You guys, I have a confession. Well, maybe not so much of a confession as much as it’s an admission. I don’t do vomiting. The sound of retching and subsequent vomiting makes me turn on my heels and run as quickly as I can in the other direction. I am fully aware how this is somewhat problematic in my line of work because I evaluate a lot vomiting children, but most don’t vomit while I’m seeing them. Thank goodness! We all have our strengths and weaknesses, and my friends, vomiting is NOT my strength, I’ll admit it. I’m even more acutely aware of this after taking care of my sick toddler over the past week that culminated in vomiting. He didn’t even vomit on me. He vomited on my husband. But just the idea of being puked on had me dry heaving and rendered me useless in helping to clean up the mess. Diarrhea, no problem. Removing sticky, caked on boogers to the face, I’m a pro. Vomiting, no thank you. Taking care of a sick child is tough. Believe me, I know. When you add vomiting and diarrhea to the mix it’s not only tough, but it can be scary as well. Please read on to find out how you can help your children when they get stomach bugs and when you should worry and have him or her seen by their primary care provider (PCP).
Vomiting is the forceful removal of stomach contents. It can be associated with or without diarrhea, which is two or more very loose or watery stools. Just having one loose stool is not diarrhea and can be totally normal from time to time. Both vomiting and diarrhea can be caused by gastrointestinal (GI) infection, either by a virus, which is the most common cause, or by bacteria. You can also get symptoms of vomiting and diarrhea from food poisoning which is ingesting contaminated food or while traveling. Have you heard of Montezuma’s revenge? Whatever the cause, vomiting and diarrhea can range from mild to severe and the biggest concern at the end of the day really is dehydration, which is what happens to your body when it has lost too much fluid.
Most children with GI infections begin with severe symptoms and then will taper as they improve. For example, it’s typical of children with viral gastroenteritis to begin vomiting everything and not be able to keep anything down in the first few hours of illness. This can last anywhere from 3 to 4 hours, sometimes longer. From there, vomiting symptoms will decrease and they might have 1 to 2 episodes per day. Most vomiting will stop after 24 hours, but some children, especially younger kids, can have mild vomiting for a few days. After the vomiting subsides, many children will develop diarrhea or will have diarrhea with vomiting. Diarrhea can last days to even sometimes weeks.
So what do you do when your sweet little one starts vomiting? First, don’t panic. While it’s terrible seeing them in that state, it hopefully won’t last for long. If they’ve thrown up over themselves or over their bedding, clean them up and get them into clean clothes and make a pile of dirty laundry for when you have time to get to it. That washer will be working overtime for the next few days. I then recommend either having a big bucket or deep bowl by the bedside and placing towels all over their bed and on the floor surrounding the bed. This makes for super easy cleanup if they miss that bucket. Another option is making a little bed of towels on the bathroom floor, but when you’re sick, it’s often times nicer to be in your own bed.
Second, don’t let them eat or drink. Yes, you heard me right. During the first few hours of GI illness, what goes in, automatically comes right back out. Do yourself (and them) a favor and let those bowels rest for a few hours before offering anything. If they complain they’re thirsty, you can let them take sips of water, but make sure just sips, or ice chips if your child is old enough and not at risk for choking.
Third, once your child has not vomited for a few hours you can then offer more fluids, but again, don’t let them do too much, too fast. I like to recommend ice pops or popsicles. It’s a way to hydrate them and give a little sugar, but because it’s frozen they don’t consume too much fluid too quickly.
Finally, after they’ve kept fluids down for a few hours, you can them offer them food, but do so sparingly. Start with saltine crackers or toast and then add more foods as tolerated. If diarrhea is your child’s main issue, or it appears after the vomiting subsides, the no drinking rule does not apply. You can let them drink and eat as they please, but try to avoid fatty, heavy, or irritating foods. It is sometimes helpful to stick to the B.R.A.T. diet (bananas, rice, applesauce, white toast) because these foods act as binders and can help plug them up. Probiotics can also be helpful with profuse diarrhea, but be careful, in a few people probiotics can make diarrhea worse. Last, but certainly not least, horchata, also known as rice milk, is a great alternative to cow’s milk when your child has bad diarrhea. You can make it yourself (recipe here) or buy it at your local grocery store. The reason why I recommend avoiding cow’s milk in the days following a GI illness or with diarrhea is it can sometimes make diarrhea worse because the body can have trouble processing the lactose, which is the sugar found in milk.
Most children will be mildly dehydrated after a GI illness. Don’t fret as this is easily fixed by pushing fluids. At what point should you worry and when is it time to make an appointment with me? Well, first, if at any point your child has decreased urine and does not urinate for more than 8 hours or if urine is dark yellow, it may be an indication of dehydration. Second, if you notice that their tongue is dry as well as the inside of his or her mouth. Don’t worry so much about dry lips as it’s not as good of an indicator. Third, if your child’s eyes are dry and they don’t make tears as they cry. Fourth, if your baby has a sunken soft-spot. Fifth, if you press on your child’s thumbnail and make it pale and let go and then count the seconds for it to turn pink again and it takes longer than 2-3 seconds refill. Sixth, if your child is acting really sick, lethargic and is too weak to stand or, alternatively, if he or she is inconsolable and you can’t calm them down. These are all signs of dehydration or worsening illness and he or she should be been by their PCP immediately.
Finally, I’d like to leave you with a few more pointers and things I’ve learned taking care of my own sick kids. When there is vomiting or diarrhea in the house it’s time for paper towels, bleach and lots of handwashing. You guys, I’m all about saving the planet, but to help protect others in the family from a similar date with the porcelain goddess, ditch the hand towels and do single use paper towels in the kitchen and bathrooms for a week. Clean all household surfaces with diluted bleach water as this is the most effective way to kill some of the most virulent stomach viruses. Finally, wash those hands!!!!! In a pinch, a dollop of your hand sanitizer is a good option, but the best way to prevent illness is to thoroughly, and frequently, wash your hands with soap and water. My hope is that your little gal or guy is feeling better in no time and the rest of your family can get through it all relatively unscathed. Vomiting and diarrhea are no fun, but with this knowledge you will get through it. And, please, know that I’m here for you for all those questions and everything in between.
Information presented adapted from :
Mary-Faith Fuller, CPNP
I am a Pediatric Nurse Practitioner who has worked at ABC Pediatrics since January 2014.