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Entries in Diarrhea (2)


Parenting Tips For Your Puking Child: What to do when the stomach bug hits your house

We have seen a large number of pitiful patients in the past two weeks with a gnarly stomach bug.  Most of these kids have had vomiting for just a couple of days but then lingering stomach aches and diarrhea for 1-2 weeks. And a lot of these kids, more than we typicaly see, have gotten dangerously dehydrated (some even are requiring hospitalization for IV fluids).  

So I was preparing to write this blog post last week with all my pediatrician tips for how to help your child through a stomach bug....and then it hit at my house!  Luckily, we avoided a trip to the hospital, but now I'll add a few practical tips from my very recent personal experience of caring for my own vomiting child.

What is a stomach bug? Though many refer to this as "stomach flu," it is NOT truly flu (as in influenza). Instead, the medical term for a stomach bug is "viral gastroenteritis" which simply means a virus that attack the small intestine causing abdominal pain, vomiting, diarrhea, and sometimes fevers.  Many viruses could cause gastroenteritis including Rotavirus (which we have a vaccine for but still can cause disease in some kids), Norovirus, Adenovirus, etc. 

What happens if your child gets a stomach bug?  Typically, a child starts with nausea (in smaller kids they may be more fussy and lose their appetite) and possibly a fever.  Vomiting occurs the first couple of days and then diarrhea comes next and may last up to 2 weeks.  Not all children get both vomiting and diarrhea.  Some children have no fever.  And although we say the vomiting only lasts a day or two, some particularly strong strong viruses can cause more severe symptoms and the vomiting may persist for several days OR if a child tries to eat or drink too much while their stomach is still upset, they may begin vomiting again.

Where did the stomach bug come from?  This can be very difficult to pinpoint because a child can become sick anywhere from 12 hours to 4 days after being exposed to the virus.  Infected patients are most contagious to others while they are running a fever or vomiting, but unfortunately some of these viruses can be passed on even 1-2 weeks after a patient's symptoms have resolved.

What can you do to help your child with a stomach bug?

1. Push fluids SLOWLY:  I saw first hand last week who heartbreaking it can be to watch your thirsty child beg for more drink after vomiting but if you let them drink too much, too quickly, you'll just trigger more vomiting. The key is to go very slowly (start with just a teaspoon every 5-10 minutes, then increase to 1/2 an ounce every 20 minutes or so for the first hour).  For small children, use a syringe to give 10 mL (which is 1/3 of an ounce) if you must. After an hour, you can increase up to 1-2 ounces every 20-30 minutes.  After two hours since they last threw up, you can double the amount up to 2-4 ounces every 20-30 minutes.  

2. Advance their diet (from clear liquids to milk to solid foods) SLOWLY:

For an infant who is vomiting, we recommend continuing to breast or bottle feed if possible.  So if you are still breastfeeding, give them 20-30 minutes after vomiting and then nurse them (this is comforting plus heps restore the nutrients they lost).

For older children or infants over 4-6 months who are refusing their milk, try Pedialyte (a special formula with extra salt and less sugar that helps replace the nutrients a child's body needs after vomiting and diarrhea).

If your child hasn't vomitted for at least 6 hours or so, you can move beyond "clear liquids" to milk.  After 8 hours of no vomiting, it's okay to try solid foods.  

Stay away from herbal teas and sodas as the caffeine can worsen dehydration.  Also, full strength fruit juice has a lot of sugar and can sometimes make diarrhea worse, so dilute it down to half-strength (or mix it with unflavored Pedialyte).

We doctors now believe that the traditional BRAT diet (bananas, rice, applesauce, and toast) that we used to recommend for diarrhea actually doesn't give kids enough protein or calories. But remember to limit high-fat foods like chicken fingers and ice cream, which are harder to digest (may be thrown back up) and avoid spicy foods and fruit juices, which can irritate the gut and cause worsening stomach aches.

3. Give probiotics: Probiotics are live microorganisms (good bacteria) used to restore the balance of normal intestinal bacteria which is often wiped out with diarrhea.  Some studies have shown that probiotics can shorten the severity and duration of diarrhea.  Probiotics are especially important for children with bad diarrhea (more than 6-8 stools per day) or diarrhea lasting more than 2-3 days. I don't recommend any particular brand (common brands include Culturelle, BioGia, Florastor) but recommend child dosing (usually half the adult dose) for kids under 12 years.  Probiotics come in liquid form or powder that can be sprinkled into a drink and served wtihin 20-30 minutes. Give probiotics 1-2 times per day until your child's diarrhea resolves.

DO NOT use any anti-diarrheal medications which can make children with diarrhea a whole lot sicker! 

4. Watch for Red Flag signs that may signal dehydration or another serious problem:

Signs of dehydration:

- Decreased urination (fewer than 3-4 wet diapers in 24 hours for infants and not urinating for more than 12 hours for older children).

- Not making tears when they cry

- Dry, cracked lips 

- Feeling dizzy when standing up

If your child is still playful and active, he or she is not dehydrated. If you're concerned your child may be dehydrated, please call the office.

Red Flag symptoms that mean your child needs to be evaluated:

- Any of the above signs of dehydration

- Vomiting blood or dark green (like the color of a Christmas tree)

- Bloody diarrhea 

- Severe pain in their right lower abdomen 

- Vomiting for more than 2 days

How do you prevent everyone at home from getting the stomach bug?  

