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Daily Dose

Vomiting & Diarrhea

2.00 to read

 

Over the years, I have talked a lot about vomiting.  In most cases of gastroenteritis, vomiting is either accompanied or followed by diarrhea.  I know, lovely topic to discuss…but the reality is we must.

Most of these episodes are typically caused by a viral infection and there are many viruses that may cause the same symptoms. Although people often think of V and D as “the stomach flu” it has nothing to do with influenza at all.

Diarrhea describes a stool that is loose and watery as well as frequent. Everyone can have a loose stool once in a while and that is not necessarily diarrhea.  But when the stools become more frequent (you will know) as well as watery, you have diarrhea.

It is interesting that day care centers may sometimes send a baby home because they have had more than 3 stools in a day, but some infants may have a loose stool more often than that and still not have what I would consider to be diarrhea. (Believe me; I get to look at a lot of dirty diapers!)     

The most important part of treating a viral diarrhea is keeping your child hydrated. If they are having frequent watery stools you can typically “feed them through” the diarrhea.

If you are putting more in the mouth than comes out the bottom then you can typically maintain their hydration. This can be done with a child of any age. For babies and younger children you can use Pedialyte to maintain their hydration, but for older children who will no longer drink Pedialyte, give them Gatorade or a similar drink.  Just keep the fluids going.

It is also important to “feed your child” through diarrhea. By this I mean you can continue to offer foods, as long as there is no vomiting.  Years ago I was taught “rest the gut” and “only feed children a bland BRAT diet”. That is no longer the treatment for diarrhea, as it was found that the intestines need protein and nutrients to heal.

A well balanced diet with lean meats, vegetables as well as carbohydrates is a better choice.  If the diarrhea is persistent I might limit dairy but otherwise let your child eat. With that being said, they may not be as hungry since they are sick, but offer them meals and let them eat as they are feeling better.

Always watch hydration by looking for moist mouth (put your finger in a baby’s mouth and it should always come out wet), drooling, tears and wet diapers. It may be hard to tell if your child is having wet diapers as the diarrhea may soak into the diaper with the urine.

If your child is crawling, playing , running around and has drool and tears then I would not worry about the diaper being wet.  The only way to really tell if there is urine in a diaper is to weigh the diaper before putting it on and then later in the day. There are very few times this is necessary and those children are usually in the hospital as well. 

The last thing to remember about diarrhea is HANDWASHING!!  The pesky “tummy flu” is easily spread by dirty hands, so make sure that everyone who comes into contact with the diaper and bathroom is washing their hands well. It is not infrequent to see an entire family, adults included, come down with diarrhea. So keep out the hand sanitizer and soap!

That’s’ your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Vomiting Kids

1:30 to read

Pick a virus ….and it is probably circulating in your area!  Seems we are at the peak of upper respiratory season, influenza like illness season and also vomiting and diarrhea season. In other words, lots of sick kids right now.

 

I just started seeing a lot of vomiting again!!  It is the worst for both the child and the doctor’s office where it seems many a child has vomited either in the car, coming up the elevator or in the exam room.  YUCK for all.

 

Remember, norovirus is the most common virus that causes vomiting and diarrhea and it is VERY contagious. Not only via “dirty hands” but it is also airborne…so in other words, those standing near by a child who is vomiting (parents, other sibs) are probably being exposed as well. That is the main reason you probably see an entire family who gets sick almost simultaneously.  

 

If your child vomits….DO NOT give them anything to eat or drink for at least 30 min. I know that is hard as they are asking for a drink,  but you need to give their tummy a minute to “recover” before challenging them with a few sips of Pedialyte or Gatorade.  A SIP is the key word too….tiny amount to start in hopes that they do not vomit again.  

 

I just saw a 6 year old little boy who had been vomiting several times during the night.  His Dad said that he had given him Zofran to help stop the vomiting (this is a prescription).  I use a lot of Zofran in children who are vomiting as it can go under the tongue.  But after the Zofran his son felt better….so he gave him strawberries and a waffle!! Surprise? He vomited again!!

 

Don’t be fooled and start trying to feed your child too quickly after they are vomiting. I know parents worry that “their child is not eating”, but fluids are the important part of staying hydrated. As one little boy told me, “ it feels like there are grasshoppers in my tummy”!! So well put. I grumbling tummy needs time to heal and frequent sips of clear liquids (no dairy) are the best way to prevent dehydration. As your child tolerates a small volume you can go up a bit and gradually increase the amount that they take.  I usually wait a good 4-6 hours after a child has successfully tolerated fluids before I even consider giving them food. Then I start with crackers, noodles or something bland (that I also don’t mind cleaning up) in case they vomit again.  

