Vomiting and Diarrhea

When your young child develops vomiting or diarrhea for the first time it can be
scary. Frequently, the vomiting will develop first and in the next day diarrhea will start. If there is blood or yellow bile in the vomit, the vomiting is projectile or if you child cannot stop vomiting you should call the pediatrician. Most of the time, however, the vomiting will stop after several vomiting episodes. The first step is to survey your child for any other problems. Make sure there is no evidence of head injury or drug ingestion. As
long as he is alert and consolable the best thing you can do is to pursue watchful waiting. Do not give anything to drink for 30 to 60 minutes. If there is no more vomiting then give 1 tsp of an oral rehydrating solution like Gatorade or Pedialyte every 10 mintutes. Do this for 1 hour and then increase to 2 tsp every 10 minutes for the second hour and 3 tsp every 10 minutes for the third hour. Thereafter, he can have as much Gatorade, Pedialyte, breast milk or formula as he likes. If he again vomits then restart the process. As long as no warning signs are present and he continues to urinate at least 2 times every 12 hours he will not become dehydrated. Trust your intuition and call the pediatrician if you have any concerns.

After he has tolerated liquids for a few hours you can gradually return him to his prior diet. Go slowly and be cautious with foods that are high in protein and fat. These can be harder to digest. Foods that are high in complex carbohydrates are tolerated best. If he
is breastfeeding then resume breastfeeding. Breast milk has natural antibodies that can help reduce the risk of vomiting and diarrhea.

If he develops diarrhea the most important thing is to protect the diaper area from skin
irritation due to the liquid stool. Loose stools are irritating and contain enzymes that will break down the skin. Use plenty of vaseline and coat the entire diaper area. If necessary check the diaper every 20 minutes and apply vaseline to the entire diaper area every time. The more vaseline you apply the better. You will also find it is easier to clean the diaper area when vaseline serves as a barrier between the skin and the diaper. There is nothing worse than an infant crying from pain due to a severe diaper rash that burns every time another episode of diarrhea occurs. It will take up to several days for most diaper rashes to clear. It is like a rugburn. Once it happens the skin will take several days to heal. Protecting the skin also helps prevent yeast infection in
the diaper area. An ounce of protection is worth a pound of cure.

In the past a clear liquid diet was suggested for infants and children with diarrhea.
This is no longer suggested. Pediatricians now suggest a healthy diet with plenty of fiber be given. The complex carbohydrate diet described above is suggested with protein and fat in moderation. Fruits and vegetables are allowed.

Be cautious about fruit juice and other sweet flavored drinks that can aggravate the diarrhea.  Watch his urine output. If he is urinating 2-3 times every 12 hours he is safe from dehydration. If you see blood or mucous in the stool call your pediatrician for advice. If the diarrhea last longer than 1-2 days or if you have a young infant less than 12 months and he is having numerous watery stools a day you should call your pediatrician. Infants and young children who continue to vomit and have diarrhea are at high risk for dehydration. Do not let this happen.

A common diarrheal illness is rotovirus. It is spread by poor hand washing and poor stool hygiene.  Infants now receive an immunization to help prevent this infection but all children and adults are at risk for this “stomach virus”. If your infant has diarrhea he should not return to day care until the diarrhea has resolved. The diarrhea can last for several days but most young children do well. Young infants can be given intravenous fluids if needed and sometimes require a brief hospitalization.