Vomiting and Diarrhea
by Dr. Brown
Diarrhea is any change in bowel habits to more frequent and looser stools. In infants, the frequency may range from just one stool to more than twenty a day! The volume of stool also increases due to malabsorption - ranging from teaspoons to overfilling the diaper in infants. Blood and mucous may also be present and can mean a more serious infection or something less serious such as an anal fissure (a sore rectum) from an irritating stool. "Food poisoning" can also cause vomiting and diarrhea. Usually food poisoning comes on very rapidly, is typically not associated with fever, and usually clears rapidly (less than 24 hours).
The most common reason for diarrhea is usually gastroenteritis (stomach flu). Gastroenteritis is most commonly self-limited and caused by viruses. Bacteria and parasites may less commonly cause diarrhea also. Other causes of diarrhea include overindulgence of drinks (especially juices) or food (high fiber foods, dried fruit, etc.) Intestinal diseases like Crohn's Disease, Ulcerative Colitis, and Lactose Intolerance can cause changes in bowel patterns. Some medications can also cause loose stools.
Both vomiting and diarrhea are usually highly contagious, and as mentioned are most commonly caused by viruses. There is no antiviral medications to treat them. Bacterial causes include Salmonella, Shigella and may require treatment with antibiotics under certain circumstances.
Treatment for diarrhea begins with control of losses of fluids, attempts to slow the stool down, and fever management.
For adults, begin with resting the bowels. That means no intake of anything. No food or drink. When diarrhea is better in 12-24 hours, begin with clear liquids, a teaspoon at a time every few minutes. If nauseated, go slowly. After 12 hours, progress to soft bland solids. Hydration is important, so drink when you can. Clear liquids include apple juice, grape juice, 7-UP, Ginger Ale, Gatorade, beef or chicken broth. Next you can begin soft, bland, strachy foods like Bananas, Rice or rice cereal, Applesauce and Toast. This is known as the BRAT diet.
Children over 18 months can be treated much the same as adults but give fluids early and often to prevent dehydration. If urine output is less than half normal volume or frequency, your child needs more fluids. If you cannot get the urine output up again quickly, IV hydration may be necessary in the Emergency Room. Begin with one teaspoon every 5-10 minutes by mouth. Progress in a few hours to tablespoons if no vomiting occurs. BRAT diet as outlined above is next. Avoid milk and milk products for a day or two. Remember to use lots of Vaseline on your child's bottom to prevent diaper rash from all the harsh diarrhea.
Infants up to 18 months become dehydrated easily, so watch urine output as above. Begin with Pedialyte (plain or fruit flavored), slowly at first with one teaspoon by mouth every 5-10 minutes for two to four hours. Go to tablespoons and then to ounces over the next 12 hours. By 24 hours your child will need calories, so start milk again, using soy milk if possible. Breast fed infants can also resume nursing, however proceed slowly with one minute feeds every 10 minutes. Younger infants may need 1/2 strength soy milk for 12 hours. Try to minimize cow's based milk for a few days, or you can dilute it a bit for a few days as this can make diarrhea worse.
Medications for diarrhea are generally not needed. Antibiotics can even make things worse!
Do use Vaseline to coat the baby's bottom to protect from the acids in diarrhea.
Do wash hands especially after cleaning up vomit or diarrhea and do not kiss on lips or share drinking cups or spoons or bottles.
Do not sleep in the same area and do not use the same pillow as the sick patient!
When to call the doctor:
If symptoms persist or worsen, check with the doctor. Generally this can be during regular office hours.
Call right away if urine is less than 1/2 for 24 hours, your child is lethargic or eyes are sunken in the skull. If he/she makes tears, this is a good sign that dehydration is not severe. Call if fever does not respond to Acetaminophen or Ibuprofen given in the correct amount and frequency. See our dosing chart for correct dosing.
Please help organize the following information for when you need to call.
1. How many stools have there been in the last 24 hours?
2. What is the stool consistency and color? Is there blood or mucous in or around the stool?
3. What is the urine output in the last 24 hours? Frequency and amount.
4. Is there fever and how high? Does it respond to Acetaminophen?
5. What is the child's activity like, normal, less active or lethargic?
6. Are there other symptoms like vomiting, rash, pulling an ear, sores in mouth or sore throat?
7. Is the child on any medications that may be contributing to the problems?
8. Are there other sick people around who may get this bug?
News release: In the past three years, there are 85% fewer admissions to the hospital for diarrhea with dehydration since the Rotateq Vaccine to prevent Rotaviral infections came out for children ages 2-8 months of age. Our statistics are even better in our office!