 

You are just wanting to make sure your child stays hydrated…tears, saliva and urine!  Keep washing those hands. 

Daily Dose

Vomiting And Diarrhea

What can you do if your child is vomiting and had diarrhea?I received an iPhone App email, this one from Holly.  She writes “my son is on his 5th day of diarrhea. What can I do? Is this going around? Will my other kids get this? HELP!!!"

While most of the country is not currently experiencing flu (yet), we are seeing a large number of cases of vomiting and diarrhea.  Many people call this the “stomach flu” but in reality it is not related to influenza at all.  The medical term for the illness is gastroenteritis, and this illness is typically caused by a viral infection.  The problem with these viruses is just like colds, there are a lot of viruses that can cause vomiting and or diarrhea.  In other words, you may see your child get several of these viruses in a season, and often, because they are contagious, you the parent develop the dreaded illness too!   I have written about vomiting in an earlier blog, so we are going to cover diarrhea today. Rotavirus was previously one of the most prevalent fall and winter viral illnesses that caused vomiting and diarrhea in young children.  A vaccine against rotavirus was introduced more than 3 years ago,  and since that time there has been a greater than 50% reduction in childhood hospitalizations for dehydration secondary to rotavirus. This also means that fewer parents may be getting rotavirus from their children.  But other viruses like norovirus, adenovirus, or enteroviral infections can also lead to vomiting and diarrhea and dehydration. If your child has loose, frequent, watery stools (which often follows vomiting) the key is to make sure that you are giving them enough fluid to maintain hydration.   It is much easier to do this once the vomiting has stopped. (think about putting as much in as comes out the bottom).  Parents often want to “show me” the diarrheal stool, but honestly, unless there is blood in the stool,” diarrhea is diarrhea” and bringing in stool is usually not necessary. The best way to maintain hydration is by giving your infant frequent breast feedings or formula feedings and to make sure that they have tears when they cry and a moist mouth.  When you stick a finger in a baby’s mouth, the finger should never come out dry. A drooling infant is not dehydrated. It is difficult to tell if your child has urinated if they are in diapers, and are having diarrhea, as it is all watery together and the newer diapers “wick” the urine. Unless there is a large volume of urine you may not be able to tell that your child has urinated.  When in doubt, we actually either put a bag on a baby to see if they urinate or weigh the diaper, but this is not necessary at home. I see a lot of babies and toddlers whose parents are worried that they are dehydrated because “they have not urinated in 12 hours”. But while saying that,  the child is crawling or walking around the room drooling.  They just could not tell that they were wet as the diaper was not saturated. So much for advanced technology diapers, sometimes they are TOO good. For older infants and children, let them have frequent drinks of either Pedialyte or Gatorade and also let them eat solid foods.  When I was first in practice it was thought that the “gut” needed to rest and a BRAT diet was recommended. So, kids who had diarrhea were only given bananas, rice, applesauce and toast.  This was not only boring, but is was found to be too limiting and did not provide enough protein and nutrition to allow the gut to heal. It is now recommended to “feed a child through their diarrhea”, but to avoid fatty foods, and food high in simple sugars like apple juice.  Provide complex carbohydrates like cereal, potatoes and bread, along with lean meats, fruits and vegetables. In most cases of diarrhea a child can still tolerate dairy products, but if their diarrhea seems persistent or returns after your child drinks milk etc. you might limit their dairy for several days in order that the cells that produce lactase may regenerate. It is not uncommon for children to have 5 – 7 days of diarrhea with a viral gastroenteritis. There is some new data on using probiotics to shorten the course of diarrhea and in cases of prolonged diarrhea I have used some of these products (such as Florastor for kids) with success. This may help the gut by restoring good bacteria to promote intestinal health. We've all been there, haven't we?  We'll chat again tomorrow! Send your question to Dr. Sue!

Daily Dose

Pet Turtles And Salmonella Risk?

The link between pet turtles and salmonella I was recently traveling to a medical meeting and often use my airplane time to catch up on my journal reading. An article from Pediatrics discussing the issue of pet turtles and salmonella infections caught my eye.

In this study of a multi-state outbreak of Salmonella (a bacteria that causes vomiting and diarrhea)
in 2007 and 2008, the long known link between turtles and salmonella was being reviewed.  Of 107 patients identified from 34 states, over 50% were less than 10 years of age, and 60% of 78 patients who were available for interviews reported exposure to turtles the week before they became ill. It also seems that small turtles (I had them when I was growing up), accounted for 87% of the exposures.

