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Care for Stomach Bugs
When to worry,
when not to worry? What to do, what not to do? These questions
plague parents of sick children, particularly when the culprit is
a stomach bug that can quickly dehydrate a child.
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Besides the drawings, clay
works, and other crafts that a child brings home from his nursery
school, you should also expect him to bring back a few stomach bugs.
Rampant in day-care centers, especially in the spring and fall,
stomach bugs are viral infections of the intestine that cause
nausea, vomiting, and diarrhea. In children, a bug typically starts
with a sudden onset of vomiting, possibly followed by diarrhea.
Fever, either high or low, may also be present. Bacteria or
parasites can also be responsible for stomach bugs, although less
frequently than viruses, and they can produce even more severe
symptoms. The main concern with all types of stomach bugs is loss of
fluid to vomiting or diarrhea. Younger children especially can
become dehydrated very quickly (see below for tips on how to prevent
or cure its ill effects).
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As far as how your darling
might pick up these bugs, let's just say that in medical terms it
goes by the poetic name of feco-oral or oro-fecal transmission.
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Vomiting from a Stomach
Virus
Vomiting can be quite violent,
especially at the onset of the illness. At first, food comes
out, but soon there is no more food, only a thin green bile. In
general, vomiting won't last for more than twenty-four hours,
especially if the fluid is replaced. Even more than diarrhea,
vomiting can cause dehydration.
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<
6 Months
Infants
Stomach viruses are rare in infants, since tiny tots don't
attend nursery school, but when a virus does strike (possibly
brought home by an older sibling), vigilance is the key. An
infant, especially a young one, can become very dehydrated after
just a few hours of vomiting. Keep in mind that other causes of
vomiting, such as blockage of the intestine, may be mistaken for
a stomach virus.
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If an infant suddenly
vomits on more than one occasion (and if it's real vomiting
instead of just a little spitting up), you should continue to
feed her breast milk or formula in small amounts, and call your
doctor for advice.
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6 Months
Children
With older kids, vomiting can usually be handled at home with
simple measures. The goal is to prevent dehydration in the first
twenty-four hours by replacing fluids. If you manage to
replenish the liquids he's losing, a child's body will do the
rest and build its defenses to banish the viral intruder.
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When To Worry
 | If the vomiting persists for more than twenty-four
hours, especially if it remains intense. |
| If the tiniest amount of fluid makes a child vomit.
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| If there are signs of dehydration. If a child
becomes dehydrated, he'll appear tired and pale. His eyes will
barely stay open, and he'll produce very little urine. These
signs indicate that oral rehydration isn't working. You should
go to the doctor's office or the hospital so a child can
receive intravenous fluids. |
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When Not To Worry
| If a child remains active. |
| If the vomiting recurs once or twice after subsiding for a
day or two. This may indicate that you have been too quick to
reintroduce foods that are a little tough on the tummy, such
as pizza, despite a child's encouraging cravings. |
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What
To Do
| Give a child the tiniest amount of liquid he will
tolerate without vomiting, but give it almost continuously
until the vomiting has settled. Use an eyedropper if you have
to, and go sloooowly. Too much volume will distend and
irritate the intestine, and that will trigger more vomiting.
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| As far as the type of liquid, you can use any soft
drink (cola, ginger ale, sports drink) diluted by half
with water and served at room temperature. Commercial
rehydration solutions such as Pedialyte are expensive and not
really any more effective than sodas at preventing
dehydration. |
| For an infant, you can use small quantities of breast
milk or formula diluted with twice as much water. If she
vomits more than a couple of times, switch her to clear
fluids, just, as you would an older child. |
| Give only fluid until at least six hours after the
vomiting ends. You can then start reintroducing very bland
solid foods, such as crackers or dry cereal. Again, go very
slowly. If a child tolerates food, you can creep back toward a
regular diet. If at any time vomiting begins again, go back to
the fluid replacement as explained above. |
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What Not To Do
| Don't use plain water. You need to replace
minerals, salts, and sugars, along with the water. |
| Don't reintroduce solid foods too quickly. |
| Don't give cow's milk or full-strength formula until
the vomiting has subsided. |
| Don't use antivomiting suppositories. They're
inefficient and potentially dangerous. |
In most cases, vomiting will last for a day or so and then
subside. It could be followed by diarrhea, which entails another
set of problems |
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Diarrhea from a Stomach
Virus
Diarrhea may follow vomiting or appear
on its own. It can vary from a few loose stools to very watery
stools.
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< 6
Months
Infants
Diarrhea is hard to define here, since young infants can
normally have up to ten very runny poops per day. A greater
frequency than that could represent diarrhea, especially if the
constituency is very runny. Since the very young are at greater
risk of dehydration, offer small amounts of breast milk or
formula, and call your doctor for advice.
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6 Months
Children
Diarrhea following a stomach virus is messy but usually not
serious, though you may be surprised by how long the loose
stools persist. Diaper rash is the most common inconvenience.
Compared to vomiting, diarrhea rarely causes worrisome
dehydration, but there's still a risk.
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When To
Worry
| If there's blood or mucus in the diarrhea |
| If the diarrhea is extremely frequent (more than
eight times daily) |
| If there are signs of dehydration [See:Above] |
| If there is a persistent high fever (over 102*F)
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Any of these symptoms could indicate a more virulent
bacterial infection or viral strain, which would require medical
attention.
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When Not
To Worry
When the diarrhea lasts. This
is more the rule than the exception. It can take up to a month
after a stomach virus for the stools to return to a normal
consistency. This does not mean that the virus is still present;
rather, it takes time for the intestine to heal and be able to
reabsorb water. Stool analysis or cultures have no benefits,
since the infection is gone. Just have patience.
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What To Do
| Feed a child whatever you would normally, but skip
the citrus and acidic vegetables like tomatoes. High-bulk
diets have no real value, and since it's going to last for a
while, you might as well be feeding him real foods. |
| Prevent outbreaks of diaper rash with naked time
when practical, and take the other preventive measures like
applying cream. |
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For a few days after
the vomiting or diarrhea, a child's appetite will, usually
decrease, and you may even see some of his ribs showing. It
could be a while before he goes back to eating with his old
enthusiasm and regains the weight he’s just lost. If you
pressure him to eat, you could end up with a picky eater or a
child who overindulges in sweets and starches. If you don't, I
promise you that this low-appetite phase will be followed by a
period When he'll be voracious, wolfing down everything you put
in front of him and calling for more. At that point, you'll see
the spaces between his ribs fill in. |
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Excerpted from The New
Basics by Michel Cohen, M.D.
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