Grab your barf bucket, steel your nerves, and let our guidelines help you through rotavirus or the stomach flu.

By Alisa Stoudt and Kate Rockwood
Updated January 13, 2020
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There you are, minding your own business, when suddenly it happens: Your kid pukes on your shoes. (Or the couch. Or her brother. Or all over her car seat. Take your pick.) And now you see the next few days of your life will be dominated by barf, saltine crackers, and the worry that everyone in the house will also fall ill. Here's how to handle two of the most common stomach issues: gastroenteritis (the stomach flu) and rotavirus.

James Yang

What is the Stomach Flu?

Officially called gastroenteritis, stomach flu is an infection of the digestive system—and it's totally unrelated to the regular flu (influenza), which affects the respiratory system. Stomach flu is the second most common illness kids get, after respiratory infections like colds. Although unpleasant, stomach flu is usually not serious. It's usually caused by viruses, but can also come from bacteria like salmonella and E. coli, as well as some parasites.

"Babies and young children are especially prone to infection because their immune systems are still forming, so they haven't yet built up the antibodies to fight off germs," says Rita Steffen, M.D., a pediatric gastroenterologist at the Cleveland Clinic in Cleveland, Ohio.

What Is Rotavirus?

Rotavirus is one type of bug that causes stomach flu and may make children sicker than other types (like adenovirus, enterovirus, astrovirus, and Norwalk virus). Until recently, most children had been infected with rotavirus once by age 2 and nearly all had had at least one bout by age 5, according to the Centers for Disease Control and Prevention (CDC). This particular bug is responsible for about 400,000 doctor visits and 200,000 emergency room trips in the U.S. every year. However, the rotavirus vaccine drastically decreased the number of cases.

Your child's most likely to get infected with rotavirus between November and May, especially if he's regularly exposed to lots of other kids in situations such as daycare or playgroups. Rotavirus is very contagious and can easily spread among kids and teachers. As with other viruses, there's no quick treatment—you have to let the bug run its course. Keeping your child hydrated is the best way to help him feel better.

Stomach Virus Symptoms

A classic stomach virus involves vomiting with diarrhea, low or no fever, and stomach pain that's worse when vomiting, says Josh Borus, M.D., assistant professor of pediatrics at Harvard Medical School. "The closer a child sticks to that script, the more comfortable I feel diagnosing gastroenteritis."

Be on the lookout for these red flags:

  • Fever
  • Vomiting (more volume than usual everyday spit-up)
  • Watery diarrhea
  • Fussiness or irritability
  • Acting more tired and sluggish than usual
  • Decreased appetite

Older children may also complain of tummy cramps, muscle aches, and headaches. Symptoms generally set in one to three days after your kid's been exposed to the bug, and can last anywhere from a day or two up to 10. The main risks from stomach flu are not from the symptoms themselves (although unpleasant), but the fact that upset stomach can make your child very dehydrated.

When to Call the Doctor for Stomach Flu

If it's your baby's first bout with stomach flu, call the doctor right away. This way she can rule out bacterial infections, which may require treatment with antibiotics.

If the diarrhea is severe, persists for more than four or five days, or contains any blood, your child may have a more serious foodborne illness, such as Campylobacter or E. coli, and you should see your pediatrician. Other warning signs that warrant a call include a persistent fever, significant abdominal pain, vomiting without diarrhea (a stomach virus nearly always has both), or tenderness when you touch your child's tummy (which could indicate appendicitis or pancreatitis), says Katja Kovacic, M.D., a pediatric gastroenterologist at Children's Hospital of Wisconsin, in Milwaukee.

Most doctors want to see babies under 3 months with rectal temperatures of 100.4 F. or higher. If your child is between 3 and 6 months, you should alert the doctor if your child has a rectal temperature of 101 F. or higher. If your child is older than 6 months, let the doctor know if your child has a rectal temperature of 103 F. or higher.

