Vomiting & Diarrhea
Most vomiting and diarrhea in infants and children is caused by viruses. Luckily, it is usually short lived and self-resolves. In the meantime, it is best to try to keep your child well-hydrated and comfortable.
Be on the lookout for signs and symptoms of dehydration: the inside of the eyes and mouth will dry out, infants will not make tears, an infant's soft spot may appear sunken, and there will be little/no urine output in a 6-8 hour period. If you think your child is dehydrated, call your doctor OR go directly to the nearest emergency room. You do not need our permission to take your child to the ER if you are concerned. Often the treatment involves intravenous fluids which must be provided in a hospital setting anyway.
If you try to keep giving food or drink to a child who is in the "heaving/retching" stage of an illness, his/her stomach will keep rejecting anything you offer and prolong vomiting. It is best to wait until the stomach is completely empty and there has been no vomiting or retching for an hour or two. Most children will feel weak at this point, and often their blood sugar has dropped a bit, which will make them feel even more nauseated. Try to bring their blood sugar up by giving sips of Pedialyte to infants, and something with sugar that can be absorbed through the inside of the cheek to older children. Often sucking on a lollipop or hard candy (if your child is old enough not to choke) is a good solution. Some people will try to give some of the syrup from a can of canned fruit a teaspoon at a time. Some people try giving the child a teaspoon of jelly. This does not require much to be sitting in the stomach, and will raise the blood sugar. (This is why your mother gave you "coke syrup" when you were younger.)
After the blood sugar has been raised, offer small amounts of a clear, sugary fluid. Some good choices are flat Sprite soda, white grape juice, ice pops, water ice, or decaffeinated iced tea with sugar. Pedialyte is the best choice for children under 12 months. The idea is to give small amounts of clear fluids that do not have to be digested and will not sit in the stomach for very long. The clear fluids will be gradually absorbed by the stomach. Even if your child is very thirsty, go slowly. If they drink 4 ounces and it sits in their stomach, it will make them nauseated again. Some people will offer a "shot glass" amount every 10 minutes, gradually increasing the volume as they are sure the child is improving. I do not recommend Gatorade for children with vomiting and diarrhea; it has a high osmotic load and can aggravate symptoms and alter blood salt chemistries.
Diarrhea without vomiting
The goal is to replace fluids by mouth in an amount which is roughly equivalent to that which they are losing in diarrhea. Again, clear, sugary fluids or Pedialyte are good choices. Avoid things that cause loose stools on a good day (such as apple juice and cider) and avoid dairy products, as diarrhea will cause temporary lactose intolerance in most children. (The lactase enzyme which digests lactose sugar in milk/dairy is in the very center of the intestinal tract. With multiple episodes of diarrhea, the lactase gets washed away and may require a few days of being well to replenish itself.)
If your child is tolerating fluids, you can use carbohydrates such as pretzels, crackers, toast, and noodles to "soak up the fluid". Other foods that can help are bananas, decaffeinated teas, rice/rice cakes, and applesauce (the pectin helps to stop diarrhea). In general keep your child's diet boring and bland for a few days, even when their hunger returns. Reintroducing their favorites such as hot dogs and pizza too early may make symptoms reappear.
Common questions and answers
What if it seems like everything I give goes right through my child?
This may appear to be the case, but is really not what is happening. Remember when you first brought your child home as an infant? Every time you fed him/her, he soiled his diaper. This is because the body has a "gastro-colic" reflex and no tone to the anal sphincter when you are very young. Every time you introduce something into the stomach, the colon starts moving things along and the rectal sphincter relaxes to expel whatever happens to be down there. If things are moving rapidly through the intestinal tract (as in the case of a viral illness), the contents do not sit in the colon/rectum long enough for the body to reabsorb any excess water. This is why it looks like the fluids you are giving by mouth are coming out the other end. Be persistent! Keep pushing the fluids and the body will eventually recover.
What do I give an infant with vomiting/diarrhea?
In general, children under 12 months of age should receive fluid replacement in the form of Pedialyte or one of the other electrolyte replacement solutions on the market. These products have the correct amount of sugar/salt to make sure the baby's "chemistries" don't get out of whack. As above, start with small amounts. If your child is not vomiting, keep offering fluids as tolerated and monitor hydration status as above. If you are breastfeeding, continue to do so with small, frequent feedings. If you are bottle feeding, offer no other foods but Pedialyte (absorbed through the stomach, and the body doesn't have to do any work to digest, so it gives the intestinal tract a "rest") for the first 24 hours. Then switch to a non-milk based or lactose-free formula for a few days. It is often a good idea to do 24 hours of Pedialyte only, followed by 12-24 hours of Â½ Pedialyte and Â½ lactose-free/soy formula, followed by full strength (mixed according to the directions on the can) lactose-free/soy formula for a few days. If your child is eating solids, you can reintroduce bland/boring things once you know they are tolerating full strength formula.
When should I be concerned?
Seek medical attention if your child appears dehydrated, symptoms persist longer than expected (vomiting continues longer than 12 hours, and/or diarrhea persists longer than 3 days), your child appears very ill/listless, or diarrhea is accompanied by severe abdominal pain/cramps and/or has mucus or blood in it.
Katie Baker, DO, FAAP