Stomach Virus (Gastroenteritis)    

"Doctor, my baby has the stomach flu!”
or
What to do for fever with vomiting and diarrhea

Viruses which cause fever, vomiting and diarrhea, are very common in children. Nearly every child experiences a “stomach flu” before he enters kindergarten. The medical term for this is “gastroenteritis” and it is highly contagious with epidemics that run in cycles every year. Enteroviruses circulate through the community every summer, and rotavirus affects children each winter. The virus is contracted from exposure to other children in preschool, day care, parties, or playtime. Incubation can be from 1 to 3 days and the virus begins suddenly with onset of vomiting and/or fever, as well as fatigue and stomach cramps. The virus damages the digestive tract and leaves the child unable to process food as usual. The immune system will eventually eradicate the virus and heal the damage, but we can help by not feeding the weakened gut foods it cannot digest. The normal course of a stomach virus is usually 1 to 3 days of fever and vomiting followed by or accompanied by 7 to 10 days of watery diarrhea. Someone with previous exposure to the virus might experience mild symptoms with only cramping and nausea for a few days, while their immune systems boosts its levels of protection. The goal of treatment of any stomach virus is to prevent dehydration by offering small sips of clear liquids until the child can tolerate more. There is rarely any need for medications, as the treatment is all dietary.

FEVER: If your baby can tolerate tiny amounts of liquid, you can use Tylenol (acetaminophen) by mouth, or you can buy over the counter “Feverall,” a suppository form of Tylenol. Rectal suppositories are dosed the same as oral medication, but are available in 80 mg , 120 mg, and 325 mg sizes. You can cut them in half if needed. Call us if you are not sure how much to give. Avoid using Advil or Motrin with vomiting, as they are harder on the stomach, and should always be taken with milk or food. 

VOMITING: Wait for at least an hour after your child vomits before trying to offer him any fluids. Keep them lying down, as they may get dizzy or weak from the virus. Don’t offer any food. Try to offer 1 or 2 sips of clear liquid every 15 to 20 minutes. For babies less than 2 years old, get Pedialyte or any other brand of oral rehydration solution. Pedialyte popsicles are great for those children with fever and vomiting. For older children, try Gatorade, ginger ale, 7-Up, Jell-O, or soup broth. Breastfeeding babies can continue at the breast, but must latch for only a minute, then stop and wait for 15 minutes, and continue on and off throughout the day. Don’t expect the vomiting to stop right away, as it usually continues on and off for the first 2 or 3 days. Call us if the vomit is bloody or becomes extremely green with retching that continues for over an hour. Call us if your child’s stomach is very tender to even the touch of your hand. Call us if your child has G E Reflux disease and takes medication for it. Call us if after several hours of fluids, none of the sips are staying down. Infants can take only Pedialyte for up to 24 hours, after that time they need a solution with more calories. (See Diarrhea)

DIARRHEA: When a child has diarrhea, the lining of the digestive tract is damaged and leaves the body unable to digest most foods. Most children with diarrhea for several days will lose weight, but will regain their weight as soon as they are feeling better. The virus also upsets the healthy balance of bacteria in the gut, and causes cramps with often foul-smelling gas. Stop all dairy products. This means no milk, cheese, ice cream, yogurt, or pudding. Stop any milk-based formula (Enfamil, Similac, Carnation, etc.) and substitute a soy formula in smaller than normal volumes, but feed more often. If the vomiting has eased off, try the BRAT diet, which stands for Bananas, Rice, Applesauce, Toast as well as saltine crackers, plain pasta, plain cookies, pretzels, scrambled egg, and chicken soup. Avoid all greasy, fatty, fried foods, as well as raw vegetables or fruits or fruit juices. Continue to offer the clear liquids listed above. Breastfeeding mothers should continue to breastfeed, but limit the volume of each feeding to only one breast every 1 to 2 hours. Over the counter products such as Pepto-Bismol, Kaopectate, or Imodium have limited effectiveness in children and are not usually recommended. Do not give these products to children who are vomiting. Stay on the limited foods until your child has 1 or 2 days of normal stools, and then slowly add back his regular diet and dairy. If your child has a very long period of diarrhea (over a week) or is not responding to the BRAT diet, or is currently on or recently finished antibiotics, he may benefit from a several day course of probiotics. Probiotics are the healthy bacteria that humans have in our guts that help us to digest our food normally. They are available over the counter at drug stores and health food stores everywhere. They are sold under many names, including Lactinex granules, acidophilus, lactobacillus and come in capsules, packets, and liquid forms. Ask the pharmacist where they keep their probiotics, or good bowel bacteria (?refrigerated?) and give your child a dose 2 or 3 times per day until stools return to normal.

DEHYDRATION: The goal of treatment of vomiting and diarrhea is to prevent dehydration. What are the signs to look for to know if your child is dehydrated? She will not pass any urine for over 12 hours, no tears with crying, and the lips are parched with no saliva in the mouth. The eyes are often sunken, and the skin has a dough-like texture, often with extreme lethargy or paleness or cool fingers from decreased circulation to the extremities. Dehydration often requires IV therapy in children who cannot tolerate oral liquids, and these children need to be seen and treated.