The CDC recommends people not eat this cereal and retailers not sell any Kellogg’s Honey Smacks cereal at this time because it might be contaminated with salmonella and could make people sick.

Justin Smith, M.D., a pediatrician at Cook Children’s Trophy Club office, said that salmonella is one of the most common bacterial causes of infections he sees in his office and it is a “fairly frequent cause” of severe diarrhea and abdominal pain in children.

Symptoms that might alert parents they should call a doctor include:

1. Severe vomiting with decreased urine frequency or other signs of dehydration.
2. Fever of more than 102.
3. Blood or mucous in the stool.
4. Severe belly pain.
5. Diarrhea that lasts more than one week.

“If you suspect your child has salmonella, your pediatrician can run stool studies to confirm the diagnosis,” Dr. Smith said. “This may not be necessary if there are known cases that the child has been exposed to. The infection will typically go away on its own in seven days or less. Most healthy children do not require antibiotics. I do not routinely recommend anti-diarrheal medications in children because they can prolong symptoms with some infections.”

If you suspect your child has one of these infections, Dr. Smith said parents should consult with their doctor and keep them out of daycare until the pediatrician is sure they will not put other children are risk.

The Kellogg Company recalled all Honey Smacks products that were on the market within the cereal’s one-year shelf-life on June 14, 2018. The CDC stated that even products with earlier dates could also potentially be contaminated.

In its press release, Kellogg Company states that none of their other products are impacted by the recall. “Kellogg launched an investigation with the third-party manufacturer who produces Honey Smacks immediately after being contacted by the Food & Drug Administration (FDA) and Centers for Disease Control (CDC) regarding reported illnesses,” Kellogg wrote in its release.

The CDC has this advice for consumers and retailers:

• Do not eat any Kellogg’s Honey Smacks cereal, regardless of package size or best-by date. Check your home for it and throw it away, or return it to the place of purchase for a refund. The Kellogg Company recalled the cereal on June 14, 2018.

• Retailers should not sell or serve Kellogg’s Honey Smacks cereal.

• Even if some of the cereal has been eaten and no one got sick, throw the rest of it away or return it for a refund.

• If you store cereal that looks like Kellogg’s Honey Smacks in a container without the packaging and don’t remember the brand or type, throw it away.

• Thoroughly wash the container with warm, soapy water before using it again, to remove harmful germs that could contaminate other food.

Illnesses due to the outbreak have been reported from March 3, 2018 to July 2, 2018. Ill people range in age from less than 1 year to 94. No deaths have been reported.

As a pediatrician, I've never been in favor of these medications as a treatment for your child's stomach virus and diarrhea. Studies have shown that use of antidiarrheal medications may prolong the course of the illness. 

Stomach viruses are the most common cause of diarrhea. Diarrhea, after a stomach bug, can last a while, even up to 1 week. A close second is diarrhea associated with antibiotics which can last as long as the child is on antibiotics and even a few days later.

For most cases of diarrhea, you probably don’t need to see the doctor. Here are some things you can do at home to help:

1. Get back to a regular diet as soon as possible. Continuing the Gatorade or Pedialyte only makes it last longer.

2. Do not use antidiarrheal medicines (even Pepto-Bismol). They don’t work and can have severe side effects. 

3. Talk with your doctor about using probiotics. Some studies have shown that they might be helpful.

Here are some reasons it might be time to go ahead and give the doctor a call:

1. Stool with blood or mucous

2. High fever

3. Signs of dehydration (dry lips, not urinating for 6-8 hours)

4. Diarrhea that lasts more than 1 week

Diarrhea will never be fun because it can ruin your life for a few days. But, if your child’s diarrhea lasts more than a week, trot (sorry) on over to your friendly pediatrician. They might need to do some tests to help you figure out what is going on.

When these are the main complaints on my patient schedule, I know it’s probably norovirus time. 

The Centers for Disease Control and Prevention (CDC) estimates that each year norovirus causes 19 to 21 million illnesses, 56,000 to 71,000 hospitalizations and 570 to 800 deaths. Anyone can get infected with norovirus and you can get it more than once. It is estimated that a person will get norovirus about 5 times during their lifetime. Many people usually get sick with norovirus in cooler months, especially from November to April.

