Vomiting and Diarrhea

Most vomiting and diarrhea in infants and children is due to gastrointestinal viruses. These viruses typically have fever, vomiting, diarrhea, and lack of appetite and energy as their predominant symptoms. Vomiting typically occurs early in the illness and lasts for 1-3 days. Diarrhea usually follows and can be very frequent and watery. Fever is frequently seen, and can be as high as 104 degrees. As with any virus, medication cannot cure this, and the virus will have to "run its course." This may only take several days, but can take up to two weeks.

What to do

Your main goal is to keep your child hydrated. If your child has just vomited, allow her stomach to "rest" for 2-4 hours. Then, give small amounts of fluid frequently. Try 1/2 - 1 ounce every 30 minutes. If she throws up again, start over. You may even need to start with just sips.

Pedialyte or Infalyte are ideal fluids in the first 24-48 hours of illness.

If your child is younger than 6 months don't give anything other than Pedialyte/Infalyte, formula, or breast milk without talking to the office.

If your child is older than 6 months, give whatever they'll take. Some suggestions are popsicles, fruit juice, water, milk or formula, Jello, pureed fruits, frozen juice on a spoon, or Gatorade. Try to avoid only water, as the body absorbs and holds onto fluid better when sugar and salt are consumed as well.

If your child has a fever, you can treat with a fever reducer to make him more comfortable. If he vomits oral medicine, consider an acetaminophen (Tylenol or Feverall) suppository.

After 24-48 hours on clear liquids, attempt to advance her diet. If she's not ready yet, don't worry; she'll start to eat as she feels better. Give her bland and binding foods such as the BRAT diet (bananas, rice, applesauce, and toast).

Rotavirus is a virus common in the late winter and early spring that gives these symptoms, and tends to be worse than many others. The diarrhea is bright green and has a distinct and malodorous scent. As this is a virus too, the above advice holds true for this disease.

When to worry

• If your child is getting dehydrated. She should urinate or have a wet diaper at least 4 times in 24 hours. Other clues that she is getting dehydrated are a dry mouth and lips, crying without tears, and lack of interest in drinking.
• If the vomit is bloody or bright dark green (bile).
• If the diarrhea is bloody or black and tarry.
• If your child has severe or unrelenting abdominal pain. Cramping abdominal pain is likely prior to a bowel movement, but should be absent or mild in between episodes. The pain should be intermittent and last less than one hour. Also, when he is not experiencing pain, you should be able to push firmly on his belly without discomfort.
• If your child has prolonged crying. Occasional episodes of crying and screaming are to be expected with the cramping belly pain of gastroenteritis, but if your child cannot be consoled after one hour of constant crying, call the doctor.
• If your child is vomiting for longer than 24 hours and hasn't had a bowel movement. Especially if the vomit is green (bile), as this could be a sign of an obstruction.
• If the vomiting persists for longer than 3 days, or if the diarrhea is not improving after 2 weeks. It can take up to a month for the lining of the intestines to heal and the stools to be completely normal again, but there should be some improvement within two weeks.