“Mommy, I have to throw up!” If you are at all like me, those words make a cold hand of fear clench your heart. I dread vomiting, both for my children as well as for me. Unfortunately, vomiting illnesses are something most children will have at some point. But generally a little pedialyte and time is all that is needed to cure most vomiting.
Vomiting may accompany many different illnesses from “the stomach flu” to urinary tract infections to pneumonia to strep throat. “The stomach flu,” one of the more common causes of vomiting, is actually a misnomer. “The stomach flu” is not related to your winter influenza, or “flu”. It is more properly termed “gastroenteritis” and is caused by a number of different viruses. Unfortunately, your flu shot will not protect you from gastroenteritis. Getting your child vaccinated with the rotavirus vaccine, however, can protect against some forms of gastroenteritis.
The term “gastroenteritis” encompasses illnesses characterized by vomiting and diarrhea. Fever may also accompany these symptoms. Vomiting often is the first symptom, may be violent and frequent, but usually resolves within the first 24-48 hours of illness. Diarrhea may begin with the vomiting or may develop later. Unlike vomiting, diarrhea may persist for even 2 weeks after the onset of illness.
While vomiting is a dramatic manifestation of illness, it is unusual for a child to become severely dehydrated from vomiting alone unless it persists for a prolonged period (more than 24 hours). I can remember a wonderful (said with sarcasm) trip to the mountains with my family when Liam, Lydia, and I all became sick with gastroenteritis. The kids were vomiting every 5 minutes at one point—they would sit up long enough to throw up and then immediately closed their eyes and lay back down. As sick as they were, we made it through without needing to go to the emergency room.
So how do you treat vomiting and diarrhea at home? Gut rest is one key. When my kids were in the worst of their vomiting, I didn’t even try to give them anything by mouth. After the vomiting had slowed down (in our situation, that took several hours), I slowly started giving them some Pedialyte. I started with a teaspoon every 5 minutes and doubled the amount I was giving them if they went an hour without vomiting. About 18 hours after it all started, they were both finally tolerating fluids.
But what if your child is begging for something to drink? If your child is exceedingly thirsty, you can dry a damp wash cloth for him to suck on—just wet enough for the mouth to feel some moisture but not wet enough to get fluid into the stomach. But don’t just give him a cup or bottle of liquids. Your child will likely guzzle the drink and end up vomiting again.
Once your child is tolerating fluids and has gone a good 6-8 hours without vomiting, you may let her start eating some bland solids. We typically talk about the BRAT diet—bread, rice, applesauce, toast. Think of things that are gentle on the stomach. I wouldn’t recommend steak and eggs as the first thing to eat!
A word about medications to stop vomiting or diarrhea: we do not generally recommend using them. For instance, medications like Imodium can prolong the amount of time that your child has diarrhea. Your child can, however, have Tylenol or Motrin as needed for fever. The most important thing you can do for diarrhea is to encourage your child to drink clear fluids.
While most of these illnesses can be treated at home, your child may need to be seen for the following reasons:
1. Your child is getting dehydrated. Signs of dehydration include not peeing at least every 6-8 hours for infants or 8-10 hours for older children or being listless and/or lethargic.
2. Your child has vomiting and fever WITHOUT diarrhea. Vomiting and fever without diarrhea may be a sign of another illness.
3. Your child has vomiting alone for more than 24 hours.
4. Your child vomits blood or has blood in her stool.
5. Your child has severe, constant abdominal pain.
6. You child has cough or difficulty breathing.
Please call our office if any of the above symptoms develop. In the meantime, please wash your hands well if you child has gastroenteritis. It is highly contagious, and nothing is worse than trying to take care of your child while you, too, are vomiting! It is definitely an experience I hope never to have again! As for school or daycare, your child should remain home until he is no longer vomiting. Diarrhea that is contained within the diaper is okay as long as your child is not overly fussy or uncomfortable.
While I have discussed gastroenteritis in this blog, do remember that there are other causes of vomiting. I remember seeing a little eight year old boy once who was vomiting after consuming 3 double cheese burgers, a large order of fries, and a large cola. Just the thought of it makes me feel queasy!!!