Sales of small turtles have been banned by the FDA since 1975 (I am really showing my age), but are currently being sold over the internet, in flea markets and even in some retail stores, without any warnings of possible salmonella infection. In fact, some people will advertise “salmonella free” turtles which have never been bred. Due to this there has been an increase in small turtle ownership over the last 10 years and up to 6% of salmonella infections in the U.S. are due to reptile contact rather than from food -borne sources. In fact, those small turtles are not the only source of salmonella infections, but all reptiles may carry this organism including iguanas, other lizards and even snakes. (okay, I have to admit with three sons we had all of these during their childhood, not knowing they could cause illness). Another interesting fact is that you do not even have to touch the reptile, (which I hated to do), but cleaning the water and the aquarium (which WAS often my job!) is also a source of exposure. So, few parents and obviously this pediatricians are aware of the fact that salmonella infections from reptiles are actually on the rise. It’s not just those small turtles that live in the bowl with the palm tree, but all of those reptiles pose a risk for infection. As parents do know, it is hard to keep children from touching or playing with the turtle, or iguana and hand washing right after touching a pet often does not occur. No one likes vomiting and diarrhea, and it may not always be due to the food at the picnic! That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue now!

Daily Dose

How to Treat A Vomiting Child

We are definitely in the throes of "sick season" in our office and with that comes a lot of kids with vomiting. I remember the first time that one of my own children vomited.

We were in Target, he was about two and he had said he "was sick". Now, seeing that he was not very specific and did not elaborate, I just went on shopping. Several minutes later, as he sat in the cart (with seat belt fastened), he just looked at me wide eyed and suddenly vomited. This is the moment as a parent that you understand the difference between babies that "spit up", and true, projectile vomiting! Now what do you do once your child has vomited (besides rush out of Target as fast as you can)? Once a child has vomited it is important not to give them anything else to eat or drink, for at least 30 to 45 minutes. That means even if they are "begging" for a drink, as you will probably see it come right back at you if you do. After waiting, you want to begin re-hydrating with clear liquids. Not a good idea to pull out the milk or food yet. In an infant you can use Pedialyte, which is an oral electrolyte solution, and instead of breast milk or formula you can try feeding your infant about an ounce of Pedialyte every 10 to 15 minutes and see if they can keep Pedialyte down. In toddlers and older children I use Gatorade, as it is not quite as "salty" and kids seem to take it better. Again, frequent small sips of Gatorade while you wait to see if the vomiting is persistent. Don't go too quickly on giving them larger volumes. The key is small amounts, frequently, which are easier to handle. As your child keeps down the Pedialyte or Gatorade you can increase the volume that they are taking and decrease the frequency. The main thing you are trying to do with a child of any age is to keep them from getting dehydrated and their vomiting is typically due to a viral illness affecting their GI tract. Because it is typically a virus that is the culprit for nasty vomiting, it just takes time to get through the illness. There is no "miracle" cure, and watching your child vomit, or cleaning up the vomit that invariably is usually not in the toilet, is one of the worst parenting jobs. That being said, there are very few children who will not experience vomiting at least once or twice during their childhood, so you need to keep "clear liquids" on hand in the pantry. Having powdered Gatorade around is a lifesaver at 2 a.m when your four-year-old wakes up and throws up. If you are giving the clear liquids, and your child tolerates larger volumes, but then vomits again later on, you just back up and start all over with smaller amounts more frequently. It is somewhat like a "balancing act" to give enough that they are hydrated, but at the same time to not give too much at one time that they vomit again. Slow and steady is the mantra. You should always be looking for your child to have tears, a wet and moist mouth (put your finger in there, it should come out with some saliva on it), and urine. It is often hard to tell if a child in diapers has had a wet diaper as they will not be "soaking" the diaper and smaller amounts of urine are "wicked" with the new super absorbent diapers. Children will also be pitiful after vomiting and may seem "lethargic" to you, but if they are an infant and can smile and make good eye contact or they are an older child who can tell you they feel terribly and don't want to drink Gatorade or play with their blocks they are probably not dehydrated. If in doubt, give your doctor a call to discuss what is going on. After using Pedialyte and Gatorade, and your child has not vomited for six to eight hours you can try adding some formula or breast milk, or other liquids such as chicken soup or a Popsicle. I still would not start solid food until the child has kept down other liquids. We parents all worry if our children don't "eat" but the fluids are the important part, and as we all know, a day without out chicken nuggets or peanut butter will be okay. Keep up the fluids!! If your child continues to vomit despite your best efforts with "slow and steady" fluids you need to call the doctor. We have plenty of patients that we see everyday to make sure they are hydrated, and to even watch them while they take fluids in our office. Occasionally, when all else fails we will have to hospitalize a child for IV hydration. Oh yes, remember to wash your hands frequently as these nasty viruses are contagious and parents will often find themselves getting sick after their children. That’s your daily dose, we’ll chat again tomorrow.

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