Illnesses which cause Vomiting and diarrhea are common. Most children with vomiting and diarrhea have viral infections which will get better after a few days on their own.

The major problem that can result from vomiting and diarrhea is dehydration (losing too much fluid).

Occasionally more severe illnesses can cause vomiting or diarrhea. You should call us immediately if your child:

Looks very weak, unresponsive, limp or gray. Has severe, progressive abdominal pain, which does not improve significantly after a bowel movement or episode of vomiting. Is less than 1 month old and has 3 or more large watery stools in a short period of time Is less than 3 months old and has a fever over 100.3 rectally. Is less than 3 months old and has 2 or more episodes of projectile vomiting in a row (projectile vomit means that the vomit travels greater than a foot from the baby's body). Is less than 6 months old and vomits yellow or green bile. Is over 6 months old and vomits yellow or green bile 3 or more times in a row. Is less than two years old and has a bloody, mucousy, diarrhea stool. Is older than two years and has bloody, mucousy stool and a fever over 101 degrees. Has signs of dehydration: Not urinating for greater than 8 hours no tears when the child cries child's mouth becomes dry or sticky to the touch child's eyes are sunken child is much less active than usual.

Below are recommendations to help avoid dehydration:

VOMITING

If your child is vomiting, give small amounts of fluid often. Children are less likely to vomit if their stomach has less in it at a time. Once your child has tolerated small amounts without vomiting, you can slowly increase the amount you give him at a time.

For infants, breast milk is the best fluid to give. Try giving small frequent breast feeds. Try feeding one side at a time every 1 to 2 hours. If this quantity of breast milk is vomited, try nursing 4 to 5 minutes every 30 to 60 minutes. If your infant goes 8 hours without vomiting , return to your normal breast feeding schedule. A re-hydrating fluid (Pedialyte, Rehydralyte, etc.) can be offered between breast feedings.

Formula fed infants can be offered formula diluted to 1/2 strength (mix ready to feed formula with an equal quantity of water or add twice the regular water to concentrated or powdered formula). If your infant can not keep down small quantities of 1/2 strength formula, try re-hydrating fluid. Start with 1 teaspoon every 10 minutes. This can be given by spoon, cup, or syringe. After 4 hours without vomiting, gradually increase the amount of fluid given. After 8 hours without vomiting, return to full strength formula.

Children older than 1 year will often tolerate clear liquids better than milk. They can be given re-hydrating fluids or diluted juices, flat soda (stirred to remove the bubbles), sports drinks or Popsicles. Start with 1 tablespoon every 10 minutes. Increase the amount given gradually if your child does not vomit. For repeated vomiting which has just begun within the last 2 hours, sometimes it is best to let your child just rest his stomach for an hour or two, before attempting to get him to drink. If possible encourage your child to sleep for an hour to give the stomach time to settle.

Infants and children that are beginning to look tired-out and dry from vomiting should be given as much re-hydrating fluid as they can tolerate. No amount is too much. As a general guide, children who weigh 15-20 pounds will need to average 1 1/2 to 2 ounces of fluid per hour and a 20-30 pound child will need 2 to 4 ounces per hour to avoid dehydration.

Children should not be pushed to eat if they feel too nauseated, but as soon as appetite returns, diet should be advanced to normal as quickly as tolerated.

Call for a visit during the next regular office hours if your child has:

Is less than two years old and has vomited for more than 24 hours and does not have diarrhea. Is over two and has vomited for over 48 hours and does not have diarrhea. Has vomiting and diarrhea lasting longer than 1 week.

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DIARRHEA

Diarrhea means frequent, loose bowel movements. Mild diarrhea, during which a child's energy level and appetite remain normal, requires no special treatment except avoidance of excessive fruit juice and an overall increase in fluid intake. Starchy foods such as rice, pasta, potatoes and bread are particularly well-tolerated. For episodes of mild diarrhea, milk does not need to be discontinued.

For moderate diarrhea, three or more large, loose stools within eight hours, you should be sure to increase your child's fluid intake. The best way to treat diarrhea is to give extra water and salts, until the diarrhea is better. For infants this should be in the form of re-hydrating fluids (pedialyte, rehydralyte, ricelyte,or resol). For older children who refuse re-hydrating fluids, this should be in the form of orange juice (a low sugar juice), or as a second choice diluted soda or fruit juice. Salty snacks such as pretzels and saltines should be given with the juice.

For a 15-20 pound child aim for at least 1 1/2 - 2 ounces of re-hydrating fluid per hour. For a 20-30 pound child aim for 2-4 ounces per hour.

For breast fed infants, continue to breast feed as you normally would, in addition to offering re-hydrating liquid. Formula fed infants with mild diarrhea can be given formula in addition to the re-hydrating fluid. Formula fed infants with moderate diarrhea should be offered formula diluted to 1/2 strength in addition to the re-hydrating fluid. Formula should be increased to full strength over the next 12-24 hours. Non-breastfeeding infants with marked diarrhea, loose stools every hour or more, or loose stools associated with a significant decrease in energy, should be given re-hydrating fluid alone for the first 8 hours of their illness. They should then be offered 1/2 strength formula, increasing to regular strength formula over the next 12 - 24 hours.

Half strength formula is made by diluting regular formula with equal parts water.

If your child is on solid foods and shows interest in eating, continue to give solid foods throughout the illness. Good choices include mashed bananas, applesauce, cooked cereals, crackers, rice, pasta, yogurt and chicken. Contrary to popular belief, milk products do not worsen diarrhea in small children. Even if your child has more bowel movements as a result of eating, he will get over his illness faster if he eats than if he doesn't eat.

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Call us for a visit during regular office hours if your child has:

Mucous in the stool for more than two days Fever and diarrhea for longer than three days Diarrhea and is known to have been in contact with someone with shigella or salmonella bacterial diarrhea Moderate to severe diarrhea and has recently handled a reptile Diarrhea lasting longer than two weeks

DO NOT use stool binders or anti-diarrhea medicines. These medicines can be dangerous if used improperly.

If you child has diarrhea from taking an antibiotic, you can give him or her a capsule of Culturelle (special kind of lactobacillus), opened up onto food once a day until the diarrhea stops.

These are just guidelines. Call us if your child's symptoms are getting steadily worse or not improving after 2 days. Call us especially if your child does not look right to you.

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