Here are 5 facts you need to know about norovirus:

1. Norovirus can cause SEVERE vomiting and diarrhea. Treating children with fluids and monitoring for dehydration is critical.

2. Norovirus is HIGHLY contagious by contact with another person with the virus, eating food that is contaminated or touching contaminated surfaces and putting your fingers in your mouth. Symptoms usually develop 1-2 days after you have been exposed.

3. Prevent infection by washing foods very well, washing your hands with soap and water frequently and disinfecting contaminated surfaces.

4. Norovirus “season” typically runs from November to April but it appears there are several cases popping up over the last month across the country and in North Texas.

5. Monitor for the following signs of dehydration including: dry mouth or lips, decreased activity level or decreased urine.

If you have had a child (or you have had) with norovirus, here is a cleaning plan to help “decontaminate” your house:

1. Wash your hands with soap and water frequently.

2. Wear gloves for everything (diaper changes, cleaning and handling clothes esp…).

3. Clean all toys and surfaces with a bleach solution (5-10 tablespoons in 1 gallon of water).

4. Wash laundry on the hottest, longest cycle available and machine dry.

Hopefully with these tips you can prevent norovirus from entering your home or at least stop the spread. If you have further questions, contact your Cook Children’s pediatrician.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.

The biggest challenge with vomiting and diarrhea is keeping the kids hydrated. After a big episode of vomiting they feel thirsty, and you want to replace the fluids. As a parent in this situation, you have to go against your instincts and not give them fluids right away. It is best to wait 1-2 hours after the vomiting episode before trying to give them fluids, otherwise it will all come back at you from a very irritated tummy.

To rehydrate, and keep the new fluids down:

• Give the stomach time to settle, we recommend waiting 2 hours.
• Start with just sips of water, electrolyte drink, breast milk, formula, or other fluid based on the age of your child.
• Offer sips every 20 minutes for 2 hours, and if they keep this down increase the amount of fluid slowly.
• Once they have kept down fluids for 8 hours then you can offer food.

The vomiting usually passes in the first 24-48 hours of the viral illness, and then can be followed by diarrhea for another 5-7 days on average. The diarrhea can last up to 2 weeks with a viral stomach bug. During this time use good hand hygiene, and avoid sharing food and drink so that the virus does not spread.

Watch for signs of dehydration:

• Urinating less than 4 times in 24 hours.
• The area under tongue looks sticky instead of moist with saliva.
• They are crying without tears.

If your child is having signs of dehydration or the diarrhea is lasting longer than expected, has blood in it, or other concerning signs then call your pediatrician to see if your child needs to be evaluated in the office.

While dealing with a stomach bug can be a miserable 24 hours or more, I can reassure you that you can get thru it safely at home in most cases. Just stick to your hydration plan, and prepare for many loads of laundry.

The DSHS has received reports of 205 cases of Cyclosporiasis in Texas. No cases have been reported at Cook Children's. In Cook Children's six-county service region, the following numbers have been reported:

The U.S. Food and Drug Administration's alert says cilantro from the Mexican state of Puebla may be the cause for the recent outbreaks.

Symptoms usually begin 2 to 14 days after ingestion of contaminated food or water.Mary Suzanne Whitworth, M.D.,medical director of Infectious Diseases at Cook Children’s, advises parents to contact their Cook Children’s pediatrician if they have a diarrhea-like illness lasting more than a few days or diarrhea accompanied by severe weight loss or fatigue. Those are symptoms of Cyclospora.

Symptoms include severe diarrhea that can last a week to months, and if not treated, the person may relapse. Additional symptoms may include fatigue, severe weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting and low grade fever. If your child is experiencing these symptoms, do not wait. Contact your Cook Children’s pediatrician. If your child is diagnosed with Cyclospora, an antibiotic can be prescribed.

However, most cases of diarrhea or an upset stomach do not need treatment with an antibiotic. Usually, diarrhea is caused by viruses, so time, rest and diet will take care of the problem.

