Getting Through Gastroenteritis!

Gastroenteritis affects millions of American children each year. Although the illness often passes quickly, it is confusing and frightening to young children who do not understand what is wrong with them. If you as his parent know what to expect and are able to remain calm, you will reassure and comfort your child in the face of this universally unpleasant illness! The following questions and answers should help to reassure you.

Q: WHAT IS GASTROENTERITIS?

A: Often called a stomach bug or the stomach flu, gastroenteritis is an infection that:

o Is usually caused by viruses but can be caused by bacteria;
o Most often begins with vomiting and ends with diarrhea;
o Frequently includes high fever (104ºF, 40ºC);
o Usually lasts 24-48 hours from beginning to end;
o Is very contagious.

Just as a reminder, vomiting --or "throwing up"-is defined as the forceful emptying of
stomach contents out of the nose and mouth. Diarrhea --or "loose poops"-- is the production of loose watery stool at least 3 times a day.

Q: HOW WILL I KNOW THAT MY CHILD HAS GASTROENTERITIS?

A: Parents are often unsure how they will recognize an illness if their child gets it. You will know that your child is developing gastroenteritis if he:

o Develops a fever, vomiting or diarrhea;
o Gets unusually cranky and/or hard to settle down;
o Appears to have a stomachache that comes and goes;
o Loses his appetite;
o Changes his normal stooling pattern;
o Seems very tired.

Q: HOW CAN I HELP MY CHILD FEEL BETTER?

A: The best way to help your child feel better if he develops gastroenteritis is to give him something to drink slowly-a sip (a teaspoon, or 5 ml) every few minutes. Drinking fluid will help him feel better and will also keep him from becoming dehydrated-the worst complication of vomiting and diarrhea. Pediatricians think of this fluid in two categories and recommend that:

o A sick child should drink his maintenance fluid, which is the amount he drinks during twenty four hours when he is well.
o A sick child also needs to drink replacement fluid which means that he must replace the fluid he is losing.

This is a lot to drink!!! There are a couple of important points here: First, the more fluid a child loses, the more fluid he needs to drink. Parents sometimes think that, because so much fluid is coming out (yuck!), they should cut back on the fluid going in! This couldn't be further from the truth.

Q: WHAT FLUID IS BEST FOR MY CHILD, AND HOW MUCH SHOULD I GIVE?

A: Knowing that your child needs fluid during gastroenteritis is one thing. Knowing which drinks are best for your child is a totally different question! Fortunately, there are excellent guidelines for parents to help them choose. Which fluid is best and how much to give depend on a child's age and weight (when he is well!). Most briefly:

o Newborns to babies three months old should continue to be offered breast milk or full strength formula as usual. If they are sleepy, babies should be awakened for feedings every 3-4 hours.
o Babies from 3 months old to 2 years do best with Pedialyte or other oral rehydrating solutions (ORS). These are readily available at many grocery stores as well as the drug store. How much to give depends on the weight of your child: if less than 22 lbs, give 2-4 ounces slowly every time he vomits or has diarrhea; if he weighs more than that, increase the amounts as noted below for older children.
o For children over 2 years old, there are many choices of fluid to offer! Begin with half strength fruit juice and call your child's doctor for her specific recommendations. Assuming that your child weighs over 22 lbs, give him 4-8 ounces slowly every time he vomits or has diarrhea.

Q: BUT DOESN'T MY CHILD NEED TO EAT?

A: Although your child needs to drink, he does not need to eat! If he is hungry, feel free to offer him his regular food in addition to the fluid above. Special diets like the BRAT diet, once considered an important component of treatment, are no longer recommended. It is more helpful to let your child eat normally if he is hungry, but please understand that he may not have an appetite. Try not to push him to eat if he is not interested in food. You will know that he has turned the corner when his appetite returns.

Q: WHAT MEDICATIONS WILL HELP MY CHILD?

