It is beginning to be that time of year when our office picks up the case pace as viruses that have been dormant all summer long begin to appear and have a stronghold on the community.
I have been seeing a lot of vomiting and diarrhea, and it is affecting all ages, including the parents. The most important thing about this common illness, also known as gastroenteritis, is making sure that your child stays hydrated. The tummy bug in our area is typically causing anywhere from 6-24 hours of vomiting, which is often accompanied or followed by diarrhea. Not much fun.
If you have a young child it is sometimes difficult to tell if they have just had a “fluky” episode of vomiting, as infants and even toddlers may sometimes seem to “lose everything” and be fine right after that. In that case, when you go to give them another bottle, you do not see another episode of vomiting. When it is truly vomiting, you get the sense rather quickly as it becomes recurrent when they are fed again!
Once you know that you are dealing with vomiting you want to do 2 things: Do not give them any more fluids for at least 20–30 minutes and when you do, give very small volumes of a clear liquid like Pedialyte (or Gatorade for an older child).
Warning: Do not give them milk as you are more likely to see more vomiting following dairy and there is really nothing like cleaning up milk containing vomit. My rule: give your child the easiest thing to digest which has less color too. It is hard to clean up red and blue Gatorade, better yellow or clear.
I often put a ½ – 1 ounce portion of Pedialyte (Gatorade) in a bottle or cup and let the child have that. If you give the whole cup or bottle they will gulp away and get too much at one time. After giving the small volume, wait for 10 – 15 minutes and if they have not vomited you may repeat that amount. The key to maintaining hydration is small and frequent sips.
After an hour or two and if there has not been any more vomiting you can begin to increase the volume of liquid and slowly allow them to take in more. If you start to see them vomit again, STOP, wait another 30 minutes and try again, with a smaller volume. If you cannot stop the vomiting despite slow, steady sips, then you will need to check with your doctor about an appt to be seen, as sometimes they will use a medication to help stop the vomiting. You should NEVER see blood or bile in the vomit. If so, call your doctor immediately.
While your child is vomiting you are just trying to maintain their hydration. A child does not have to eat ANYTHING during this “short-lived” episode of vomiting as long as we can keep them hydrated!! I know not eating worries parents, but just think about you, food during vomiting is not appetizing. Once the vomiting has stopped we can think about re-feeding with solid foods.
A good way to assess hydration is to look at your child’s mouth, which should remain moist, not dry and tacky. Babies will continue to have drool. Tears and mucous are also signs of hydration, so if you child is crying tears and has a runny nose, they are not showing signs of dehydration. I find it hard to assess hydration from wet diapers as the newer diapers are so good, that they pull small amounts of urine into the diaper and it is very hard to tell if there is any urine unless the diaper is weighed.
Your child does have to have urine, but they will not have “sopping wet” diapers during this time. If they are having diarrhea as well you cannot tell if there is urine mixed in with the liquid stool, so look for tears and drool. It is easier to tell in an older child as they are talking to you and can try and urinate for you etc.
Lastly, dehydrated children are lethargic, not just “puny and pitiful” but lethargic. They often will not walk or play. They will barely lift their heads to take a sip of fluid. Their eyes look sunken and their skin seems to lose its elasticity. These are all bad signs and point to dehydration and an urgent call to your doctor.
I always say, a dehydrated child does not come walking into my office and exam room, they are carried and appear sick. They do not play with their toy train, or watch a video on Mom’s phone, they look sick.
That’s your daily dose for today. We’ll chat again tomorrow.