Vomiting and Diarrhea

            Spring is the time that “stomach flu” viruses come around. Because they are viruses, they come on suddenly, often late in the day, and can be accompanied by fever and chills. They usually start with vomiting for the first 24 hours followed by diarrhea. The diarrhea gets worse through the second 24 hours. The vomiting is the worst in the first 24 hours and decreases in frequency over 2 days. The fever lasts for about 3 days, especially at night and the diarrhea can last a week or more but slows down after the first 48 hours. Although the child can have the usual aches and rotten feeling that comes along with most viral illnesses there usually is not a lot of stomach pain. If a lot of cramping pain occurs, suspect food poisoning, appendicitis or some other problem.

            The risk that comes with viral gastroenteritis (stomach“flu” is not influenza) is dehydration. Children get dehydrated more easily than adults because of their body make-up and also because they won’t drink when they feel miserable. The first 48 hours can be especially dangerous because they have both vomiting and diarrhea and feel so bad with fever that they won’t cooperate with anything. This is the time when parents are advised to give small sips frequently of the electrolyte solutions. The reason is not that these solutions stop vomiting; it is because these solutions are rapidly absorbed so that even if the child vomits soon after drinking them, there still will be a little absorbed. The object is to just get a little more in than is coming out. Pediatric websites such as the WHO website have specific directions for rehydrating children using oral fluids and also tell you how to make the solutions at home. The problem is that these solutions taste salty and kids don’t like them. Manufacturers keep working on improving the taste and if you freeze them like popsicles the child will sometimes accept them better. Just keep the fluid going in – even sports drinks like Gatorade are better than soda, milk or plain water. A little pain/fever medication can help the child feel better which may improve your chances of getting him to drink. If the child is cooperating, drinking and responding normally to you in the first 48 hours, keep increasing the amount of fluid as tolerated.  Once the vomiting and fever resolve, the risk of dehydration lessens even though the diarrhea continues. If, however, the child is not drinking or is acting more ill, weak or withdrawn, he needs to be seen. Dehydration develops rapidly and is dangerous but it can be easily cured with fluid if caught in time.

            After the vomiting slows down, go back to feeding the child a regular diet, even though he still vomits occasionally. The diarrhea will last longer, sometimes as long as two weeks, but will decrease to 2 -3 times a day. This is when some Pepto-Bismol can help firm up the stool in older children. Because it has a form of salicylate in it, some doctors don’t recommend using it. Ask your caregiver. A common mistake is to continue clear fluids just because the child has diarrhea. The best way to get back to regular stools is a regular diet. The child’s gut needs nutrition to recover from the insult of the viral infection.

Lastly, the incubation period is within about the same three days as for other viral illnesses. Remember to keep washing your hands, but it is almost impossible to keep the virus from spreading through the family.