Every parent dreads hearing the three words, "My tummy hurts." Immediately, you start imagining the worst-case scenario: Your child is totally wiped out for days with nonstop vomiting and diarrhea; your home becomes a breeding ground for germs; and this flu spreads like wildfire through your entire family. Unfortunately, this is a reality. In stomach-virus season, entire classrooms and childcare centers can be taken by storm.
Thanks to a new vaccine that fights against rotavirus, a common stomach bug, the number of children who are getting sick with this infection has dropped significantly. But there's an increasing number of different strains of norovirus -- another major cause of tummy trouble, according to the Centers for Disease Control and Prevention. To protect your family, read up on six surprising lessons about the so-called stomach flu.
Officially called viral gastroenteritis, a stomach virus also causes inflammation and irritation in the small intestine and has nothing to do with the respiratory virus we call influenza. Influenza is spread through the air when a sick person coughs or sneezes; your child picks up a stomach virus when he touches a surface or an object or eats a food that's contaminated with infected stool or vomit. Symptoms include nausea, vomiting, diarrhea, stomach cramping, fever, and body aches. Diarrhea can last for several days; most of the other symptoms subside within 48 hours.
Doctors can't always distinguish between a stomach virus and food poisoning -- or even appendicitis. That's because all three conditions can cause pain and vomiting. However, fever generally doesn't accompany food poisoning, and diarrhea is not often associated with appendicitis. (ER docs frequently miss appendicitis in young children, but the telltale clue is sharp pain that starts around the belly button and moves to the lower-right side of the abdomen.) Food poisoning usually comes on suddenly and is gone within 12 hours, says Charlotte Cowan, MD, author of the children's book The Moose with Loose Poops.
"When there's an infection in the gut, toxins get released in the stool," explains Michael Russo, MD, assistant professor of pediatrics at the Children's Medical Center in Dallas. "Antidiarrheal drugs slow down stool production so toxins linger in the body for a longer time. And Pepto-Bismol can turn stool black, making it hard for doctors to determine whether the discoloration is due to something more serious, like blood in the stool." What's more, the adult version of Pepto-Bismol contains an aspirin-like ingredient that increases the risk of Reye's syndrome, a potentially fatal disease. Your pediatrician may, however, prescribe medication for persistent vomiting.
She probably won't feel much like eating, but when her appetite returns, you can give her most of what she normally eats. Doctors now believe that the traditional BRAT diet (bananas, rice, applesauce, and toast) doesn't give kids enough protein or calories. Steer clear of high-fat foods like chicken fingers and ice cream, which are harder to digest and may be more likely to be thrown up. Also avoid spicy foods and fruit juices, which can irritate the gut or cause bloating.
Phone your pediatrician if your child has signs of dehydration, including a lack of tears when he cries, a dry mouth, no wet diapers in six hours for babies, or no urination for 12 hours in older kids. Because babies are particularly vulnerable to dehydration, stay in touch with your doctor if your child is 6 months or younger. Also call the doctor immediately if your child has projectile vomiting, bloody or greenish vomit, diarrhea that's bloody or has a jellylike consistency, a tight distended abdomen, shaking chills, or worsening pain. These symptoms can signal anything from a tear in the esophagus to a bowel blockage.
For starters, if you have a baby be sure she gets the rotavirus vaccine, which is given between 2 and 6 months of age. Researchers are working on a vaccine for the norovirus. For now, the best protection is to wash your hands often and use alcohol hand gel if you can't get to a sink. If someone in your family has a stomach bug, wash hard surfaces frequently with disinfecting wipes. Don't share utensils, cups, pillows, or towels, and cut your child's fingernails to prevent viruses from lingering underneath.
With all that vomiting and diarrhea, a kid with a stomach bug can easily get dehydrated. Left untreated, dehydration can lead to seizures, kidney failure, and even death. Take this quiz to be prepared.
1. The best beverage to offer a vomiting child is:
B. A clear, sweet liquid like ginger ale or apple juice
C. Oral rehydration solutions
D. Sports drinks
Answer: C. Oral rehydration solutions such as Pedialyte contain water and electrolytes in specific concentrations to replenish what your child has lost. (Check with your MD if your child is under 3 months.) If she refuses to drink one, give her water, ice pops, diluted juice, or (if she's older than 18 months) salty pretzels to suck on.
2. Every time your child drinks something, she throws up. You should:
A. Give up -- she'll drink as soon as she's ready.
B. Offer small sips regularly.
C. Force her to drink as much as she can even though she's throwing up.
Answer: B. Slow and steady wins this race. Even if your child can't handle gulps of liquid, she should still be able to keep down small sips (about a teaspoon) every five minutes. "A teaspoonful of liquid every few minutes adds up to a few ounces in an hour," says Dr. Michael Russo.
Answer: C. Stick with nursing or bottle-feeding, but offer smaller amounts more frequently. If your baby seems sleepy, wake him up often for feedings. Stay in touch with your pediatrician; he can help assess signs of dehydration and advise supplementing with an oral rehydration solution if he thinks it's necessary.
Originally published in Parents magazine.
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