Vomiting & Diarrhea (Gastroenteritis)

Most vomiting and diarrhea in infants and children is caused by viruses. Luckily, it is usually short lived and self-limited. In the meantime, it is best to try to keep your child well-hydrated and comfortable.

Be on the lookout for signs and symptoms of dehydration: the inside of the eyes and mouth will dry out, infants will not make tears, an infant's soft spot may appear sunken, and there will be little/no urine output in a 6-8 hour period. If you think your child is dehydrated, call your doctor OR go directly to the nearest emergency room. You do not need our permission to take your child to the ER if you are concerned. Often the treatment involves intravenous fluids which must be provided in a hospital setting anyway.

Vomiting

If you try to keep giving food or drink to a child who is in the "heaving/retching" stage of an illness, his/her stomach will keep rejecting anything you offer and prolong vomiting. It is best to wait until the stomach is completely empty and there has been no vomiting or retching for an hour or two. After at least one hour without vomiting, begin to offer small amounts of a clear, sugary fluid. Some good choices are flat Sprite soda, white grape juice, ice pops, gatorade, broth, or pedialyte. Pedialyte is the best choice for children under 24 months. The idea is to give small amounts of clear fluids that do not have to be digested and will not sit in the stomach for very long. The clear fluids will be gradually absorbed by the stomach. Even if your child is very thirsty, go slowly. If they drink 4 ounces and it sits in their stomach, it will make them nauseated again. Start with 1 teaspoon every 5-10 minutes for an hour. If this is tolerated, then increase to 1 tablespoon every 15 minutes for an hour and then 1 ounce every 30 minutes. If your child vomits, hold fluids until he/she has not vomited for at least an hour and then start with 1 teaspoon every 5-10 minutes and advance as tolerated.

Diarrhea without vomiting

The goal is to replace fluids by mouth in an amount which is roughly equivalent to that which they are losing in diarrhea. Again, clear, sugary fluids or Pedialyte are good choices. Avoid things that cause loose stools on a good day (such as apple juice) and avoid dairy products, as diarrhea may cause temporary lactose intolerance in some children. If your child is tolerating fluids, you can use carbohydrates such as pretzels, crackers, toast, and noodles to "soak up the fluid". Other foods that can help are bananas, rice/rice cakes, and applesauce (the pectin helps to stop diarrhea). In general keep your child's diet boring and bland for a few days, even when their hunger returns. Reintroducing their favorites such as hot dogs and pizza too early may make symptoms reappear.

Common questions and answers:

What if it seems like everything I give goes right through my child?


This may appear to be the case, but is really not what is happening. Remember when you first brought your child home as an infant? Every time you fed him/her, he soiled his diaper. This is because the body has a "gastro-colic" reflex and no tone to the anal sphincter when you are very young. Every time you introduce something into the stomach, the colon starts moving things along and the rectal sphincter relaxes to expel whatever happens to be down there. If things are moving rapidly through the intestinal tract (as in the case of a viral illness), the contents do not sit in the colon/rectum long enough for the body to reabsorb any excess water. This is why it looks like the fluids you are giving by mouth are coming out the other end. Be persistent! Keep pushing the fluids and the body will eventually recover.

What do I give an infant with vomiting/diarrhea?


In general, children under 12 months of age should receive fluid replacement in the form of Pedialyte or one of the other electrolyte replacement solutions on the market. As above, start with small amounts. If your child is not vomiting, keep offering fluids as tolerated and monitor hydration status as above. If you are breastfeeding, continue to do so with small, frequent feedings. If you are bottle feeding, offer Pedialyte for the first 24 hours. Then switch to a non-milk based or lactose-free formula for a few days. If your child is eating solids, you can reintroduce bland/boring things once you know they are tolerating full strength formula.

When should I be concerned?


Seek medical attention if your child appears dehydrated, symptoms persist longer than expected (vomiting continues longer than 12 hours, and/or diarrhea persists longer than 3 days), your child appears very ill/listless, or diarrhea is accompanied by severe abdominal pain/cramps and/or has mucus or blood in it.

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