Norovirus is a highly contagious virus that typically occurs during the winter months (November to April).   

Cook Children’s Medical Center Fort Worth and Prosper has seen a 26% positivity rate of norovirus during the week of Feb. 22 to Feb. 28. Tarrant County Public Health maintains regular surveillance of norovirus. 

What parents should 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 food well, washing your hands with soap and water frequently and disinfecting contaminated surfaces. 

4. 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: 

• Wash your hands with soap and water frequently.
• Wear gloves for everything (diaper changes, cleaning and handling clothes).
• Clean all toys and surfaces with a bleach solution (5-10 tablespoons in 1 gallon of water).
• Wash laundry on the hottest, longest cycle available and machine dry. 

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Last fall, two studies showed that probiotics may not work as well in kids who have “tummy bugs” as we had previously thought.

I am defining acute gastroenteritis here – that’s the term we docs use to describe a tummy bug – as that all-too-common few days of vomiting and loose stools/diarrhea your kids pick up at school.

In the studies (which were actually pretty good ones), two large groups of children (one study had 971, another had 886) were randomly selected to take five days of mostly Lactobacillus rhamnosus or Lactobacillus helveticus, two common probiotics we recommend for kiddos this age, if they walked into certain U.S. or Canadian ERs with symptoms of gastroenteritis. Another group was assigned a fake/placebo.

The studies seemed pretty fair. Their poops were tested and found to have similar germs (viruses vs bacteria vs no cause found). Similar numbers in each group had gotten antibiotics or vomiting medicines. Neither study was run by a corporation – they were publicly funded.

After 14 days, participants were given a survey to see how their symptoms were doing. I’ll spare you the details – the probiotic group didn’t feel any better than the placebo group in both studies.

What does this mean? Well. Probiotics may not be beneficial to our kids when it comes to tummy bugs. But, let’s remember our critical thinking skills when we read medical studies –

• They only tested two types of probiotics.
• They only tested a five-day course of it.
• These studies were done on one age group only: 3 months to 4 years.

Probiotics have, in other studies, been proven to be beneficial in helping other ailments! Like colic, irritable bowel syndrome, chronic constipation, and even preventing necrotizing enterocolitis in premature babies. So let’s not give up on them yet.

But I do think this is enough evidence to prove that probiotics likely wont help your kids tummy bug. If you have questions, talk to your pediatrician about other ways probiotics can help.

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.

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.