Kids' Stomach Bugs, Diarrhea and Vomiting: What to do

An intestinal infection (acute gastroenteritis) with diarrhea, vomiting and sometimes fever seems like a curse to us all. We feel awful and can do little. But they do help us appreciate how important our intestines are to our everyday existence. And fortunately, most of us get past each episode and back to our normal lives.

Infants or children are different. Their smaller water and nutrient reserves make them more vulnerable to dehydration, especially if vomiting or fever accompany the diarrhea. Particular attention must be focused on maintaining their hydration. As long as they continue to drink plenty of liquids, and can keep them down, they generally do well. They'll urinate normally, have moisture in their mouths, and have tears when they cry.

Children Need Fluids More Than Medicine

Medications usually aren't the answer and ones that slow the intestinal tract can be dangerous. The problem is that infants and children still lose water and salts into the intestinal tract. When the diarrhea isn't discharged, we may miss early clues that a child is dehydrated. In stopping the diarrhea, many of these medications also prevent the body’s elimination of the bacteria or virus causing the infection. This can prolong the illness. For some bacteria, these medications which also slow intesinal passage prolong and perpetuate the illness. These medicines can be used for severe abdominal cramps, but they should be reserved for older children.

What infants and children need isn't medicine but fluid to replace the salt and water they are losing in the stool and to keep up their normal maintenance requirements. Those needs increase when there's a fever. For every two degrees Fahrenheit the temperature rises, fluid needs increase by 10 percent.

So a child whose temperature is 101 degrees needs 20% more fluids. He or she will also need more sodium, potassium, and bicarbonate. These are lost in diarrheal stool and must be replaced to avoid problems of salt imbalances and dehydration.

Infants with Gastroenteritis

Breastfed babies should continue their usual feedings, and you might increase them if the baby is having frequent diarrhea. If you have similar symptoms, you can continue to feed, as long as you remain adequately hydrated yourself. You may transfer the infection to the baby, but you may have done so even before you developed the actual symptoms. And the most important thing you can do is to keep the baby hydrated.

For formula-fed infants, already mixed solutions, Pedialyte and Lytren, (by Abbott and Mead Johnson, respectively), are available with Pedialyte also available as freezer pops. These assure that babies receive the right proportions of fluid and salts the baby needs. Sugar isn't added for taste, but to help the salt get fully absorbed. A maximum of 1 quart should be given per day.

Some babies want to drink more. If your baby has already begun infant solids and remains hungry, you can offer cereal and fruits (particularly bananas for potassium). If your baby is vomiting, these fluids should be given frequently but in very small quantities. Often, that will mean feeding the infant as little as a tablespoon every 15 minutes and advancing the amount as you're able. If the baby is unable to keep even that small bit down, you need to cll your doctor.

Once the acute stages of diarrhea are over, you may resume a simple feeding regimen. The breastfed baby continues on the breast, generally without problem or change. For the formula-fed infant, you can dilute several bottles by half before returning the child to normal formula. Some babies briefly have trouble absorbing lactose after an infection, so carefully watch babies on milk-based formulas and talk with your doctor if the baby seems particularly uncomfortable or has ongoing diarrhea.

Babies should be able to resume their normal solid feeding routine within a day or two, and should have no problem doing so.

The Older Child

Gatorade and Jell-O can help to hydrate the toddler or older child who does not react to artificial food coloring and flavoring. (These should only be used temporarily for an infant--giving you time to get to a store). Both have adequate amounts of sodium. But they have large amounts of sugar which can stimulate more diarrhea and they are low in potassium. The sugar itself may stimulate further diarrhea, which will be difficult to differentiate from an infection.

Do remember that with little in your child’s intestine, the coloring may come through, so don't be surprised by some “bloody” diarrhea.

Less expensive, online recipes for rehydration solutions replicate the World Health Organization’s recommendations, but these salt and sugar versions are generally tasteless (though they can be adapted by adding bananas or chased with a small amount of juice). Because the ratio of sugar and salt has to be precisely balanced, these recipes can be harmful if an error is made. For the same reason, boiled skim milk should be avoided since that concentrates the protein and salts.

Some children benefit from a brief recovery period on a bland diet that consists chiefly of bananas, rice cereal, applesauce, and toast, and hence called the BRAT diet. Crackers and similar bland foods can also be added on a progressive basis. These foods avoid lactose and fats, both of which are difficult for some children to handle after a bout of gastroenteritis. These foods can generally be expanded to return the child to a normal diet within several days.

Probiotics

A probiotic can shorten the duration of the diarrhea. Several have proven helpful, but, again, be careful in your selection. They have to have enough active cultures to resist breakdown by the gastric acid, and they have to adhere to the surface of the intestine. Yogurts with live active cultures (the label should say that) can be used for older infants (at least eight months of age) and children. However, even those with the live active cultures only have to have 100 million colony-forming units per gram at the time of their manufacture, and the number of units tends to decrease over time.

Among the commercially available probiotics, Culturelle is the most tested for various types of diarrhea. Culturelle contains 1 billion cells per packet of Lactobacillus GG, a bacteria that is highly acid resistant; it also has a high affinity for the intestinal lining to protect the surface from infection. You may not need it if the diarrhea only lasts a day or two, but if the gastroenteritis becomes prolonged, this relatively expensive brand may be worth the investment.

Dr. Stan Cohen13 May 2015

Dr. Stan Cohen is one of our founders and our CEO as well as the Chairman of our Medical Advisory Board. Dr. Stan is an internationally recognized expert in Read more

  • 0
  • 0 Comments