HOME MANAGEMENT OF GASTROENTERITIS
Diarrhea and vomiting are usually the responses of your child’s intestinal tract to some
viral infections. Although this type of infection is self-limited and will run a natural
course, it can cause a great deal of distress with cramping, frequent stools, vomiting and
fever. It can also lead to dehydration.
There has been a major change in our understanding of diarrhea and its management.
This new understanding has resulted in management recommendations from the
American Academy of Pediatrics, which differ greatly from those in the past. If current
recommendations are followed carefully, emergency room visits, hospitalizations and
dehydration in young children are markedly reduced.
Goals of Management:
1. To maintain nutritional status by maintaining an almost normal diet when
possible;
2. To prevent dehydration or correct mild dehydration by encouraging liberal fluid
intake;
3. To avoid measures which may make the diarrhea worse or possibly cause harm to
your child.
DIARRHEA: Children with diarrhea, without significant vomiting, may be fed breast
milk, formula, or cow’s milk, as well as most of their normal foods. “Starchy” foods
(bread, rice, pasta) are frequently well tolerated. Juices, soda, Kool-aid, Jello, and
Gatorade all tend to make diarrhea worse, and should be avoided. Any food with high
sugar content, such as sweetened fruit, jellies, and syrup should also be avoided.
Artificial sweeteners often worsen diarrhea and may also be a hidden ingredient in food
and drink, for example, in flavored water. Water, tea and diluted milk are not adequate
sources of minerals or nutrition for the body, and should be avoided in young children.
They may result in a major imbalance in your child’s body chemistry and cause serious
harm. Balanced-electrolyte solutions, such as Pedialyte will not lead to this type of
imbalance. They are not adequate nutrition and should not be used as a substitute for a
more regular diet unless there is also vomiting or dehydration. However, supplementing
the diet with these solutions at the onset of diarrhea may be beneficial in preventing
dehydration. Lactobacillus preparations, such as Lactinex, may decrease the frequency of
stools.
Diarrhea from viral infections may persist from a day or two to 1 – 2 weeks. If your
child can eat a normal diet, remain active, and does not lose weight, continue to feed him
or her as described above until the diarrheas is resolved. If he refuses fluids, becomes
lethargic, loses weight, or shows other signs of dehydration (dry mouth and eyes, sunken
eyes or soft spot, or marked decrease in urine output), please call our office. Fever is a
common symptom of viral infections and can be treated with acetaminophen or
ibuprofen. It is hard to tell if a child in diapers with frequent diarrhea is urinating
adequately. If the child is active and drinks well, the child probably is urinating
adequately. Bloody or very mucousy diarrhea may represent more significant infection.
Please contact our office to report these findings. If the diarrhea does not seem to be
resolving in a reasonable period of time or you have other concerns about your child,
please let us know.
Vomiting
If you child experiences repeated vomiting as well as diarrhea, normal feedings should be
discontinued until the vomiting is controlled. At this point, diligent application of the
oral rehydration technique described below is necessary until the vomiting is controlled
(please see Oral Rehydration section below). The diet described above should be
resumed when vomiting is no longer a significant problem. No diarrhea or vomiting
medications are effective in children with viral infections, and many of these can be
harmful. Please do not use diarrhea or vomiting medications.
Oral Rehydration Technique
If your child has repeated vomiting, along with diarrhea, the risk of dehydration is much
greater. The most important advance in preventing dehydration or correcting mild
dehydration in young children is the use of the Oral Rehydration Technique. The doctors
at Pediatric Associates have had to hospitalize very few children with dehydration since
we have started using this technique. This technique involves using an easily absorbed
solution such as Pedialyte, Kaolectrolyte or Infalyte, and spoon or syringe-feeding the
solution into the child, instead of using a glass or bottle. Try different flavors or brands
until you find one your child will accept. Pumped breast milk or formula may be used if
the baby refuses electrolyte solution. Fluids other than balanced-electrolyte solutions,
breast milk or formula can make diarrhea worse, or cause a serious chemical imbalance
in a young child’s bloodstream. The solution, breast milk, or formula should be poured
into a bowl, and infants should be fed 1-2 teaspoons every 10 - 30 minutes. Do not give
larger amounts at a time until 2 - 3 hours have passed without vomiting. Spoon/syringe
feeding the electrolyte solution should be continued even if your child vomits. This is a
tedious process for parent and child, but if it is carried out diligently, it is likely to
prevent dehydration and hospitalization. It is frequently helpful to distract your child
with a video. It is absolutely necessary to spoon-feed almost continuously, rather
than wait for the baby to ask for more fluid. Otherwise, adequate amounts of fluid
to prevent dehydration may not be given.
This technique works because spoonfuls of fluid are less irritating to the stomach than
larger quantities. Also, even if the child still vomits intermittently, feeding very frequent
spoonfuls of fluid will usually result in enough absorption of fluid between the vomiting
to prevent dehydration. If frequent small feedings of the balance-electrolyte solution are
administrated successfully, and no vomiting has occurred for 2-3 hours, somewhat larger
amounts of this solution can be given. Also, small, frequent breast feedings or
formula/milk feedings may be tried, Then a more normal diet, as described earlier, may
be started. Keep the feedings small and frequent to avoid irritating the stomach, and
avoid juice and sweet foods to prevent increased diarrhea.
If the child does not respond to these measures within 48 hours, please call our office.
The child should appear better hydrated, be more active, urinate several times a day and
be tolerating small frequent feedings. Diarrhea may continue, but this will not usually
lead to dehydration if vomiting has stopped and liberal fluids and feedings are continued.
If at any time you have any questions about management of your child’s illness, or
concerns about his/her condition, please call our office.