Vomiting And Diarrhea In Children

Vomiting is typically self-limited and caused by a viral infection. Wait at least an hour before offering the child anything to drink. The first feedings should be small amounts of clear liquids such as Pedialyte; older children may prefer flat ginger ale, 7Up or sports drinks. Breast-fed infants may be nursed for a few minutes. Sips of these fluids may be offered every 15 to 20 minutes for the first few hours, and followed up with a “soft” diet including broth, Jello, plain crackers, etc. If the vomiting recurs, wait an hour or more and start over.

If vomiting persists beyond eight hours, or is accompanied by marked lethargy or high fever, there may be a serious underlying illness. Vomiting following a head or abdominal injury may also be a more serious sign. Prescription medication by injection or suppository is available for difficult cases.

“Diarrhea” means frequent, uncontrollable, loose to watery bowel movements. It is usually caused by a virus, and antibiotics are rarely helpful. Diarrhea accompanied by high fever and passage of blood is called “dysentery” and may be a sign of a more serious infection, especially if the patient has been out of the country recently. The principles of treatment are to prevent dehydration and permit healing of the inflamed intestine.

Mild diarrhea often clears up spontaneously. If there have been more than 5 or 6 loose stools in 24 hours, only clear liquids should be offered. The best is Pedialyte (available in several flavors and in popsicle form). Gatorade or other sports drinks are acceptable for older patients. Jello water (half strength Jello), clear broth, weak herbal tea, rice water or barley water are fairly good substitutes. Plain water or fruit juices are NOT appropriate. Breast-fed infants may continue to nurse.

As the child improves and appetite returns, simple starch foods can be introduced such as boiled rice or potato, ripe banana, mashed apples or carrots, rice cereal, and Jello. The next foods might include lean meat or poultry and soups for older children. Milk products and wheat products may be difficult to digest for up to three weeks and should be introduced with great care. Bottle-fed infants may resume formula when improved; diluting it by half often helps. Soy formulas often work better at this point, especially Isomil-DF.

Medications may be offered after age two to lessen cramps, but they are no substitute for a careful diet. Safe choices include Imodium and Pepto-Bismol. Kaopectate is seldom effective. Prescribed drugs such as Lomotil are dangerous and should not be given to children.

Signs of dehydration include dry skin and mouth, reduced urine output, absent tears, and lethargy. Fever may increase the risk of dehydration and should be treated if high. Children who are vomiting can be given Feverall (acetaminophen) suppositories if necessary. Careful handwashing is most important for protection of yourself and others and prevention of other cases. Vomiting and diarrhea should be assumed to be contagious.