Vomiting & Diarrhea
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/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"
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 it's 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 best, 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 (infants only)
Jell-O water (mix acc. to dir. 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:
cereals
toast & jam
fresh fruit
crackers
rice
pasta
potatoes
yogurt
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. |
