VOMITING AND DIARRHEA
Vomiting and diarrhea are most often caused by viral infections of the GI tract. Other illnesses that may cause these symptoms include respiratory infections, otitis media, strep throat, and urinary tract infections. In rare instances a more serious condition, such as bowel obstruction, appendicitis, meningitis, poisoning, or head injury, may cause vomiting with or without diarrhea. Bilious (green) vomiting, bloody vomiting, or bloody diarrhea need urgent evaluation.
Treatment of Vomiting and Diarrhea
In most cases, vomiting will cease within 24 to 48 hours. Diarrhea will often persist for over a week, and it may be over 2 weeks before the stools return to normal. Over-the-counter remedies for vomiting and diarrhea are generally not indicated for use in children. They do not cure the underlying causes, and may in fact mask the symptoms of more serious illness. Antibiotics or other prescription medications are only used in the few cases that are caused by bacterial or parasitic infections.
Most physicians now agree that proper fluid intake and continued solid feeding through episodes of vomiting and diarrhea is the best way to manage the symptoms. Your child’s intestines actually need the nutrition provided by a well balanced food intake to heal damaged tissue; otherwise the diarrhea may be prolonged. The following guidelines will help put you on the road to recovery:
· You may decide to give no fluids or food for the first 2 hours to allow the stomach and intestines to rest.
· Start re-feeding by offering small quantities of clear fluids. This means one teaspoon every 15 minutes for a child under age 5; children over 5 may have small sips. If your child vomits the first attempt, wait 15 minutes and try again. Do not wait an additional 2 hours with every episode of vomiting.
· The most correct fluid to use for dehydration caused by vomiting or the early phases of diarrhea is a commercial electrolyte solution such as Pedialyte or Gerber LiquiLytes. If your child is only mildly dehydrated they may not like the taste of these solutions. If you offer your child sugary fluids like fruit juice or sports drinks, be sure to dilute them with water, because too much sugar will actually worsen diarrhea. Remember, the more dehydrated an infant or child becomes, the more important it is to re-hydrate them with electrolyte solutions.
· You may continue breast feeding through vomiting or diarrhea. Formula is also fine and does not need to be diluted. For children over a year of age, cow’s milk in moderate amounts is acceptable.
· After 4 to 6 hours of clear liquids you may try to begin solid foods. For babies, this includes formula and any of the baby foods he was previously eating. Foods to choose initially for toddlers and older children include bananas, rice, applesauce, wheat, bread, lean meats, yogurt, fruits, vegetables, potatoes, and cereal. Avoid fatty foods. After 24 to 48 hours it is fine to resume a regular diet.
· If you believe vomiting has been caused by the ingestion of a poison, then call the MetroAtlantaPoisonControlCenter at (404) 616-9000.
Reasons to Call the Office
The main concern associated with vomiting and diarrhea is dehydration. Early signs of dehydration include decreased tears and decreased moisture in and around the mouth. Worsening signs of dehydration include dry lips and tongue, inability to make tears, and decreased urine output. These signs should prompt an office visit. Late signs of dehydration, in addition to decreased urine output, may include sunken eyes and cold or grey colored skin. These signs warrant immediate medical assessment. Other reasons to call the office include:
- Vomiting not improved after 24 hours.
- Greater than 10 episodes of vomiting and/or diarrhea in a 12 hour period.
- Fever greater than 103 degrees.
- Blood in vomitus or stool, or bilious (green) vomiting.
- Infant or child who is listless, difficult to awaken, disoriented, or irritable.
- Abdominal pain that becomes worse and is not relieved by the vomiting or diarrhea.
- Swollen or distended abdomen.
- Vomiting associated with a severe headache, stiff neck, or painful urination.
- Infant or child who cannot cry tears or has not urinated in greater than 8 to 10 hours.