Diarrhea is any change in bowel habits to more frequent and looser stools. In infants, the frequency may range from just one stool to more than twenty a day! The volume of stool also increases due to malabsorption - ranging from teaspoons to overfilling the diaper in infants. Blood and mucous may also be present and can mean a more serious infection or something less serious such as an anal fissure (a sore rectum) from an irritating stool. "Food poisoning" can also cause vomiting and diarrhea. Usually food poisoning comes on very rapidly, is typically not associated with fever, and usually clears rapidly (less than 24 hours).
The most common reason for diarrhea is usually gastroenteritis (stomach flu). Gastroenteritis is most commonly self-limited and caused by viruses. Bacteria and parasites may less commonly cause diarrhea also. Other causes of diarrhea include overindulgence of drinks (especially juices) or food (high fiber foods, dried fruit, etc.) Intestinal diseases like Crohn's Disease, Ulcerative Colitis, and Lactose Intolerance can cause changes in bowel patterns. Some medications can also cause loose stools.
Both vomiting and diarrhea are usually highly contagious, and as mentioned are most commonly caused by viruses. There is no antiviral medications to treat them. Bacterial causes include Salmonella, Shigella and may require treatment with antibiotics under certain circumstances.
Treatment for diarrhea begins with control of losses of fluids, attempts to slow the stool down, and fever management.
For adults, begin with resting the bowels. That means no intake of anything. No food or drink. When diarrhea is better in 12-24 hours, begin with clear liquids, a teaspoon at a time every few minutes. If nauseated, go slowly. After 12 hours, progress to soft bland solids. Hydration is important, so drink when you can. Clear liquids include apple juice, grape juice, 7-UP, Ginger Ale, Gatorade, beef or chicken broth. Next you can begin soft, bland, strachy foods like Bananas, Rice or rice cereal, Applesauce and Toast. This is known as the BRAT diet.
Children over 18 months can be treated much the same as adults but give fluids early and often to prevent dehydration. If urine output is less than half normal volume or frequency, your child needs more fluids. If you cannot get the urine output up again quickly, IV hydration may be necessary in the Emergency Room. Begin with one teaspoon every 5-10 minutes by mouth. Progress in a few hours to tablespoons if no vomiting occurs. BRAT diet as outlined above is next. Avoid milk and milk products for a day or two. Remember to use lots of Vaseline on your child's bottom to prevent diaper rash from all the harsh diarrhea.
Infants up to 18 months become dehydrated easily, so watch urine output as above. Begin with Pedialyte (plain or fruit flavored), slowly at first with one teaspoon by mouth every 5-10 minutes for two to four hours. Go to tablespoons and then to ounces over the next 12 hours. By 24 hours your child will need calories, so start milk again, using soy milk if possible. Breast fed infants can also resume nursing, however proceed slowly with one minute feeds every 10 minutes. Younger infants may need 1/2 strength soy milk for 12 hours. Try to minimize cow's based milk for a few days, or you can dilute it a bit for a few days as this can make diarrhea worse.
Medications for diarrhea are generally not needed. Antibiotics can even make things worse!
Do use Vaseline to coat the baby's bottom to protect from the acids in diarrhea.
Do wash hands especially after cleaning up vomit or diarrhea and do not kiss on lips or share drinking cups or spoons or bottles.
Do not sleep in the same area and do not use the same pillow as the sick patient!
When to call the doctor:
If symptoms persist or worsen, check with the doctor. Generally this can be during regular office hours.
Call right away if urine is less than 1/2 for 24 hours, your child is lethargic or eyes are sunken in the skull. If he/she makes tears, this is a good sign that dehydration is not severe. Call if fever does not respond to Acetaminophen or Ibuprofen given in the correct amount and frequency. See our dosing chart for correct dosing.
Please help organize the following information for when you need to call.
1. How many stools have there been in the last 24 hours?
2. What is the stool consistency and color? Is there blood or mucous in or around the stool?
3. What is the urine output in the last 24 hours? Frequency and amount.
4. Is there fever and how high? Does it respond to Acetaminophen?
5. What is the child's activity like, normal, less active or lethargic?
6. Are there other symptoms like vomiting, rash, pulling an ear, sores in mouth or sore throat?
7. Is the child on any medications that may be contributing to the problems?
8. Are there other sick people around who may get this bug?
News release: In the past three years, there are 85% fewer admissions to the hospital for diarrhea with dehydration since the Rotateq Vaccine to prevent Rotaviral infections came out for children ages 2-8 months of age. Our statistics are even better in our office!