Also: Stomach Flu

Gastroenteritis is an inflammation of the stomach and intestines, often called the “stomach flu” (although it is not caused by the influenza virus.) The symptoms of gastroenteritis commonly include vomiting, stomachache, diarrhea, headache, fever and decreased appetite. Symptoms typically begin 1 to 2 days following exposure and may last for 1 to 10 days.

You should call your pediatrician immediately if your child has any of the following symptoms:

  1. Looks weak or is unresponsive
  2. Severe worsening abdominal pain
  3. A rectal temperature greater than 100.4ºF if child is less than 3 months old
  4. Vomits yellow or green bile
  5. Blood or mucus in the diarrhea
  6. Projectile vomiting occurring 2 or more times a day in a child less than 3 months old. (Projectile vomiting means that the vomit travels greater than 1 foot from the baby)
  7. Vomiting over 24 hours without diarrhea
  8. No improvement in diarrhea after 1 week

What is Diarrhea?

Diarrhea is the passage of watery stools, usually 3 or more in a 24 hour period. It is the change in consistency of the stools, more than the number, that is important. Babies fed breast milk will usually pass very loose, yellow stools. Mild diarrhea, during which a child’s energy level and intake of fluids remains normal, requires no special treatment other than the avoidance of excessive fruit juice. More significant diarrhea can cause dehydration and should be treated.

What is Dehydration?

Dehydration is a loss of both water and salt from the body. The usual cause is a lot of vomiting and/or diarrhea. Those most susceptible to dehydration are babies under a year of age and those with a significant fever in addition to vomiting and diarrhea. There is no one way to determine dehydration. Early signs of dehydration include dryness of the mouth and thirst. As dehydration worsens, symptoms can include irritability, lethargy, decreased urine output, few or no tears when crying vigorously, dry or stickly saliva, and worsening nausea.

How do you avoid dehydration?

The best treatment for dehydration is oral re-hydration therapy (ORT). When successful, ORT can prevent trips to the emergency room and the need for intravenous fluids. ORT does NOT stop vomiting or diarrhea, but will help prevent dehydration.

ORT is different from other beverages in that it provides the proper balance of sugars and salts to safely rehydrate the body and prevent worsening of diarrhea. GOOD examples include Pedialyte, Rehydralyte, Ricelyte, Resol, and Gerber or Kaolectrolyte powders. POOR examples include sodas, sports drinks, or fruit juices. Sports drinks such as Gatorade and juices such as white grape juice should only be used in children with mild gastrointestinal symptoms who are not yet dehydrated. Apple juice can sometimes worsen diarrhea.

Using ORT is not always easy. If a child is not yet dehydrated, they may refuse it due to its salty taste. If a child is actively vomiting or nauseated, they may also be reluctant to take the fluid. In this situation, treatment requires time and patience. To overcome a nauseated child’s refusal to drink, ORT can be given in small, frequent amounts with a dropper or teaspoon every 2-3 minutes. If a child vomits, wait at least 10-15 minutes before giving more fluid.

· For a child under 20 pounds, aim for 2 ounces of ORT every hour over a 4 to 6 hour period.
· For a child over 20 pounds, try for 3 ounces of fluid every hour over 4 to 6 hours.
· If your child is not vomiting and is improving consistently, you can gradually increase the fluids. Slow down if vomiting recurs.
· As long as tolerated, breastfeeding can continue in lieu of other fluids.
· If after 4 hours your child is not vomiting and I consistently thirsty, they can drink unlimited amounts of ORT.

Tips on improving the taste of ORT:
· The colder the ORT, the better it will taste.
· Try frozen ORT pops.
· Try kaolectrolyte or Gerber powders (diluted in WATER) which have longer shelf lives than ORT liquids and are easier to carry on trips.
· Add sugar-free Koolaid or Crystal Light powder to ORT for better taste. ORT is NOT effective if mixed with other beverages.

“BRAT” diet:
As soon as your child’s appetite returns, you can feed them (assuming they have tolerated 4 to 6 hours of fluid replacement without vomiting.) Good food choices include toast or crackers, rice, noodles, applesauce, bananas or yogurt. Avoid fatty foods and milk until your child has not vomited or had diarrhea for 24 hours.

Occasionally when your child has had a prolonged bout of diarrhea, their intestines may not properly absorb lactose, a milk sugar, for several weeks. Try lactose-reduced milk (i.e. lactaid) or a lactose-free formula (or breastmilk) for 1-2 weeks to allow the intestinal lining to recover.