Stomach Flu (Gastroenteritis)

Stomach flu also referred to as Gastroenteritis, is an infection in the stomach and intestines.  It is most commonly caused by a virus, but can also be caused by bacteria, parasites and other things.  It is one of the common problems seen in children.  In US 20-35 million episodes of diarrhea occur each year. Rota virus is notorious for causing severe diarrhea.

 Symptoms

Children with gastroenteritis have vomiting ("throwing up") and/or diarrhea (frequent, loose stools).  Most children will have vomiting for only a short period of time, usually between 12 and 24 hours.  However, it is not uncommon for diarrhea to last for 7-10 days.  Since gastroenteritis is usually caused by a virus, antibiotics will not help.  Other over the counter medications to stop the diarrhea is not needed, since this is how our bodies get rid of the infection.  Gastroenteritis is contagious while your child has vomiting and/or diarrhea.  It spreads from person to person by fecal - oral route or by ingesting contaminated food or water. Good hand washing is the most important way to prevent the spread of infection to others.  Disinfecting diaper changing surfaces and keeping trash that contains vomit or stool away from the living area will also help.

Some kids are at higher risk of developing stomach flu than others. It includes younger age children, immune deficiency, malnutrition, international travel to a place where this is endemic (area in which this problem is very common), child care centers and exposure to unsanitary conditions.

 Vomiting and diarrhea can be harmful if your child loses too much body fluid and becomes dehydrated.  It is very important to monitor your child very closely for dehydration, particularly in infants, as it can happen very fast.  Signs of dehydration include:

-Decreased urine output ("peeing") or less wet diapers         

-No tears when crying

-Dry, sticky mouth

-Sunken eyes

-Sunken soft spot in infants

-Less activity, weakness or sluggish behavior

-Irritability or excessive crying

-Dry skin that is not as springy as usual

If your child has any signs of dehydration, high fever, refusal to drink, blood in stool or vomit, severe vomiting or explosive diarrhea, your child needs to be examined by a physician. 

 Tests

 Every stomach flu child does not need testing. In selected cases the healthcare provider decides to do testing which includes - blood test for electrolytes, kidney function and blood cell counts. Stool for rotavirus, bacterial culture, ova and parasite. 

Treatment

 There are some things that can be done at home for vomiting and diarrhea to prevent dehydration from occurring.  The most important thing is to provide enough fluids to replace those that are lost during the illness.  During the first 24 hours offer plenty of clear liquids frequently throughout the day.  Do not use plain water, as it does not provide the essential nutrients that are lost with vomiting and diarrhea.  Oral rehydration solutions such as Pedialyte is the best.    Below are instructions for clear liquid and vomiting diets.

 A) CLEAR LIQUID DIET INSTRUCTIONS

 Birth to 6 months

        Day 1 - Pedialyte or other oral rehydration solutions are recommended for the first 12 hours.  They provide the appropriate amount of electrolytes and replacement fluids. After 12 hours if improvement is seen, half strength formula may be started for infants.  Half strength formula is made by mixing one part formula + one part water + one part pedialyte.  If using ready to feed formula mix one part formula + one part pedialyte.  If your baby starts having severe diarrhea when formula is started then call you doctors office. If the diarrhea has been going on  for more than 5- 7 days then consider using lactose free formula like Similac lactose free, Isomil, Prosobee, Alimentum, Nutramegin or Progestimil during the length of illness and a week after. Need rapid rehydration in first 4- 6 hours if the child is dehydrated and then adequate amounts to maintain rehydration (approx. 1-2 ounces of fluids need to be given for every stool the child has).

         Day 2 - Full strength formula can be started.  If your baby usually eats foods such as rice cereal, applesauce or stained bananas, these may be started as well. If the diarrhea has been going on for more than 5- 7 days then consider using lactose free milk like Lactaid or Soya milk (Lactose free) during the length of illness and a week after. Need rapid rehydration in first 4- 6 hours if the child is dehydrated and then adequate amounts to maintain rehydration (approx. 2-4 ounces of fluids need to be given for every stool the child has).

 Breast fed babies should stay on breast milk and take in extra fluids such as Pedialyte.

 Seven Months and older

          Day 1 - Clear liquids and a light, bland diet may be started.  Examples of clear liquids are pedialyte and pedialyte popsicles.  Avoid fruit juices as it can make the diarrhea worse. Also avoid Kool-Aid, tea, soda and jell-O. No diet or presweetened products should be used.  A light diet of rice, dry white toast, saltine crackers, noodles, mashed potatoes, applesauce and bananas can be used.  Avoid using red liquids, as it can be mistaken for blood in the vomit. 

        Day 2 - If diarrhea is improving, children can gradually return to their usual diet over a few days period, as tolerated.  Fatty foods, spicy foods, bran and raw fruits and vegetable should be avoided during this time. 

B) VOMITING DIET

After vomiting, allow your child's stomach to rest for about 20 - 30 minutes.  Then clear liquids may be given in small amounts frequently. 

 Children under 2 years:  Offer 1 teaspoon of clear liquids every 20 minutes for the first hour.

Children over 2 years:  Offer 1 tablespoon of clear liquids every 20 minutes for the first hour.

 Double the amount each time.  Gradually increase to amount to as much as the child wants.  After 8 hours of no vomiting, then a light diet can be started.  Babies may have rice cereal, applesauce, and bananas.  Children may have bananas, rice, crackers, toast, applesauce or soup.  Continue to offer clear liquids.  Normal diets for babies and children can usually be started after 24 hours. Some people use zantac or pepcid  for 2-5 days to decrease the acidity and improve the appetite. Both are available over the counter in many stores. 1) Zantac (EFFERdose 25 mg) tablet is available which should be completely dissolved in a teaspoon of water and given by mouth. If somebody has Phenylketonuria, they should avoid ZANTAC EFFERdose as it contains phenylalanine. Tablet is not to be chewed, swallowed whole, or dissolved on the tongue. 

2) Pepcid 10mg chewable tablet may be used in the following dose.                  

Antibiotics are generally not needed for stomach flu. If there is bacterial infection antibiotic may be needed. Recommend seeing a physician if there are signs of dehydration, high fever, confused, blood in the stool, diarrhea going on more than 2 weeks, short of breath or seizures.

 Food poisoning

Food poisoning or water borne illness contribute to about 6- 81 million stomach flu in a year in US. It should be suspected when 2 or people develop symptoms of sudden vomiting, diarrhea (with or without blood), abdominal cramps, tingling and numbness or paralysis after ingesting the same food or water. It can start after eating contaminated food at a fast food restaurant or after eating left over food from the previous day. Usually the symptoms start within 8 hours. Some of them start between 8 to 72 hours after ingesting the triggering food or water. It needs to be reported to the public health department so that they can take necessary action.