The Stomach Virus and Dehydration: a Parent’s Guide

‘Tis the season for that most delightful of infections, the stomach virus. Spring and summer are peak times for the several viruses that cause infections in the intestinal tract leading to fever, vomiting, diarrhea, and sometimes, dehydration. These can be incredibly frustrating infections for parents and doctors alike with no easy solutions or quick fix. As with most viruses, it simply has to “run its course.” In little guys especially, it can be a serious infection and cause significant dehydration, so it certainly merits close monitoring.

A viral gastroenteritis, or stomach virus, typically begins with fever and vomiting, though the older child may skip the fever all together. Generally a few hours to a day or two later, the diarrhea starts. The vomiting may be multiple times a day, after any drop of food or drink is attempted, and may last for a few days, though it tends to ease up by the second day of illness. The diarrhea on the other hand can last a great deal longer, even up to 10-14 days, though it should be improving after 5-7 days. It can be very watery, explosive, and just all around nasty (and may have a particularly foul odor). Since it is all caused by a virus, there are no antibiotics that will work for this illness; time will have to run its course. Meanwhile, it’s important to try and keep your child drinking as much as possible—she can skip food for a while, but must have an adequate supply of liquid to keep her body hydrated and working properly.

For anyone who is vomiting, it may help to let the stomach have a short rest period before trying any fluids at all. For an older child, try waiting 2 hours or so after they throw up before giving them anything to drink. Infants may not be put off for as long, but give them a little resting space as well. When offering fluids, give them only a very small amount at a time, but very frequently. These little sips are easier on the upset stomach than a large amount all at once and are more likely to stay down. For infants, this may mean using a syringe or medicine-dropper to give them about a teaspoon (5 ml) of liquid every 4-5 minutes, or breastfeeding for half the usual amount of time, but twice as often. Toddlers may need firm assistance with this technique—remember that they are probably thirsty and may want to chug a large amount at once—but if you can help them go slowly, it will decrease the risk of vomiting it right back up. While an oral re-hydrating solution like PediaLyte is best, any liquid that the child will voluntarily take is better than nothing. Popscicles and ice chips are good as they dissolve slowly and may be more easily taken at a low rate. Fever control is also important, since a child that feels bad is less likely to want to drink. Using Tylenol or Motrin to bring (and keep) the fever down may increase your child’s cooperation with the hydration process.

The diarrhea is a bit of a different story, since we are basically powerless to stop it. For children in diapers, it’s important to change the diaper very frequently, as soon as you detect that they have stooled again. Starting early with extra balm with each diaper change will help keep an irritant diaper rash at bay—these can get pretty uncomfortable if your child is having 10-15 bouts of watery diarrhea a day. Thick balm with a good barrier like zinc oxide is best, and feel free to really goop it on. Once the vomiting has improved, you can start your child on solid foods again, slowly advancing to her regular diet. Cereals, toast, pasta and starches like these are good “binders” and may help decrease the diarrhea. Fruit juices and “P fruits” in particular (peaches, pears, plums, prunes) tend to loosen the bowels, so you may want to limit their intake until the diarrhea is resolving. It is still important to increase liquid input, more than try to force the foods. Even if she has stopped vomiting, she’ll still lose a lot of liquid in the diarrhea, so make sure she’s drinking more than usual.

With lots of fluid losses from the vomiting and the diarrhea, dehydration can easily develop, which while less messy, is much more serious. Vomiting and diarrhea alone do not necessitate a doctor’s visit, but concern for dehydration certainly does. It can be difficult for a parent to tell if their child is getting enough fluids in, especially when she continues to vomit periodically and is having multiple diarrheas a day. Dehydration can occur pretty rapidly, especially in infants, so it’s an important issue to be alert for. While you’re giving your child those frequent, small sips or brief nursing times, check the mouth and tongue, which should be nice and shiny-wet, even if she is a little behind in her liquid intake. If they look dry an evaluation by her doctor may be warranted, and especially if you’re having trouble getting the child to drink. You should also keep track of the amount of urine that your child is producing. Continuing to urinate is a sign that she has at least some extra water in her system to spare—a dehydrated baby will have much fewer wet diapers. A third sign that your child may be dehydrated is her activity level, though this one is a bit less specific. A child that continues to be active and relatively playful is most likely not dehydrated. On the other hand, a listless child may be dehydrated, or may just have a fever and feel bad. If the fever has come down and she continues to have poor activity level, along with a dry mouth or decreased urination, she should be seen by a health care professional. And remember, the stomach virus is highly contagious, so keep washing those hands! The entire family may well get this infection, and that’s a sure way to ruin a couple of weeks this summer.