Vomiting and Diarrhea (Gastroenteritis)

Vomiting and Diarrhea (Gastroenteritis) 2017-03-17T03:43:55+00:00

Vomiting happens when the stomach becomes irritated. This is usually caused by a viral infection, although there are other causes. When vomiting is due to a routine stomach virus, it is usually associated with diarrhea. Although uncomfortable, vomiting in and of itself is not dangerous to the child. If your child’s vomiting is associated with a significant head injury, please refer to the section on “head injury” in this handbook.

Diarrhea is characterized by frequent, loose, watery stools. It is most commonly caused by a viral infection called gastroenteritis. This causes the cells of the stomach and intestine to become sick and even stop their normal function (absorbing fluids and nutrients). Gastroenteritis often begins with vomiting and fever. Then, after several hours, the vomiting resolves and diarrhea follows. Rarely, there are other more serious causes of diarrhea other than stomach viruses. These include diarrhea due to bacteria (Salmonella, E. Coli, Campylobacter, Shigella and others), parasitic infections (such as Giardia) and milk allergy.  The vast majority of the cases of diarrhea are due to gastrointestinal viruses, which resolve without any specific treatment. Our approach to treating vomiting and diarrhea is based on the assumption that the vomiting and diarrhea is due to a stomach virus which will eventually resolve on its own. Please see the section below on when to worry that your child’s vomiting and diarrhea is more serious.

The main concern with vomiting and diarrhea is that dehydration may result. Our goal with therapy of vomiting and diarrhea is to prevent this until the intestine can recover and resume its normal function. We do not recommend the routine use of medications to stop diarrhea unless specifically prescribed by our office. Certain types of diarrhea can be dangerous to stop with an anti-diarrheal medication. These particular medications work by paralyzing the intestine and not by reversing the diarrhea process. Serious types of diarrhea producing germs can sometimes enter into the blood stream in a small child if anti-diarrheal medications are used. The underlying cause of the diarrhea must be treated, not masked, and this is done by diet.

Dehydration results when there are excessive fluid losses from the infant or child, usually as a result of the vomiting or diarrhea. Dehydration can also result from any condition in which the child does not take in adequate fluids such as with severe mouth ulcers and other viral infections, such as RSV bronchiolitis. Dehydration is serious and should be evaluated in the office or emergency room. Signs of dehydration include:

  • Dry mouth. Place your finger inside the child’s cheek and then rub your thumb and forefinger together. If it is wet, there is not need to worry about dehydration. If, however, it feels sticky or dry, then dehydration may be present. A child that is drooling is not dehydrated.
  • Poor urine output. Infants and children usually urinate at least once every eight hours. Decreased urine output in the presence of diarrhea may mean that dehydration is present.  No urine output in a 24 hour period is a serious sign of dehydration.
  • Absence of Tears. If your child is making tears when she cries, then there is little chance of dehydration. If there are no tears when your child cries, this could possibly indicate dehydration when taken with other symptoms outlined above.
  • Decreased skin turgor. Pinching the skin on the back of the child’s hand or abdomen should cause it to snap back into place readily and rapidly. If the skin is slow to return to its place, then dehydration may be present.
  • Lethargy. If your child or infant is not alert or shows little interest in her surroundings and little interest in normal activities such as eating and playing and, this behavior is in association with diarrhea and / or vomiting, this may be a sign of dehydration.

Note: The most reliable and important signs of dehydration are items #1 and 2.

Your Child Should be Evaluated If:

  • Signs of dehydration are present.
  • The diarrhea is associated with high fever over 104 degrees unresponsive to acetaminophen.
  • Pus or blood is noted in the stool.
  • Diarrhea persists for more than three days despite diet changes listed below.
  • Vomiting persists more than 24 hours.
  • Your child becomes confused or difficult to arouse.
  • The vomiting is associated with a severe headache.
  • The vomitus is green stained (bilious).
  • Your child is less than three months old and is vomiting forcefully.
  • Your child is less than three months old and is having a high volume of diarrhea after 24 hours.

Treatment of Vomiting and Diarrhea in Infants:

For the first 24 hours:

  • Give nothing by mouth for two or three hours after your child’s vomiting begins. Then, begin to give fluids gradually increasing the volume. If your child is breast fed, continue to breast feed your baby. Smaller more frequent feedings can be helpful.  Breast milk is very easy on the stomach and has antibodies and other anti-infectious factors which can help your baby get over a stomach virus more rapidly.
  • If your baby is formula fed, discontinue giving the formula and give one of the oral re-hydration solutions instead. We recommend Pedialyte or Infalyte. These solutions have simple sugars and salts in them which are easily absorbed and help sustain your child until he or she recovers from the illness. Give these solutions in small amounts, frequently and at room temperature. Even if your infant’s vomiting persists encourage these fluids anyway, in between vomiting episodes. If diarrhea alone is present, begin fluids as outlined below in large amounts. The goal of fluid therapy in vomiting and diarrhea illnesses in children is to give more fluid to the child than is lost in the diarrhea and vomiting so that dehydration won’t result.
  • Watch closely for signs of dehydration. (see above signs of dehydration)

After 24 hours:

  • Continue breast-feeding.
  • If your baby is formula fed, restart their regular formula.   You can alternate this with Pedialyte or Infalyte every other feeding.  Do this for 24 hours then go back to their regular formula alone.
  • Watch closely for signs of dehydration. (see above signs of dehydration)

Treatment of Vomiting and Diarrhea for Older Children:

For the first 24 hours:

1. Give nothing by mouth for three or four hours after your child’s vomiting begins. Then, begin to give clear liquids, gradually increasing the volume. Give these in small amounts, frequently and at room temperature. Even if your child’s vomiting persists begin the fluids anyway, in between vomiting episodes. If diarrhea alone is present, begin fluids as outlined below in large amounts. The goal of fluid therapy in vomiting and diarrhea illnesses in children is to give more fluid to the child than is lost in the diarrhea and vomiting so that dehydration won’t result.  You should give the following:

  • no milk products
  • clear fluids in small amounts at room temperature and offer frequently such as:
  • Pedialyte or Infalyte
  • Jello, Jello water
  • Sprite or 7-Up
  • Bouillon or chicken soup
  • Popsicles

2. Watch closely for signs of dehydration. (see above signs of dehydration)

After 24 hours:

1. Offer bland foods as your child can tolerate these. These foods include:

  • Chicken and rice soup
  • Rice or cooked cereals
  • Ripe bananas
  • Applesauce
  • Crackers or dry toast
  • Plain macaroni, spaghetti, noodles (no cheese or grease)

2. Watch closely for signs of dehydration. (see above signs of dehydration)

You should you should return to your child’s normal diet as soon as they feel up to it. BRAT (Bananas, rice, applesauce and toast) foods aren’t bad. They just don’t provide the fat and protein that they need. Sticking with them too long could actually slow your recovery.

Reviewed 3/16/17 by Dr. Byrum