The doctor will likely also ask whether your child has any of these signs of dehydration:

  • Fewer than 6 wet diapers a day for babies or 8 hours without peeing for older kids
  • A sunken soft spot on top of baby's head
  • Few or no tears while crying
  • Acting unusually sleepy, sluggish, or unresponsive
  • Wrinkled skin
  • Dry mouth or cracked lips
  • Dizziness, headaches, or muscle pain in older kids
  • Urine that's dark yellow (instead of light or clear)
  • Weight loss

If a child of any age seems severely dehydrated, call the doctor right away. The child may need to go to the hospital to get rehydrated through IV fluids.

James Yang

How Do Children Catch the Stomach Flu?

Stomach bugs are highly contagious. Playing with an infected child is the main way the virus spreads, since germs can live on toys and clothes for hours or even days. If the infection results from bacteria or parasites, your child may have consumed contaminated food or water (most likely while overseas or camping, for example).

What makes stomach flu particularly virulent is that children are contagious before they actually show any symptoms. Also, adults with their heartier immune systems may harbor the germs and pass them along without ever getting sick themselves.

How to Prevent the Stomach Flu

Obviously, you want to keep your family from getting sick. "It only takes a few virus particles to infect someone, and there are billions in just a drop of vomit or diarrhea," says Aron Hall, a researcher for at the Centers for Disease Control and Prevention's Division of Viral Diseases, in Atlanta. However, you can take steps to prevent a full-scale invasion.

Get vaccinated. Your baby will get two or three doses of the rotavirus vaccine (depending on which brand your doctor uses), which protects against 85 to 98 percent of severe rotavirus illness. However, there is no vaccine against norovirus.

The vaccine only prevents the four most common strains, so kids who have been vaccinated can still catch different types of rotavirus or other bugs that cause stomach flu. However, symptoms will likely be less severe in children who've been vaccinated, says Stanley Cohen, M.D., a pediatric gastroenterologist at the Children's Center for Digestive Health Care in Atlanta, Georgia.

Wash your hands. "We can't stress enough how important hand-washing is," says Dr. Cohen. For a thorough scrub, use soap and warm water and rub your hands together for at least 15 to 20 seconds (sing "Happy Birthday" for a gauge of length); this helps prevent passing germs around your family.

It's a good idea to wash not just after using the bathroom, but after coming home from public places like malls or movie theaters or after being around other kids on playdates, for example. Also wash your hands after handling a sick kid and before preparing food. Show your toddlers and preschoolers how to wash properly, and ask their childcare providers whether kids are required to clean their hands throughout the day (not just after using the bathroom and before meals).

Isolate sick kids. Keep your sick child in his room or the family room, away from siblings and the kitchen. If you have more than one bathroom, have him stick with one (direct the rest of the family to the other), and dry his hands on paper towels instead of a hand towel. Follow these arrangements for at least two days after he feels better, says Hall.

Disinfect the house. To kill of microscopic viruses, go through the house frequently with disinfectant wipes (use ones containing bleach) and attack places your kid may have touched (faucets, doorknobs, countertops, light switches), and places where he pooped or vomited. For areas that you know are germy, like the bathroom, grab a bleach-based disinfectant and go to town on the entire area. Wearing disposable gloves and a face mask can dramatically lower your odds of catching the bug while cleaning, says Hall, as can using paper towels rather than reusable rags. Put any germy laundry in the washing machine (crank the heat and opt for the longest cycle!) and toss your gloves in the trash. Wash your hands with soap and water for at least 20 seconds to ensure that any particles that transferred from the gloves to your skin go down the drain.

Stomach Flu Recovery Tips

Unfortunately, there is no specific treatment for viral stomach flu; it just has to run its course.

