RECOMMENDATIONS FOR THE CARE OF VOMITING AND DIARRHEA
Diarrhea and vomiting are very common problems during infancy and childhood. Most often they are caused by viral infections and may be accompanied by fever. Diarrhea or vomiting may last for several days or may get better for 1-2 days and then recur. If diarrhea persists beyond one week, please call for appointment (sooner if your child appears dehydrated, very sick or if there is blood or mucus in the stool). Any neonate or young infant with bilious (yellow-green) vomiting should be examined.
Very often, several members of the family will be sick with the "intestinal flu" at the same time. It is very contagious. Good hygiene, including careful hand washing and avoiding sharing germs by eating and drinking from the same food or liquids, will help prevent spreading in one's own family. It is important to maintain as much reasonable isolation as possible. Proper treatment of vomiting and diarrhea is of paramount importance to the small child in order to prevent dehydration.
One sign of dehydration is not urinating more than 3 - 4 times in 24 hours. An infant who has not wet his or her diaper for over 8 hours should be seen. Also, any child with severe, uncontrollable vomiting or listlessness should be examined.
THE MOST IMPORTANT ASPECT OF TREATMENT OF VOMITING AND DIARRHEA IS TO MAINTAIN HYDRATION. By this, we mean for the child to drink enough for the body to function properly. Solid foods are often very poorly tolerated during the initial period of gastrointestinal upset. If frequent vomiting is not stabilizing or improving after 24 hours, or if there is ever any doubt as to the seriousness of the problem, call the office.
FOR VOMITING OR DIARRHEA
THE FOLLOWING TREATMENT SHOULD BE FOLLOWED
1. Omit all solid foods until there has been no vomiting for 4-6 hours. The most intense period of vomiting in
viral gastroenteritis is the first 12-18 hours.
2. IT IS CRUCIAL TO GIVE ENOUGH OF THE PROPER TYPE OF FLUIDS TO
PREVENT DEHYDRATION. Especially with vomiting, you must find the amount
of fluid your child can retain. If you give too much, it may be vomited right back up.
You may have to give one teaspoonful or one swallow at a time, but then it must be given
every 5-10 minutes so your child will get enough. Very cold fluids seem to stay down better.
Once the vomiting becomes less frequent, you can give larger amounts, less often.
3. Best fluids to give: Oral Replacement Solutions such as PEDIALYTE or PEDIALYTE
FREEZER POPS, or DRIP DROP.
These are examples of appropriate electrolyte replacement solutions that are available in drug stores
and supermarkets. They contain a good combination of water, sugar, and minerals to replace what is
lost during the vomiting or diarrhea. This solution is more palatable when given cold. Water may also
be given if your child is at least 1 year of age, and there is no diarrhea..
4. The Oral Replacement Solutions (ORS) should be given as follows:
Children less than the age of 4 years: Give 1 tsp of Pedialyte or a bite of Pedialyte popsicle every 5
minutes during the first hour. If the fluid is not vomited, double the quantity of fluid given during the
next hour (ex.. Give 2 tsps every 5 minutes) and continue to double the quantity of fluid
given over each subsequent hour until the patient has not had any vomiting for 4-6 hours.
Children greater than 4 years of age: Give 2 tsps of Pedialyte or bites of Pedialyte popsicle every
5 minutes during the first hour. If the fluid is not vomited, double the quantity of fluid
given during the next hour (ex. 4 tsps every 5 minutes) and continue to double the quantity
of fluid given over each subsequent hour until the patient has not had any vomiting for 4-6
hours. If the patient vomits when given the replacement fluids: withhold the oral fluids for
15-30 minutes, then restart at the initial amount of fluid for the patient’s age.
5. Fluids that are NOT RECOMMENDED: Gatorade and other sports drinks are not
recommended because of their improper sugar and mineral contents. Plain water,
soda and Jell-O are not commended in children younger than 1 year old. They are also not
recommended in children older than 1 year who have both vomiting and diarrhea because they do not
have the proper amounts of sugar and minerals.
6. Breast milk: If your child is nursing, frequent small feedings of breast milk are usually
tolerated. The breast milk can be given in quantities as described in #4 above.
7. Formula: Formula should not be given initially if there is significant vomiting. In place
of the formula give Pedialyte until there has been no vomiting for 4-6 hours.
8. Alternative Fluids: Clear broth of any kind. Do not add salt. It is best to alternate broth with
other clear fluids such as Pedialyte. Ice chips or small amounts of water can be offered
if your child is at least 1 year of age, and there is no diarrhea. Fluids with proper sugar and minerals must be the main treatment (ex. Pedialyte). DO NOT GIVE JUICE.
Severe diarrhea is the passage of many watery, sometimes malodorous, bowel movements
more than 5-6 times per day. Diarrhea is often caused by a viral infection of the stomach and
intestines. The treatment for severe diarrhea is as follows:
1. If the patient is exclusively breast fed: continue with small, frequent feedings.
2. If the patient is exclusively on formula: If the formula is milk based (e.g. Similac Advance
or Enfamil Lipil) then switch to a soy based formula (e. g. Isomil or Prosobee)if the diarrhea is severe. If the diarrhea is mild (less than 4 times per day) the milk based formula may usually be continued.
3. If the patient drinks cow’s milk: discontinue until the child has no diarrhea for 1-2 days. A
replacement fluid such as rice milk, soy milk or lactaid milk is usually better tolerated.
4. DO NOT GIVE APPLE JUICE OR OTHER JUICES because they may cause the diarrhea to
worsen. If the patient refuses breast milk, formula or cow’s milk give them the oral replacement solutions, such as Pedialyte. Water in combination with solid food is also acceptable.
5. If the patient is on solid foods: change from their regular diet to bland types of foods for the
initial 24 hours of the symptoms. Recent information suggests that it may be helpful to return
to a relatively normal diet within 1-2 days, even if some diarrhea persists. Avoid any foods that normally encourage more frequent bowel movements or produce gas (prunes, beans, etc.) Also, foods high in sugar, fat or spices may not be well tolerated.
If the patient is still on baby foods and has had the following food items, you may give: rice cereal, applesauce and bananas in addition to breast milk or soy formula.
If the patient is on table foods, you may give: the BRAT diet which consists of banana, rice food items, applesauce, dry toast, dry cereal (i.e. Rice Krispies), chicken soup, crackers (i.e. Saltines).
6. Probiotics: Diarrhea may occur with the use of antibiotics. Probiotics act to replenish the
“good” bacteria that should be in the intestines and restore the intestinal balance that can
be upset by some antibiotics.
Here is some good information about PROBIOTICS.
Culturelle is available as a capsule that can be opened and sprinkled onto applesauce, cereal, yogart, etc. or swallowed whole.
“Culturelle for Kids” (< 100 lbs) 1 pk/day
“Culturelle” (> 100 lbs) 1 cap/day
- VOMITING AND DIARRHEA: Follow the treatment protocol for vomiting by omitting solids and fluids (other than the oral replacement solutions such as Pedialyte), until no vomiting for 4-6 hours. Once the patient is able to retain the oral replacement solutions for 4-6 hours, follow the diarrhea protocol by beginning the BRAT/ bland food diet as tolerated. Return to the patient’s regular diet within 1-2 days, as tolerated.