Vomiting and Diarrhea (AKA Gastroenteritis)

Tonight, I was enjoying a kid-friendly dinner with my boys, when I looked up just in time to see my oldest holding his stomach, with terror in his eyes. I quickly grabbed the little one and a tray, but was not fast enough to catch all the vomit that ensued. While trying to simultaneously calm both of my boys and clean up the mess, a very friendly waitress brought over a Sprite. My sweet boy wanted to take a drink, but I quickly told her to take it away. Instead, I cleaned up, ordered a Gatorade to go and started my 7 step program to taking care of a child with vomiting (and the diarrhea most likely to follow).

1) Get out a big bucket and towel
2) Wait 20-30 minutes before giving anything to drink
3) Start VERY slowly with drinking. Babies and toddlers should get 1 teaspoon (5 ml) of Pedialyte every 5 -10 minutes for 30-60 minutes. Older children can have sips every 5- 10 minutes of water or Gatorade. Next I try Popsicles - Pedialyte pops for babies and toddlers. You can also freeze Gatorade or even give ice cubes.
4) Wait until your child asks for food, then start with bland, easy to clean up foods. I like bread, crackers, soup. Give them only small amounts at a time.
5) Wait for the diarrhea to start (could be right away or 3 days from now). When the vomiting has stopped and the diarrhea has started, stop giving Pedialyte and do not give juice. This will make the diarrhea worse. You can let them eat whatever they want, but foods like bread, bananas, rice, noodles (like the BRAT diet) can help make the poop more solid. I also like to add yogurt (especially live-active culture) to the regimen.
6) Start a Probiotic. Several are available over the counter. I like Culturelle, but any brand will work. This will help your child re-establish normal gut bacteria and shorten the duration of diarrhea.
7) Wash hands and surfaces frequently!

If a child has persistent vomiting and can not tolerate any fluids for 3-4 hours in a younger child or 5-6 hours in an older child and they have signs of dehydration, like extreme fatigue, dry eyes (no tears with crying), dry mouth, dark urine or no urine they need to be seen by a pediatrician. There are anti-nausea medications available for children, though most do not need them. The majority of viral gastroenteritis illnesses last 1-3 days (if a child is immunized against Rotavirus), but children can continue to have diarrhea and a few episodes of vomiting daily for several more days. Some children develop an intolerance to milk for 1-2 weeks after a bout with viral gastroenteritis, this can lead to continued symptoms when they eat or drinks milk products. Children tend to have upper abdominal pain with vomiting, but this should improve when the vomiting stops.

Signs that it is not gastroenteritis and your child needs to see a pediatrician:
1) Severe lower abdominal pain - especially on the right side
2) Fever and vomiting, without diarrhea after 2-3 days
3) Cough associated with vomiting
4) Vomiting with any urinary symptoms - especially pain while peeing
5) Vomiting bile - not yellow stomach acid, but dark green, disgusting vomit 
6) Vomiting blood or material that looks like coffee grounds
7) Pooping blood or mucous

At bedtime, I held my little boy, while he held his towel and puke bowl. For now, he is sleeping and I hope that we are done with puke in our household for the night! 

Heather Joyce, MD

Originally published on Peds for Parents