine use for about four years in the United States.  However, the vaccine is not 100% effective and your child may still contract Rotavirus, but to a much milder degree (perhaps, only nausea or nausea with one episode of vomiting while the rest of the family vomits for a day or two).  In addition, there are several other viruses that circulate at this time of year that can also cause the same symptoms of vomiting (for 1-4 days) and diarrhea (for up to 14 days).