Vomiting and Diarrhea

Parenting in the Early Years

Vomiting and Diarrhea

Vomiting

Vomiting is the forceful, repeated throwing up of food and liquid from the stomach. Vomiting is most commonly caused by a viral illness. However, it may be associated with trauma or poisoning. It can also be the result of illness of many organ systems including the gastrointestinal, respiratory, urinary and nervous system. Vomiting is different from the small amount of spitting up frequently seen in babies under one year of age.

When to Contact Your Doctor

Most vomiting is a self-limited condition that responds to the simple home treatment described on the following pages. Because vomiting can be associated with more serious illness you should contact your physician for the following reasons:

Dehydration

This is the loss of body fluid and is the most common problem associated with vomiting. Severe dehydration can be life threatening. Indicators of dehydration include decreased saliva, loss of tears, decreased urination, sunken eyes and a sunken soft spot on an infant's head. Dizziness upon standing, marked irritability or marked sleepiness may be seen. A weight loss can be measured on a home scale.

Blood in Vomitus

Blood in vomitus can appear bright red or coffee-ground brown. It is most commonly seen after swallowing blood from a nosebleed. It can be caused by a tear in the esophagus from repeated vomiting or it could represent a severe inflammation of the stomach lining called gastritis. Other diseases could be present such as an ulcer. Blood in vomitus should always be reported.

Severe Abdominal Pain

A constant, severe stomach ache lasting more than an hour or stomach pain that seems to be getting worse needs to be evaluated. The pain could be caused by many problems including appendicitis, a telescoping of the gut into itself called intussusception, or an infection in the abdominal cavity called peritonitis. Gently push on your child's abdomen and watch his reaction. If your child's abdomen is tender when you push on it or the abdominal pain is causing your child to walk bent over, contact your physician.

Poisoning

If you think your child has ingested a poison or medicine that has led to vomiting, he needs to be evaluated. (See the POISONING section for more detail.)

Head Trauma

Repeated vomiting of more than three times after a head injury can be a symptom of a significant injury to the brain. If this happens to your child, he will need to be evaluated. (See the HEAD INJURY section for more detail.)

High Fever

Children with marked elevated temperatures and vomiting have an infection. Most of these are viral and are self-limiting. However, there are some more serious infections that can be present, including strep throat, pneumonia, urinary tract infections, encephalitis and meningitis (an infection of the brain or surrounding layers). Call your physician for directions on how to proceed.

Confusion or Difficulty Arousing

These symptoms can be present with unrecognized injury, poisoning or nervous system disease. Immediate medical attention is needed.

Duration

The risk of complication varies with the age of the child. The youngest are the most vulnerable.

  • Infants less than 2 months: Call if vomiting occurs more than 3 times
  • Infants less than 6 months: Call if vomiting lasts longer than 6 to 8 hours
  • 6 months and older: Call if vomiting lasts longer than 24 hours

Home Treatment

Allow the stomach to rest for 30 minutes after vomiting. Then offer clear liquids (breast milk if breast-feeding) starting out with one or two tablespoons at a time. (See the TREATMENT section under DIARRHEA for specific fluid recommendations.) This can be given in 10 to 15 minute intervals.

If fluids are held down for 15 minutes, they are absorbed and are beneficial even if vomiting returns. Remember that a child who is vomiting may be thirsty and if allowed to drink as much as he desires, more vomiting may occur.

Once your child is able to tolerate small quantities of clear liquid, gradually increase the amounts and then offer bland, easily digested foods such as toast, crackers and cereal. Introduce more general foods as tolerated, introducing the greasy and spicy foods last. After the most severe period of vomiting, which usually last less than a day, a child may continue to vomit several times a day for the following 2 to 3 days.

Diarrhea

Diarrhea is loose, watery stools that occur more often than the child's usual bowel habits. Diarrhea is one of the most common childhood illnesses. It can be serious enough to require hospitalization and results in about 500 childhood deaths a year in the United States. It is usually caused by a viral infection.

Rotavirus is the most common viral cause of diarrhea and we are currently vaccinating infants against this infection. Other viruses can cause diarrhea as can many bacteria including salmonella, campylobacter, shigella and E. Coli or parasites, the most common being giardia. Other causes of recurrent diarrhea include irritable colon, non-specific diarrhea of infancy, food allergies and inflammatory bowel disease.

While diarrhea can be frustrating and messy, it usually improves with time and can most often be treated at home. The greatest danger to your child is dehydration, which occurs when the body loses more water and electrolytes than is replaced.

Signs of Dehydration

Signs of dehydration in your infant or young child are:

  • Dry lips, tongue and mouth
  • Decreased saliva
  • Loss of tears
  • Decreased urination or fewer wet diapers (there should be at least three in 24 hours)
  • Sunken eyes or sunken soft spot on an infant's head
  • Dizziness upon standing
  • Marked irritability or listlessness
  • A weight loss that can be measured on a home scale

When to Call Your Doctor for Diarrhea

Call your doctor if you child has:

  • Signs of dehydration
  • Blood, mucus or pus in stools
  • Constant belly pain for more than one hour
  • Is sleepy all the time and hard to wake up
  • Is having more than 10 stools a day or the diarrhea is not improving after 48 hours

Treatment

Your goal in treating diarrhea is to start rehydration fluid treatment early to prevent serious dehydration, followed by early feeding. Early feeding with the appropriate foods during diarrhea has been shown to reduce dehydration, hasten recovery, reduce stool frequency and improve nutritional status.

The recommended fluid to begin is called an oral rehydration fluid. It is the appropriate mixture of sugar and salts. These are available commercially as Pedialyte® or Kao Lyte® and others similar in content. If breast-feeding, continue. A homemade solution of 1/2 to 1 cup rice cereal, 1 cup of water and 1/4 teaspoon of salt can be used. Try to give 2 to 4 ounces of rehydration solution for each stool. If your child is formula feeding, a lactose-free formula such as Lactose-Free®, Prosobee® or Isomil® may be better tolerated.

For mild diarrhea, increase water intake. Crackers, rice cereal, bananas, yogurt-based drink and vegetable juice would be appropriate.

Fluids such as soda, juices and Jello may worsen diarrhea because of their high sugar content.

Use foods rich in complex carbohydrates including breads, pasta and beans. Return rapidly to a balanced diet including dairy products, eggs, cooked vegetables, meat, chicken and fish. Avoid high sugar content foods, including fruits and candies.

The addition of a probiotic called acidophilus or lactobacillus may help your child recover from diarrhea. This can be obtained in most pharmacies or health food store and is also present in cultured yogurt. Use one half capsule opened up and mixed in with liquid for infants under age 2. For those over 2 years of age, use 1 full capsule.

The illness that caused the diarrhea will probably get better in a few days and the stools will not be as runny, but your child may still have softer and more frequent bowel movements for a week or longer.

In Cases of Severe Diarrhea or Vomiting

If your child is having severe diarrhea or vomiting, please keep a record of stooling and vomiting frequency as well as the amount and type of fluids taken in, and call your doctor.