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Vomiting And Diarrhea

by Sue Hubbard, M.D.

I received an iPhone App email, this one from Holly.  She writes “my son is on his 5th day of diarrhea. What can I do? Is this going around? Will my other kids get this? HELP!!!”

While most of the country is not currently experiencing flu (yet), we are seeing a large number of cases of vomiting and diarrhea.  Many people call this the “stomach flu” but in reality it is not related to influenza at all.  The medical term for the illness is gastroenteritis, and this illness is typically caused by a viral infection.  The problem with these viruses is just like colds, there are a lot of viruses that can cause vomiting and or diarrhea.  In other words, you may see your child get several of these viruses in a season, and often, because they are contagious, you the parent develop the dreaded illness too!   I have written about vomiting in an earlier blog, so we are going to cover diarrhea today.

Rotavirus was previously one of the most prevalent fall and winter viral illnesses that caused vomiting and diarrhea in young children.  A vaccine against rotavirus was introduced more than 3 years ago,  and since that time there has been a greater than 50% reduction in childhood hospitalizations for dehydration secondary to rotavirus. This also means that fewer parents may be getting rotavirus from their children.  But other viruses like norovirus, adenovirus, or enteroviral infections can also lead to vomiting and diarrhea and dehydration.

If your child has loose, frequent, watery stools (which often follows vomiting) the key is to make sure that you are giving them enough fluid to maintain hydration.   It is much easier to do this once the vomiting has stopped. (think about putting as much in as comes out the bottom).  Parents often want to “show me” the diarrheal stool, but honestly, unless there is blood in the stool,” diarrhea is diarrhea” and bringing in stool is usually not necessary.

The best way to maintain hydration is by giving your infant frequent breast feedings or formula feedings and to make sure that they have tears when they cry and a moist mouth.  When you stick a finger in a baby’s mouth, the finger should never come out dry. A drooling infant is not dehydrated. It is difficult to tell if your child has urinated if they are in diapers, and are having diarrhea, as it is all watery together and the newer diapers “wick” the urine. Unless there is a large volume of urine you may not be able to tell that your child has urinated.  When in doubt, we actually either put a bag on a baby to see if they urinate or weigh the diaper, but this is not necessary at home.

I see a lot of babies and toddlers whose parents are worried that they are dehydrated because “they have not urinated in 12 hours”. But while saying that,  the child is crawling or walking around the room drooling.  They just could not tell that they were wet as the diaper was not saturated. So much for advanced technology diapers, sometimes they are TOO good.

For older infants and children, let them have frequent drinks of either Pedialyte or Gatorade and also let them eat solid foods.  When I was first in practice it was thought that the “gut” needed to rest and a BRAT diet was recommended. So, kids who had diarrhea were only given bananas, rice, applesauce and toast.  This was not only boring, but is was found to be too limiting and did not provide enough protein and nutrition to allow the gut to heal.

It is now recommended to “feed a child through their diarrhea”, but to avoid fatty foods, and food high in simple sugars like apple juice.  Provide complex carbohydrates like cereal, potatoes and bread, along with lean meats, fruits and vegetables. In most cases of diarrhea a child can still tolerate dairy products, but if their diarrhea seems persistent or returns after your child drinks milk etc. you might limit their dairy for several days in order that the cells that produce lactase may regenerate. It is not uncommon for children to have 5 – 7 days of diarrhea with a viral gastroenteritis.

There is some new data on using probiotics to shorten the course of diarrhea and in cases of prolonged diarrhea I have used some of these products (such as Florastor for kids) with success. This may help the gut by restoring good bacteria to promote intestinal health.

We’ve all been there, haven’t we?  We’ll chat again tomorrow!

Send your question to Dr. Sue!

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