How to manage vomiting related to a stomach virus.
Check out the PedsDocTalk YouTube Video: Managing Stomach Viruses in Your Child, for more information and guidance on stomach virus symptoms, food poisoning, contagious, how to manage symptoms, pain medication, dairy and sugary drinks with diarrhea, how to prevent the spread, and when to seek medical attention.
Read on for the basic infectious reasons our littles can have vomiting and diarrhea with a how-to on how to get through those dreaded stomach viruses!
Common reasons for vomiting and diarrhea include a stomach viruses, stomach bug or viral gastroenteritis. These are all synonymous terms. You can also have vomiting and diarrhea from a bacterial infection – this would be something like shigella or salmonella. Food poisoning can also cause vomiting and diarrhea and in rare instances – parasites.
These are the infectious reasons of vomiting and diarrhea and of course there are other reasons that a child can have this as well. A stomach bug is called viral gastroenteritis and this basically means that there’s inflammation in the stomach or the intestines. Symptoms can be vomiting, diarrhea or both. Symptoms can be short-lived or they can linger with your child, saying that they feel nauseous for even days or a week or more after the symptoms improve. When it’s a virus it doesn’t really matter which virus is causing the symptoms because the management is the same which is something called “supportive care.”
Because it’s a virus there’s no treatment. For example, COVID-19 can cause stomach upset in some children, which can include vomiting and diarrhea – so it’s important that if your child is having vomiting and diarrhea symptoms that you speak to your child’s pediatrician.
And the annoying part is—they can spread fast throughout the home. Everybody and even the dog seems to get this virus. Stomach viruses usually cause major symptoms for 24-48 hours, with lingering nausea or diarrhea days (sometimes weeks) after the peak. The worst tends to be in the first 12 hours and usually includes rapid vomiting and/or diarrhea back to back. Stomach viruses can include just diarrhea, just vomiting, and if you’re really lucky both at the same time. Abdominal pain and nausea are also likely present.
Should you keep them home?
If your child has symptoms of a viral gastroenteritis, we would want to keep them home for 24 hours fever and medicine free. This means things like no Tylenol or Motrin. We want to make sure that they are okay without a fever before we send them back into school or daycare.
Consider abdominal pain
If a child is in a lot of discomfort where they’re doubled over in pain and the vomiting and diarrhea does not alleviate any of that pain and that pain persists, your child needs to be evaluated. Other signs that your child needs to be evaluated are the following: if your child is younger than two months of age and there is blood in the vomit or dark green vomit, if there is blood in the stool that’s persistent (meaning more than one episode), if there is yellowing of the eyes or skin (which can be a sign of jaundice or an obstruction in the biliary tract), or if your child has an underlying medical condition where vomiting would be a concern.
You should seek medical attention if:
- You are worried your child is not able to keep any liquids down and is getting dehydrated (no tears, no urine, sunken eyes).
- Your child is having bloody stool.
- Your child is very irritable/inconsolable.
- Your child is having severe abdominal pain that is persistent and unrelenting.
- Your momma or poppa instinct is kicking in and you want them checked out.
Let’s talk about hydration
The key to managing a stomach virus is focusing on hydration. Food is not a priority but liquids are! We can go many days without food but we cannot go hours and days without hydration. It is really important to focus on hydration! You’re going to still offer the food but you have to remember that they may not want it.
Signs of dehydration include decreased urine output (which means less diapers or if your child is potty trained less time going to the toilet), dry tongue and mucous membranes, dry eyes and no tears, sunken soft spot in babies and slow capillary refill. This is when you press the tip of your child’s finger and it takes a long time more than two seconds for the color to return. If any of these things are happening with reduced oral intake of liquids, it’s important to seek medical attention.
For hydration in children over 1:
- Remember to wait at least 20 minutes after a vomiting episode before you offer liquids. If you give something right after, its more likely to be vomited back up. Focus on small amounts initially (10-20ml sips) of water, electrolyte solution like Pedialyte, or diluted Gatorade/Powerade. Pedialyte popsicles are also great.
- Sugar-free popsicles or ice popsicles are a great idea to prevent the chugging that children often want to do that can induce more vomiting.
- Avoid fruit juices and drinks with heavy amount of added sugar, especially if they also have diarrhea—as it can make it worse sometimes.
- Once vomiting has stopped, focus on these small amounts as often as often as you can while awake. Don’t let them pound the drink. Sometimes, they think they are ready, but they are not.
- If they do have a food appetite. Start slow. Don’t let them gorge. Anything is okay that they normally eat, but I would avoid spicy, fried, greasy, or sour foods as that can irritate the stomach.
For hydration in children under 1:
- Continue with formula or breast milk. Let them also do small sessions at the breast or 2 ounces of formula or pumped breastmilk at a time.
- Shorter, frequent feeds are best. You can increase the amount as you see they are tolerating.
- Also, use the 30 min rule as mentioned for older kids.
- If your child is not able to keep their normal liquids down, discuss with your pediatrician best oral hydration strategies (including pedialyte) and amount. Smaller, frequent sips are better than guzzling.
- Wait 30 minutes after a vomit episode before offering sips.
How to stop the spread
- Wash your hands. Most infections are spread through touch, especially in regards to stomach viruses. Teach them to wash hands for 20 seconds—two rounds of “row row row your boat.”
- Sanitize surfaces with a bleach-based product. I am not a big deep-cleaning fan on a regular basis. I believe some degree of germs are healthy and important for our immune system, but if you have a stomach virus in the home, step up your game!
- Wipe surfaces with gloved hands. Obviously the bathroom, but don’t forget, doorknobs, tables, toys, handrails, and most importantly TV remote controls and cell phones (IMO, hidden germ reservoirs we often forget).
- If able to, have the sick child sleep in a separate, comfortable room. But please understand that if that’s not feasible in your living situation, its okay. You do the best you can.
- For dirty clothes and plush toys, try to wash immediately or put in separate bag for launder. Those germs can live on those surfaces for a while.