1. Wash Hands! Wash Hands! Wash Hands! Use warm water and soap (not just hand sanitizer).  

2. Wash their bedding, clothes, etc in hot water and dry on high heat.  

3. Wash hard surfaces frequently with disinfecting wipes.

4. Don't share utensils, cups, pillows, or towels.

Other miscellaneous tips:

- Take Cover!  If your child is in a crib, try putting an extra waterproof mattress cover on the crib and an extra sheet (so you can just peel off the top sheet and cover if your child vomits in the crib in the middle of the night).  For older children, cover everything with towels - the bed, the couch, the floor beneath, pillows, anything within range that will be a pain to clean. Have a stack of spare towels ready for when the old ones need to be changed.   And even drape a towel on yourself before you scoop up your puking child. This way you don't have to change clothes too every time they throw up and you're whisking them to the bathrrom.

- Empty a laundry basket and keep it nearby to toss in the dirty towels and clothes. Then later you can throw everything into a heavy wash together when you have a minute.

- Use Pedialyte freezer pops to help quench your child's thirst but keep them from drinking too much too quickly.  Have them hold it with a small hand towel so that their fingers don't get too cold.



In the News: Norovirus (Stomach Bug) Runs Rampant 

You may have seen the news reports in the last few days, that a new strand of Norovirus is spreading rapidly here in the US.

The new virus strand, "GII.4 Sydney" was identified in Australia last March.  More than half of 266 norovirus outbreaks reported during the last four months of 2012 were caused by the Australian strain, according to data released from the Centers for Disease Control and Prevention. 

And although it is often referred to as the "stomach flu" - Norovirus has no connection to the influenza virus. 

What symptoms does Norovirus cause?

The illness often begins suddenly. You may feel very sick, with body aches, stomach cramping, vomiting and/or diarrhea.

Symptoms typically appear within 12-48 hours after exposure to the virus and people remain contagious for approximately 3 days after their symptoms resolve.

How common is Norovirus?

The CDC estimates that each year more than 20 million cases of acute gastroenteritis are caused by noroviruses (so about 1 in every 15 Americans will get norovirus illness this year).

How does Norovirus spread?

Norovirus is tough to beat for two main reasons

1. It spreads rapidly and takes a very tiny amount of exposure to make someone sick.  One British scientist referred to it as the "Ferrari of the virus field" for its spreading speed. Fewer than 20 virus particle are enough to infect someone. 

2. Someone who is sick is contagious before they have symptoms:   Someone infected with Norovirus is shedding billions of viral particles (and start shedding virus without any symptoms, so they don’t know they have it and there’s no way to advise them about how to avoid spreading it).

Its rapid spread can be especially devastating in crowded, closed places such as daycare centers, schools, hotels, and cruise ships.

The viruses are found in the vomit and stool of infected people and are typically spread by the following ways:

  • Eating food or drinking liquids that are contaminated with norovirus (someone gets stool or vomit on their hands, then touches food or drink).
  • Touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth.
  • Having direct contact with a person who is infected with norovirus (for example, when caring for someone with norovirus or sharing foods or eating utensils with them).

How serious is Norovirus?

For most otherwise healthy people, Norovirus is usually not serious, just very uncomfortable.  Most people get better within 1­ to 2 days.

But, norovirus illness can be very serious in young children, the elderly, and people with other health conditions (like Diabetes). 

Norovirus is estimated to cause over 70,000 hospitalizations and 800 deaths each year in the United States.  Deaths are typically due to the main complication from Norovirus - dehydration.

Symptoms of dehydration to watch for in children:

- Decrease in frequency of urniation (fewer than 6 wet diapers in 24 hours in a young infant under 6-9 months and urinating fewer than 3-4 times in 24 hours in older children).

- Dry mouth and throat

- Feeling dizzy when standing up

- No tears when crying

What treatment is available for Norovirus?

There is no particular treatment for Norovirus.   

And, unfortunately, you can get norovirus illness more than once during your life.

Antibiotics will not help if you have norovirus illness. This is because antibiotics fight against bacteria, not viruses.

While infected, the most important thing is to ensure you (or your child) remains well hydrated.  Usually sipping small amounts of fluids frequently is the best approach (water or Pedialyte are best as juice and sugary drinks can worsen dehydration). 

Do not give an anti-diarrhea medication (such as Immodium) to your child. Anti-diarrhea medications usually allow the virus to increase reproduction and make the illness worse.

How to protect yourself from Norovirus?

1. Practice Hand Hygiene: Wash your hands carefully with soap and water (especially after using the restroom or changing diapers) and always before prepping food or eating.  Alcohol-based hand sanitizer is better than nothing, but is not equivalent to washing with soap and water if possible.  And if you've been an unlikely victim of the Norovirus, do not prepare food for others while you have symptoms and for 3 days afterwards.

2. Be careful in the kitchen:  Carefully wash fruits and vegetables and cook shellfish thoroughly before eating.

3. Clean contaminated surfaces: If someone in your home falls victim to the Norovirus (or any stomach bug), immediately clean and disinfect contaminated surfaces using a beach-based household cleaner (as directed on the product label).  You can make your own cleaning solution by mixing 5 tablespoons to 1.5 cups of household bleach per 1 gallon of water.

Of note: On hard surfaces in the environment, the Norovirus can survive for up to 12 hours. On contaminated carpet, noroviruses have been found to survive for up to 12 days.

4. Wash laundry!:  Immediately remove and wash clothing or linens that have been contaminated with vomit or stool.  Items should be washed with detergent at the maximum available cycle length and then machine dried. If available, wear rubber or disposab le gloves while handling soiled clothing or linens and wash your hands after reomving them.