One of the super great (sarcasm added for emphasis) consequences of working with sick kids is that I get sick. The Montaigne Stomach Bug of 2017 was one of those times. I was hit while driving home from work. Do you have any idea how hard it is to drive while also vomiting? It’s tricky. My husband was next. And then, my poor, sweet 15-month-old son got it. I’m sure most of you know this, but a toddler does not warn you when he is about to throw up. So yeah, hot mess express.
The stomach bug, or gastroenteritis, happens year round but has an upswing in the fall and winter. It hits fast, and hard. Typically, symptoms start 12-24 hours after exposure. Gastroenteritis spreads by the “fecal-oral” route, and it tends to be super contagious. The virus takes up residence in the intestines, where it destroys the intestinal wall lining and allows water and electrolytes to leak out. Then, since the intestines are all jacked up, your body can’t digest or absorb food the way it’s supposed to. And this, my friends, is the equation for diarrhea.
Most people start with the vomiting, for 1 – 2 days, and then end with diarrhea, for 5 – 7 days. Everyone is a little different, so everyone’s response to the stomach bug is a little different. Some people may have vomiting alone, some may have diarrhea alone, and some get the whole kit and caboodle! Kids tend to have worse symptoms. Their immune systems are more naive, so they mount bigger responses when they’re exposed to stuff. They are more likely to get dehydrated from all of the fluid loss, too.
The nausea and vomiting component of the illness is just annoying. There’s really not much benefit to it. So, we stop it. We can prescribe Zofran (ondansetron) to stop the vomiting and queasy feeling. It blocks the nausea symptom so kids can keep fluids down. The diarrhea is a good thing, though. It’s the body’s way of evacuating the virus so kids can get better faster. So, don’t use any anti-diarrhea medications. It just makes the virus stay in the intestines longer.
Here are my top tips and tricks for gastroenteritis:
Stop the vomiting:
Whether it’s with prescription medicines like Zofran, or alternatives like ginger and peppermint, just make it stop early. Vomiting is harder to stop when it’s been going on for hours. This is one of those times where it is OK to come in early, as soon as your child starts throwing up. Vomiting as a symptom alone, can be tricky to evaluate. So, come on in to KidMed! One trick I learned while working in a pediatric ER was an alcohol swab. For some kids, just sniffing an alcohol swab was enough of a distraction from the nausea that they wouldn’t throw up. Sucking on sour hard candies has always been helpful for me when I am nauseated. But, only use this trick for kids who won’t choke on hard candies!
The fluid loss from vomiting, diarrhea, and even fever is serious. But it’s hard to keep up with it when you don’t feel like putting anything in to your belly. Sucking on ice cubes, or frozen liquids like coconut water or bone broth may work for some kids. My son would take a tablespoon of liquid every 15 minutes if I gave it to him in a medicine dropper. You could also make a slushie by microwaving a popsicle for a few seconds and adding a bit of water to the mix. Find what works for your child and push the fluids. If your child is breastfed, keep up the good work. Breastfeeding during rehydration tends to reduce the number, volume, and duration of diarrhea stools. Some fluids is better than no fluids. So, if your child prefers water to Pedialyte, stick with water. The body can go for up to 3 weeks without solid foods, but only 3 days without fluid. If all else fails, we can give your child IV fluids at KidMed.
Slowly reintroduce foods:
Traditionally, people would eat the BRAT diet (bananas, rice, applesauce, and toast). But, research shows that this is not the best idea. The BRAT diet is unnecessarily restrictive and provides suboptimal nutrition. Let your child eat what he or she wants to eat. With that being said, complex carbohydrates, lean meats, yogurt, fruits, and vegetables are better tolerated than foods with a lot of fat and sugar. Sometimes, low blood sugar makes nausea worse. Then kids refuse food, making the low blood sugar worse. So, you can give them a spoonful of the syrup from a jar of fruit. It’s a quick sugar boost, without a large volume to upset the tummy.
There is mixed evidence on using probiotics to treat gastroenteritis diarrhea. However, it is an affordable, over the counter option that is unlikely to be harmful. I use probiotics for my family.
It’s also important to remember that it takes a while for the body to “re-boot” after gastroenteritis. Appetite changes, and even loose stool are not unusual for up to a week afterwards. All that diarrhea sloughs off the intestines’ ability to digest foods, so some kids have a mild lactose intolerance as the good bacteria are regrowing. If you notice this in your child, avoid dairy for a few days. Sugar-sweetened foods and drinks (including Gatorade, by the way) can make diarrhea worse. So, avoid or dilute these things too. And lastly, if your child is on an all liquid diet then you can expect all liquid stool. I know it’s gross, but if your child seems well but still has runny poo, try adding some fiber filled carbohydrates and starches like bananas, sweet potatoes, and carrots.
One last thing to mention: the stomach bug does not die with regular Lysol spray or hand sanitizer. A dilute bleach spray and traditional soap and water are necessary to clean surfaces and hands, respectively!
I hope you and your family avoid the stomach bug this season. But, these tips and the pediatric services at KidMed are great options if you need them!