No one enjoys vomiting and diarrhea, especially not children. They are miserable when they feel nauseous. Acute gastroenteritis (the stomach bug) is a very common illness. It is sometimes called a stomach flu, but it is not related to influenza (flu), which is a respiratory illness. It can lead to doctor visits and even hospital stays. The risk of this type of illness is dehydration. Infants have a higher risk of dehydration. Infants and children can die from dehydration if not properly managed. This is why it is so important to recognize and treat this before it worsens.
Usually vomiting (throwing up) is caused by a virus and will resolve on its own. Watch to be sure that your child does not choke while vomiting. Roll infants to their side while vomiting. Vomiting from a virus will occur several times over a couple of days. This must be differentiated from spitting up or reflux in babies, which may be frequent and common. With viral causes of vomiting, when the vomiting subsides after a day or two, diarrhea may begin.
Diarrhea is defined by watery, loose stools, usually 3 or more per day. Diarrhea and vomiting may be from a virus, but it can also be a sign of other illnesses. A detailed history and physical examination should be obtained by your pediatric healthcare provider to determine the cause of the diarrhea and vomiting. Viral diarrhea can be spread easily so wash your hands well after changing diapers. If this is found to be viral in nature, it then needs to be determined if the child is dehydrated.
Dehydration means that your child has lost too much fluid and has become dry. Signs of dehydration are dry lips and a dry mouth, no tears when they cry, less urine than usual (urination less than every 8 hours), sunken eyes, and weakness or fatigue (sleeping a lot). Infants may have a sunken soft spot (fontanelle). If allowed to become severe, dehydration can be life-threatening.
What should you do?
If you are concerned that your child is dehydrated, go to the nearest emergency room, or dial 911. You may also reach out to your pediatric healthcare provider for further advice or evaluation. There are medications that help to stop vomiting that your provider may prescribe, although most cases of viral acute gastroenteritis will resolve on their own. Do not give your child any over-the-counter medication unless specifically prescribed or recommended by your pediatric healthcare provider. If your pediatric healthcare provider is concerned that your child is dehydrated, they may send them to the hospital emergency room to get IV fluids.
If your pediatric healthcare provider feels that the vomiting/diarrhea is viral in nature, that your child is not dehydrated, and sends you home, consider home remedies to prevent dehydration. After your child vomits, allow the child’s stomach to rest for at least one hour before offering fluids. If fluids are given too quickly after vomiting, the child will just vomit again. After an hour, offer a small amount (1-2 tsp.) of Pedialyte (which has the correct amount of sugar, water, and salt) every five minutes for the first hour, then slowly increase Pedialyte the following hour. Give small amounts of fluids frequently. Pedialyte ice pops can be used in older kids. Soda or sports drinks contain too much sugar and may make matters worse.
Provide a fluid-only diet for the first 8-12 hours as food may trigger more vomiting. After 8 hours (without vomiting) you may re-introduce a bland diet, including such foods as crackers, toast, soup, rice, chicken (without the skin). Infants may continue with breastmilk or formula after a few hours of Pedialyte. Do not keep a child on Pedialyte (clear fluids) for longer than 8-12 hours.
If your child is not vomiting, but has diarrhea, you may continue with a normal diet, but be sure to increase your child’s fluids. Adding “binding” foods like bananas, rice/rice cereal, applesauce, and toast may be helpful. Avoid juices, sports drinks, or soda which may make diarrhea worse. Infants with diarrhea can stay on breastmilk or formula but offer a bottle or the breast more frequently.
Call your pediatric healthcare provider if your child vomits more than a few times in a day, has signs of dehydration, is an infant (less than 1 year) with vomiting and/or diarrhea, looks sick, or if the illness does not seem to be improving. Vomiting which persists for longer than 2 days or diarrhea which persists for longer than 10 days to 2 weeks should be evaluated by a pediatric healthcare provider. Any bloody diarrhea is cause for urgent evaluation. Dehydration is a real risk which must be watched for and prevented. Seeking appropriate medical care and providing adequate rehydration fluids can help keep your child safe.
For more information, visit https://kidshealth.org/en/parents/dehydration.html