“Past outbreaks of Cyclospora in the U.S. have been caused from imported, fresh produce,” Dr. Whitworth said. “The best way to prevent Cyclospora in your household is to wash your fruits and vegetables as thoroughly as possible. Let fruits and vegetables soak for a few minutes in clean water in the sink, and then drain and spray them off with clean water before eating them. Thorough washing of fresh produce is highly recommended, but it may not remove the risk of someone in your family getting Cylospora entirely. If your child has these symptoms, it’s best to see a pediatrician and get treated as quickly as possible.”

Cyclospora is generally not transmitted directly from person-to-person, however children with diarrhea should always avoid swimming in pools to avoid the spread of infection.

The Centers for Disease Control and Prevention has more information about Cyclospora.

When should you call your pediatrician about diarrhea? Watch this video from Justin Smith, M.D., for more information.

Watch the video below for five key facts about diarrhea that every parent needs to know in only a minute. 

In today's video, Doc Smitty explains:

1. What are the common causes?
2. How long can it last?
3. When are the symptoms more than a stomach bug?
4. When do you call your pediatrician?
5. What are the biggest risks?

Learn the answers to these questions. It only takes a minute.

How do you know when it is something else or when it could be more dangerous?

A report last week from the CDC described a cluster of infections caused by shigella, a bacteria that can cause severe diarrhea.

Shigella is common, causing an estimated 500,000 cases of diarrhea in the United States annually. But this group of infections is unique because it has been found to be resistant to the most common type of antibiotic used in adults used for shigella. Most cases have been located on the East and West coast and many have been associated with travel outside the United States.

Fortunately, there were no cases of this more severe form of shigella reported in Texas so I feel that we are pretty low risk at this point. I did want to take a second to tell you about warning signs that might alert you that diarrhea might be more than a stomach bug.

Here are some symptoms that might alert you that should trigger a call to your doctor:

1. Severe vomiting with decreased urine frequency or other signs of dehydration.
2. Fever more than 102.
3. Blood or mucous in the stool.
4. Severe belly pain.
5. Diarrhea that last more than one week.
6. Let your doctor know if your child has traveled recently.

What are Salmonella and Shigella?

Two of the most common bacterial causes of infection are salmonella and shigella. They are both fairly frequent causes of severe diarrhea in children.

They can both be transmitted by contaminated food or water but can also be spread from person to person. Salmonella is more frequently caused by transmission from contaminated food, but also can be contracted from infected reptiles. Shigella is more frequently acquired from other children and is much more contagious than salmonella.

(Just to give you an idea, stool of a child infected with shigella contains 100,000,000 bacteria per gram of stool. Ingesting just 200 bacterial cells is enough to cause infection. Because of this, outbreaks of Shigella are common in child-care settings.)

The most common symptoms with both infections are diarrhea, abdominal pain and fever. With shigella, fever is often higher and children are more likely to have blood or mucous in their stools.

For either infection, your doctor can run stool studies to confirm the diagnosis. This may not be necessary if there are known cases that the child has been exposed to.

Both infections will typically go away on their own in seven days or less. Most healthy children do not require antibiotics. I do not routinely recommend anti-diarrheal medications in children because they can prolong symptoms with some infections.

If you suspect your child has one of these infections, consult with your doctor and keep them out of day care until we are sure they will not put other children are risk.

Fever, headaches, joint and muscle aches, weakness, fatigue, diarrhea, vomiting, stomach pain and lack of appetite.

Over the next few months, many children will have these symptoms and many parents will, and should, call their Cook Children’s pediatrician because of how their child’s feeling.

Unfortunately, many parents will assume the worst … Ebola. But the chances of that being a reality are extremely low. While knowing it’s not likely to be Ebola may be a relief, it’s important to remember that Ebola is not the only dangerous virus on the horizon for our children. The symptoms listed above are much more likely to be the flu.

Investigation of 25 outbreaks of Ebola over 38 years has shown that only direct contact with a person with Ebola would cause someone to become infected. Right now, there’s no approved vaccine to limit the epidemic in West Africa.

On the other hand, influenza can be deadly. The 2013-2014 flu season led to 108 pediatric deaths in this country. The flu is spread readily through the air by small droplets which can be infectious to someone near a person who is coughing and sneezing and is much more easily acquired and easily prevented through vaccination.

Please make sure to get your children the flu vaccine and parents should get them too! ASAP. Both injection and nasal mist vaccines are effective.