Dr. Molly’s Weblog

Molly O’Shea starts a revolution in pediatric care

Oh crap, stomach flu season is here December 17, 2008

Filed under: Uncategorized — drmolly @ 12:12 am

I cannot think of anything more fun than showering a vomit covered, sobbing seven year old at 2 am while his bedding is being stripped and changed.   Of course it would be way more fun if while you were stripping the bed, you start vomiting too.  BONUS! 

Ahh the stomach flu.  We all have had it and frankly we’ll all have it again and again.  Lots of different viruses cause vomiting and diarrhea and most of them are self limited and last only a few horrific days.  In addition to feeling like you have been hollowed out and if you move even slightly the delicate balance you have achieved that has prevented you from throwing up will be lost, the stomach flu can cause dehydration and acid build up in your system.  For adults, this usually takes a day or more of vomiting without keeping anything down but for children and especially infants it can happen much more quickly. 

Most children over 2 can handle vomiting for several hours before getting so dehydrated that they need to get IV fluids and most children with diarrhea alone can drink enough to prevent dehydration.  The child though with frequent vomiting for a long time (usually more than hourly for 8 hours) and diarrhea is at real risk.  Kids under 2 have an even smaller reserve and may get dehydrated even more quickly. 

How do you tell if  your child is dehydrated?  First and foremost, activity level.  Even if your child is having a ton of diarrhea and vomiting,  if she is smiling and interactive, chances are slim that she is significantly dehydrated.  Other signs that are reassuring are tears when crying and peeing every 6-8 hours.  That last one is a toughie though because often there is enough diarrhea that telling whether there is pee too can be a challenge.  If your child has signs or symptoms of significant dehydration, your child needs to be seen.

Ok, let’s assume that your child isn’t dehydrated enough to be seen…then what?  If your child is actively vomiting, you should wait about 2 hours from the last episode of vomiting before offering anything to drink.  Ideally offer pedialyte or slightly watered down juice but avoid sports drinks like gatorade which can worsen diarrhea and don’t use plain water since it can lead to seizures in some children.  Only offer a teaspoon or two at a time every 10 or 15 minutes for the first couple of hours.  If you drink too much too fast, you will start the vomiting all over again.  If your child has an episode of vomiting, restart the two hour clock and try again.  Once a couple of hours has passed, allowing more liberal drinking or offering a popsicle is a great choice.  It is essentially sugar water and is a treat to boot!  After about 6 hours or so without vomiting you should offer some real food to eat.

That takes us to the next point….what should you feed a child who has a stomach bug and is ready for real food?  The American Academy of Pediatrics studied this question and it seems that there is no real advantage to avoiding milk once you are pretty well hydrated again with pedialyte.   It is important to offer nutrition to help heal the intestines and so offering some age-appropriate food (it doesn’t have to be the boring BRAT diet) relatively early in the course of recovery is important. 

Fever may be a part of a ‘normal’ stomach flu but if the fever persists beyond a day or two or if your child has blood in his stool or is significantly dehydrated, you need to make an appointment.  Oh yes, before I forget…WASH YOUR HANDS LIKE CRAZY!  That’s all you can do to decrease your chances of getting the stomach flu or spreading it.  Too bad there’s no flu shot for this kind of flu!

Wash your hands, wash your hands, wash your hands and each day will be your best!

Molly O’Shea, MD  Birmingham Pediatrics + Wellness Center

www.birminghampediatrics.com

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3 Responses to “Oh crap, stomach flu season is here”

  1. Tracy Gaulzetti Says:

    This is really helpful info. Thanks for posting it!

  2. riddlej Says:

    You seem like a really down-to-earth (and excellent) pediatrician, so I hate to add my own laymen’s observations. But it often seems to me like the AAP and public health info seems rationalized or impractical. For example, I have had four kids in five years and not ONE of them has been able to keep Pedialyte down. I know it is supposed to be better than Gatorade, but we have had SOOO much success with sports drinks rather than Pedialyte. And water. I know the salt balances or whatever aren’t right, but juice gives them diarrhea again and Pedialyte (even tsps) make them vomit. So we have foregone that.

    Also, I really like your 2-hr waiting rule for offering liquids, but when it comes to offering food I think you are overly optimistic. No way any of my kids have been able to keep down even Cheerios six hours after a stomach bug spree. Now we’ve only had the bug four or five times, but I have definitely learned to wait 12 hrs or more until offering food. And even then, only crackers or something ultra-bland. Milk definitely upsets the system again–my last two year old who had it was happy but still having occasional diarrhea seven days later, and when I gave her some milk, it caused her (and my three year old) to go right back into regular diarrhea problems. So I think the original warning to forego milk is good advice.

    Anyway, I’m sorry about being a pest, but I wanted to say something. As someone who is not a doctor and often taken by surprised by signs and symptoms, I just wish that websites and public info were closer to what I actually see in my home–stomach bug included.

  3. Renata Says:

    Thanks for this blog post. We all are ready to eat 🙂 Offering fluids by the spoon were much easier. I just told my 2 year old that it was medicine.

    I can understand RiddleJ’s frustration. However, it has been helpful for me to realize that public information is never specific enough to suit everyone’s needs. Unfortunately, we are bombarded with plenty of recommendations that imply that “one size fits all”, which is far from the truth. There are many different strains of viruses, and each body responds at different rates and intensities.
    This is why no public information can substitute the individualized care of a health professional.


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