Along with colds and coughs, winter brings the joy of stomach bugs. Often referred to as the

“stomach flu”, it usually starts with vomiting. Within a day, a child will start having diarrhea. As

a parent, how can you help your child at home? When should you bring them to the office?

When should you worry? Let’s try to answer some of those questions.

Most causes of “gastroenteritis” are viral. Historically, the most common cause has been

rotavirus. When I was training to be a pediatrician, my days on the wards were filled seeing

kids hospitalized for dehydration from rotavirus. In 2006, a vaccine came out to prevent kids

from getting rotavirus. It has been amazing! There has been an incredibly dramatic drop in

hospitalizations for rotavirus. There are still multiple other viruses that can cause

gastroenteritis but, fortunately, it’s much improved from a couple of decades ago. A lot of

these germs are picked up through fecal oral contact. Yep. You read that right. Improper

hand washing is a major spreader. And knowing that it can only take a few viral particles to

infect someone (and one stool can have millions of viral particles), this is not surprising.

Less commonly, bacteria can cause gastroenteritis. Bacteria can be picked up through food or

contact with known carriers of a bacteria. For example, reptiles are know to carry the bacteria

salmonella. We have seen our share of salmonella from pet turtles and lizards. This is why it’s

recommended to avoid having reptiles as pets if you have kids under five-years-old.

We usually don’t do a lot of testing in children when they have gastroenteritis. Stool studies

tend to be expensive and don’t usually change the management of your child. Exceptions to

this would be if your child is having bloody stool, if you have been traveling, camping, or if you

have a known exposure to concerning animals. Rarely do we treat a child with antibiotics for

diarrhea, even if it is bacterial. In some situations, antibiotics can actually prolong carrying the

bacteria so it is not to be prescribed lightly.

The most important thing when your child has gastroenteritis is to make sure that they stay

hydrated. As parents, we worry when our kids don’t eat. It’s human nature. But kids can go

days and days without eating. Hydration is what I worry about with my patients. If they are

vomiting, avoid trying to give them food and work on slowly getting liquids in them. Start with

just a teaspoon. If it stays down for fifteen minutes, try another teaspoon. If not, take a break

for a half an hour and try again. Children’s bodies tend to get an imbalance of electrolytes

faster and more often than adults. The younger they are, the more true that is. Try using a

solution like Pedialyte to hydrate your child. Pedialyte has the right combination of salt,

potassium, sugar, and water to replenish what your child is losing. I often will suggest

Pedialyte popsicles which can be found behind the counter at the pharmacy. It helps get fluids

in your child without giving a big load of liquid all at once. When your child has had several

hours without vomiting, slowly start going back to letting them eat. Once they have really

stopped vomiting, there is no need for a special diet even if they have diarrhea. We used to

prescribe the “BRAT” diet (bananas, rice, applesauce, and toast) for diarrhea but this has gone

by the wayside. Kids need more protein than that diet contains to heal their gut when they

have diarrhea so stick with a normal diet. That being said, it wouldn’t be a great time to feed

your child a bag of dried prunes!

When should you be worried? Signs of dehydration would be the main concern. Your young

child should have a wet diaper at least every six hours. Older kids will urinate at least a few

times a day. Is your little one making tears? Does the inside of their mouth look dry or their

eyes look sunken? Those would be signs they are getting dehydrated. If you are trying to

rehydrate them at home and they can’t even keep a teaspoon down after trying for a few

hours, we will often prescribe Zofran. Zofran helps break the cycle of vomiting. We see these

kids in the office before prescribing it to make sure there is nothing more to be concerned about

(like dehydration or appendicitis). You don’t need to rush to the ER if the only concerning

symptom your child has is bloody stool but I would recommend being seen in the office. Any

worsening abdominal pain should be checked out as well. If your child truly can’t keep

anything down and is dehydrated, they belong in the emergency room where they can get IV

fluids.

Usually, the vomiting can last a day or two and the diarrhea can last up to a week. If you are

experiencing something different than that, I would check in with your provider at South Lake.

We are happy to help navigate their illness. And, remember, wash your hands!