The stomach flu - how to stop the flow

Pediatrics for Parents, Nov, 1991 by Harry Pellman

Gastroenteritis is the medical term for infections causing inflammation of the stomach and intestines. The symptoms caused by these infections include fever, nausea, vomiting, abdominal cramping, and diarrhea. When nausea and vomiting are present, they are usually strongest the first 12-24 hours and slowly improve thereafter.

In addition, diarrhea and cramping may begin during this 24 hour period or immediately afterwards. Diarrhea may last but a day or two, or, in younger children, even a week or longer. In general, the younger the child, the more severe and the longer the duration of the diarrhea. Fever is usually short-lived in gastroenteritis, lasting one to three days. Most gastrointestinal infections are caused by viruses. Viral intestinal infections cannot be cured by antibiotics or other medications. Gastrointestinal infections caused by bacteria are called dysentery. These infections are generally more severe and serious. Symptoms can include bloody diarrhea and a toxic (seriously ill) appearance of the child. Antibiotics are helpful in many types of dysentery. Less commonly, gastrointestinal symptoms are caused by parasites (especially giardia) and toxins (food poisoning). In general, gastroenteritis is treated to lessen the symptoms (nausea, vomiting, cramping. and diarrhea) and to prevent its main complications - dehydration (loss of significant amounts of body water). Water loss is inevitable when nausea and vomiting is present. You will notice your child urinating less often and in smaller amounts. This is to be expected and is the body's attempt to conserve the water that remains. If the diarrhea and/or vomiting are severe and the child looses too much water, the child will become dehydrated. The following are signs of dehydration; weight loss of over 5% of body weight over a relatively short period of time. sunken or hollow appearance of eye sockets, dryness of the mouth with stringy saliva, dry and cracked lips, strong smelling and dark urine, and children that are continually listless. A child who has perky or happy periods is not dehydrated. Treatment How about medications? Antispasmotics such as Donnagel, Lomotil. and the like should not be used because they are harmful and not at aD helpful. Since most of these illnesses are viral, antibiotics are rarely of benefit. There is a recent study suggesting benefit from a Pepto-Bismol type of medication if used in high enough doses. A study confirming this benefit and establishing its safety would be nice. So, how do we help a child running off at both ends through both major orifices? Treatment includes proper replacement of the excessive water and salts lost by vomiting and diarrhea and allowing sufficient time for the body to heal the damage to the gastrointestinal tract lining caused by the infection. The goal in feeding is to give those liquids and foods that will be best absorbed by the damaged intestinal lining. The following is an outline on how to best do this. Vomiting: Withhold all food and liquid until the child has stopped vomiting for several hours. In an infant, waiting 2-4 hours seems appropriate. In a child, 4-8 hours or so is usually necessary. In an older child and adult, as long as 8- 12 hours or more may be required. When reintroducing liquids into the diet, start with little test doses, 1/2 to 1 ounce every 15-30 minutes for two or three hours The liquids that are preferable are cared electrolyte replacement solutions, such as Pedialyte and Rice-lyte. They contain water, glucose (an easily absorbed sugar), and salts in the correct concentrations to promote body water and salt retention. After these amounts of fluid are well tolerated, slowly increase the volume by an ounce or so every 3060 minutes until 4 ounces is well taken without vomiting. If the child vomits, start from the beginning again. Once decent volumes of liquid are retained, age appropriate foods such as jello, popcycles, clear soups, crackers, toast, dry cereal, etc. can be slowly introduced into the diet as tolerated. Diarrhea: The types of food used in diarrhea are the same as in vomiting, but there is no volume restriction. If diarrhea is severe (severe cramping, listless, 10-20 or more stools a day), Just use clear liquids such as the above electrolyte replacement solutions for 12-24 hours. This is followed by gradual dietary additions such as jello, clear soups, liquids such as Gatorade, crackers, toasts, rice. bananas, etc. over the next 1-3 days. If the diarrhea is mild to moderate (minor cramping, a child that acts OK most of the time, less frequent and less watery stools), only minor restrictions are necessary (no fruit, fruit juices, cow's milk, greasy, or difficult to digest foods). Breast fed infants should continue to breast feed in all but the most severe forms of diarrhea. Formula fed infants may continue to drink their normal formula unless the diarrhea is severe. Your doctor should be contacted if any of the following occurs: * Signs of dehydration. * A child that looks seriously ill or demonstrates unusual behavior. * Bloody diarrhea. * Infants with severe symptoms. * Infants under two months of age with repeated vomiting. * No improvement in symptoms despite proper dietary management. * Your parental intuition says " It's time to call the doctor." Dr. Pellman's column appears monthly in Pediatrics for Parents. He welcomes your comments and suggestions for future columns.