We always get plenty of phone calls

Here are some common scenarios for which we have parents call our office:

Vomiting with diarrhea—could be a viral gastroenteritis, commonly called the “stomach flu”. It’s usually not dangerous, but very uncomfortable. Very young children are most at risk for dehydration. But, because most children are very resilient, significant dehydration won’t occur if the child is able to take sips of liquids frequently during the illness and the illness is short, typically a day or 2.

Vomiting with fever—many conditions can cause this from early symptoms of a cold or the flu to some gastroenteritis or strep throat.

Vomiting with bloody diarrhea—could be due to serious intestinal infections and the child should be seen as soon as possible.

Vomiting with change in mental status (confusion, disorientation, excessive sleepiness)—could be due to a head injury, a poisoning, etc. A child with this presentation should be seen immediately.

Vomiting with a headache—may be due to a migraine, an infection such as the flu or strep, but if these symptoms occur after a head injury, this could signal a serious problem due to the injury. In this case, go to the emergency room.

Over -the-counter products are not typically recommended for young children.

If a clinician determines that the condition isn’t serious, then recommendations for home treatment will be given.

We would love to be able to “turn it off” so your child feels better, but most of these conditions are only treated with supportive care and TLC—care that parents can provide at home.

Often we see children in the office to assess for dehydration. Signs to watch for include:

• Dry cracked lips and a dry mouth
• Decreased urine output and very dark urine
• Drowsiness or irritability
• Cold or dry skin
• Low energy levels, appears weak or limp
• No tears when crying
• Eyes sunken or a baby’s soft spot (fontanelle) sunken in

Commercially available solutions such as Pedialyte, Gastrolyte or Enfalyte will contain the properly balanced amounts of water, sugars, and salts to promote absorption of the fluid. Oral rehydration is the best option for mild to moderate dehydration. Give your child 5-10 milliliters (1-2 teaspoons) of one the previously mentioned drinks every 5 minutes, slowly increasing the amount as your child tolerates. If you breastfeed your child, continue to do so.

If your child refuses to take an oral rehydration solution, try giving fluids you know your child likes, such as milk or water mixed with juice. But if your child has severe diarrhea, milk and juice may make it worse. So encourage the oral rehydration as best you can.

If you think your child is severely dehydrated, go to the Emergency Department immediately.

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.

Not much else to say here. To me, there is nothing worse than throwing up … besides maybe feeling nauseous all day thinking that any sudden move could make you vomit, but not.

It’s also never a good sign to see the child walk in the office with what is obviously the family puke bowl: some of my favorites are the very large silver metal bowl or the smaller plastic bowl with the paper towel inside …

My least favorite is the kidney bean shaped emesis basin that we provide to our families. Who pukes so politely that this thing will actually catch it all?

The most common cause of vomiting is gastroenteritis. This is usually a viral illness that is self-limited (meaning it goes away on its own with no treatment). If the vomiting lasts more than 24-48 hours, you need to call your doctor.

So, what do we recommend for vomiting?

Fluids, fluids, fluids

• My favorites are Gatorade^® or Pedialyte^®.
• Small frequent sips are the way to go (1 tsp every 5 minutes is 2 ounces in an hour which is more than enough for most children and not so much that it will cause vomiting); use the medicine syringe if you have a baby that won’t drink.

Close Observation

Watching your child for:

• Activity level - a baby who is lying around and won’t wake up to drink, can’t stay hydrated.
• Urine output - if the child is peeing every 6-8 hours, you’re probably OK.

If you see a change in either of these things, you need to contact your doctor. It is possible that your child is already dehydrated and may need some IV fluids.

So, good luck and happy cleaning…