Vomiting and diarrhea usually result from gastroenteritis (GE), an intestinal infection. They can also arise from acute food poisoning (which acts and is treated just like GE), food allergies, or surgical problems such as appendicitis. The best way to be sure it is not the latter is to look for pain and tenderness. All GE may be accompanied by a vague, crampy pain especially right before an episode of vomiting or diarrhea. Surgical problems virtually always have a more constant, sharp, and localized pain – severe enough to make the child visibly tense up when you try to touch his or her belly. You should call immediately if your child has this kind of pain. Only a tiny percentage of GE cases require any medication at all to get better, regardless of whether they are viral or bacterial. Those few who may need an antibiotic will be distinguished by high fever (>104°), bloody stools, or persisting and very crampy diarrhea for more than 3 days. We will want to culture the stool of a child with this pattern, but stool tests are NOT routinely necessary in most children with diarrhea.
The MAIN DANGER OF GE IS DEHYDRATION– not enough fluid in the body. As long as you can keep up with replacing the fluid being lost, however, the child will be fine. This is easier to do with diarrhea than it is with vomiting, but luckily in most cases the vomiting is worst right at the outset then subsides. Signs of dehydration include:
- decreased frequency/amount of urination
- dark/strong smelling urine
- sunken eyes and/or “soft spot” in an infant
- extreme drowsiness or fussiness
- crying without tears
- dry or “sticky” mouth
If you feel your child is becoming dehydrated despite your best efforts (see below), you should not hesitate to call. Some IV fluid for a few hours, or a short stay in the hospital, may be necessary.
Dehydration is best prevented (& treated) by giving small amounts of liquids very frequently (see chart at end of this section). The best liquid to give by far is an oral electrolyte or rehydration solution (ORS). ORS is not just a “drink” – it’s a medicine that does 3 important things no drink can do –
- ORS turns on microscopic pumps in the stomach, so it gets absorbed into the bloodstream more quickly than any other fluid – literally within minutes. It can therefore prevent or improve dehydration even if vomiting continues, because some of it always gets absorbed before the next episode.
- ORS replaces not just the water, but also the salt lost by vomiting and diarrhea. This makes it much safer than other fluids in this situation, which, when given in large volumes, can lead to a condition of too-little salt in the body (“water poisoning”) and cause dangerous convulsions.
- ORS actually calms the stomach and usually stops the vomiting after several hours.
Examples of ORS include Pedialyte, Rehydralyte, Enfalyte, LiquiLyte, Naturalyte, CeraLyte, ReVital, as well as generic “store brands” – these are available at most pharmacies and supermarkets without a prescription. Parents find many children are reluctant to drink ORS due to its poor taste. An infant can be forced to take ORS using a dropper, and usually will start taking it willingly after that has been done a few times. A toddler or older child can be more stubborn, but in recent years a number of new improved ORS flavors have come out, and if a child is truly in the early stages of dehydration they will usually be thirsty enough to drink it, perhaps with some coaxing, despite its taste. Also, ORS can be frozen into a “Pedialyte Popsicle” and this may encourage some children to take it (caution: each popsicle typically contains only 1 oz. Of ORS – and the child needs to take many ounces and so many popsicles to stay hydrated).
ORS is really the only safe, effective choice for a child with severe vomiting & diarrhea (episodes occurring every 2-3h or more) or who is already showing signs of dehydration (see above). For the child with milder symptoms, ORS is still the best option, but other clear liquids such as juice (any kind except apple), flat soda, or sports drinks may suffice to prevent dehydration. The advantage is these may be easier to get your child to take. The disadvantages compared to ORS are that they may actually perpetuate the diarrhea (by virtue of their high sugar content) and they won’t have the stomach-calming effect that ORS does. Some “half way” (not as good as ORS but better than juice or soda pop) alternatives:
- Chicken Soup alternating with other (non-ORS) clears.
- Mixture of 2 parts ORS + 1 part Gatorade
- Mixture of 1 part ORS + 1 part breast milk or infant formula
- Jell-O water (mix according to directions, then add 2 extra cups water)
When diarrhea is the main problem, and there is little or no vomiting, you should CONTINUE TO FEED YOUR CHILD food. Despite the GE, he/she still needs and is able to absorb the calories. Diarrhea actually gets better faster if there is solid matter in the intestine with which to form normal stools. Foods to avoid because they could make matters worse include milk, cheese, and most other dairy products; fast food, fried foods, oily dressings and other greasy things; chocolate and foods that are particularly spicy. Foods that are often quite good for a child with GE include:
toast & jam
lean meats (broiled, roasted, or boiled, NOT fried)
Diarrhea medicines, over-the-counter or by prescription, are rarely indicated. Some of them are actually dangerous. In particular, children should NEVER be given medicines such as Lomotil and Immodium often used for adults in this situation. Kaopectate, Pepto-Bismol, & other similar products are safer, but they are not very effective and probably not worth buying. Again, the key to managing your child with vomiting and diarrhea is FLUID, not medicine.