A: Many parents find it hard to resist the temptation to medicate their sick children. But medicine is not much good for children with gastroenteritis! There are four categories of medicine to consider, only one of which is usually helpful.

o Medicine that might appear to help by slowing down vomiting or diarrhea often in fact prolongs a child's illness. This is because infecting organisms can reproduce quickly, and the longer they are in the digestive tract, the more of them there are to make your child sick! Please give this kind of medicine to your child only on the advice of your doctor.
o Antibiotics are rarely helpful-and can be harmful. This is because gastroenteritis is mostly caused by viruses against which antibiotics simply will not work. Surprisingly, the use of antibiotics may prolong a child's infection rather than shorten it. Even if they are prescribed, do expect your child's blood, urine and stool to be sent for tests before antibiotics are given.
o Medicines that treat your child's fever or pain are excellent and often can make a sick child feel much more comfortable. Please check your child's temperature before giving acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Note that some fever medicines come in rectal suppositories which can be very handy in a miserable but vomiting child.
o The possible role of probiotics is worth discussing with your pediatrician. Data are just emerging about the ways in which probiotics may help the gut recover from illness.

Finally, if your child takes medicine every day for another problem and cannot hold it down now, please call your doctor for advice about whether to hold or repeat doses. Above all, remember: the best medicine for children with gastroenteritis is fluid!

Q: WHEN SHOULD I CALL THE DOCTOR?

A: If you have a child who is vomiting or has diarrhea, and you know what fluids to give him (as well as what medicines to offer or avoid), you still may worry about when and whether you should call the doctor. What are worrisome signs in your child? Some guidelines follow, but make sure to call your pediatrician if you are worried! When in doubt, please call for advice.

o Call if your child's vomit is bloody or greenish, "projectile" or shooting out of his nose and mouth, and/or lasting over 1-2 hours without slowing down.
o Call if your child's diarrhea is bloody or looks like jelly, is occurring twice as often as usual poops, and/or is or happening with shaking chills.
o Call if your child's fever is over 100.4ºF (38ºC) for a baby less than 3 months; over 102ºF (39ºC) for a child less than 2 years; over 104ºF (40ºC) for a child over 2 years.
o Call if your child is becoming dehydrated. If this is happening, he will have: darker or less urine than usual; drier diapers than usual; dry lips and mouth; sunken eyes with few tears; and cool, splotchy extremities.
o Call if your child develops pain which is new, worsening during his illness, or causing constant crying.

Q: WHAT ARE THE COMPLICATIONS OF VOMITING and DIARRHEA?

A: The most common complications of vomiting and diarrhea include dehydration and skin breakdown in the diaper area. Dehydration is the biggest problem for most children and a special risk for very young children. This is discussed above. Skin breakdown is common in diaper-aged children with diarrhea. It can be treated quite easily with thick barrier creams to protect the diaper area.

Q: HOW CAN I KEEP MY WHOLE FAMILY FROM GETTING SICK?

A: Parents are often aware that gastroenteritis is "catchy", and they are eager to learn how to keep their families from getting sick. Most causes of gastroenteritis are indeed very contagious not only because the infecting viruses are found in a child's saliva, vomitus and stool (!) but also because his stool can be infected with virus for weeks after the child's infection. To prevent the illness from spreading throughout your house, you can follow some simple rules of good hygiene:

o Wash your hands (and make sure your family washes theirs) after bathroom use, after changing diapers, and before eating!
o Do not kiss your sick child on the lips.
o Do not share towels, toothbrushes, cups or straws.

Q: WHEN MAY MY CHILD RETURN TO DAYCARE OR SCHOOL?

A: As your child begins to recover from gastroenteritis, you will begin to wonder when he may return to daycare or school. He will not feel like going to school for a couple of days and should not return until several criteria have been met:

o He has had no fever for 24 hours;
o He is drinking and eating normally;
o He is urinating usual amounts;
o He is acting like himself again, buzzing around with energy to spare!

Gastroenteritis is ubiquitous and unpleasant, but it certainly can be managed at home by parents who are both willing to watch their children carefully and able to keep the faith that, like so many childhood trials, this too shall pass! It may not always be easy, but you will all get through it!

The purpose of this article is to educate. While every effort has been made to ensure its accuracy, its content should not be construed as definitive medical advice and is not a substitute for the professional judgment of your child's health care provider in diagnosing and treating illness. Because each child's health care needs are unique and because medical knowledge is always evolving, please consult a qualified health care professional to obtain the most current recommendations appropriate to your child's medical care. Neither the author nor the publisher shall be liable for any outcome or damages resulting from reliance upon the content of this publication.

MOTRIN® is a registered trademark of Johnson & Johnson. TYLENOL® is a registered trademark of The Tylenol Company. ADVIL® is a registered trademark of Wyeth. PEDIALYTE is a registered trademark of Abbott Laboratories. No association, affiliation or endorsement of this article or its contents by the referenced companies is intended or implied.