But replacing lost fluids and nutrients will help your child feel better more quickly and prevent the bug from getting worse. Here's what to do:

Avoid medications. It may be tempting to offer over-the-counter remedies, but experts strongly recommend caution against giving kids adult tummy meds without consulting your pediatrician. That's because some, such as Pepto-Bismol and Kaopectate, contain aspirin or aspirin-like ingredients that increase the risk of Reye's syndrome in children younger than 12. This rare but serious condition causes swelling in the liver and brain.  Likewise, antidiarrheals like Imodium can lead to side effects in young children and should be avoided.

Keep up the fluids. Dehydration is a concern because fluids are leaving your child's body faster from both ends than they are being replaced. Prevent dehydration with the following methods.

  • For breastfed or formula-fed babies: Let your infant's belly rest for 15 to 20 minutes after a bout of vomiting or diarrhea, and then try nursing or bottle feeding again. "Breast milk is actually well tolerated by sick babies; plus the antibodies in it can help strengthen their immune systems," says Dr. Cohen.
  • For toddlers and older kids: Ask your doctor about rehydrating drinks, like Pedialyte, which are absorbed better than water. These solutions replenish the crucial salts and sugars lost when your child is throwing up or has diarrhea. Kids also tend to drink more flavored beverages than plain water, because they taste good.

Your child may have a hard time keeping down fluids at first. But sticking to small, frequent doses (try a teaspoon every couple of minutes) may help rebalance fluid and salt levels in the body, which can actually help stop vomiting over time. If your child goes longer than eight hours without peeing or your infant has fewer than three wet diapers per day, you should call your pediatrician, advises Dr. Kovacic.

Get back to a normal diet. Don't worry about food while your child is still throwing up. But once his stomach calms down, you can get back to a (mostly) regular diet. While the BRAT diet (bananas, rice, applesauce, and toast) used to be the standard advice after a stomach bug, doctors now say there's no reason to keep your kid's food bland for more than a day, since the diet lacks balanced nutrition, points out Dr. Kovacic. Still, take it easy on high-fat and high-sugar foods, which can irritate her still-sensitive digestive tract, and continue to push plenty of fluids until her diarrhea is gone.

Treat the fever. If a higher-than-normal temperature is making your child uncomfortable, you can use acetaminophen or ibuprofen to bring his temperature down. This may help relieve other aches and pains too.

Let him rest. Your child will probably be sleeping and napping more than usual, which is normal. But if your baby or toddler has been asleep more than 4 hours (and has been having diarrhea or vomiting), you may want to wake him up to offer fluids. "Remember that infants can become dehydrated more quickly than older kids," says Dr. Steffen. "Use common sense, like watching for signs of dehydration."

How Long Will Stomach Flu Last?

Depending on the virus and your child's immune system, the stomach flu can last anywhere from just a day or two to around 10 days. "Children tend to throw up for just the first day or two, but diarrhea can last more than a week," says David B. Nelson, M.D., chair and professor of pediatrics at Georgetown University Hospital in Washington, D.C.

Stomach flu can also make your child prone to short-term and completely reversible lactose intolerance (the inability to digest an enzyme in milk and dairy products), which may be responsible for lingering diarrhea in toddlers and older kids. "If milk seems to make diarrhea worse, ask your pediatrician what to feed your child," says Dr. Nelson. You may want to try yogurt instead, which is easier to digest, and return to milk a day or two after.

If your child is still throwing up after two days or has diarrhea for more than four days, check in with the doctor again. She may want to do additional tests to see if a different type of infection or condition might be to blame.

Sources: Stanley Cohen, MD, pediatric gastroenterologist at the Children's Center for Digestive Health Care in Atlanta, Georgia. David B. Nelson, MD, chair and professor of pediatrics at Georgetown University Hospital in Washington, D.C. Rita Steffen, MD, a pediatric gastroenterologist at the Cleveland Clinic in Cleveland, Ohio. AAP section on Management of Acute Gastroenteritis in Young Children. Mayo Clinic sections on Viral Gastroenteritis, Dehydration, Lactose Intolerance and Salicylates. FDA section on RotaTeq. CDC sections on Viral Gastroenteritis and Rotavirus Vaccination.

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