It's flu season. When people talk about flu, they can be talking about either stomach flu or respiratory flu. Today, I'd like to discuss stomach flu. This is also known as gastroenteritis, or sometimes just enteritis. It is characterized by vomiting, diarrhea or both. It can sometimes be associated with fever, abdominal pain or cramping, but not always. Stomach flu in adults typically lasts 1-2 days. However, in children and teens, it frequently lasts 5-7 days. For this reason, I'd like to talk about what you can do to make your child more comfortable when this occurs.
Usually, the vomiting starts first. As parents, our natural tendency is to withold food and drink from a child who is vomiting. Nothing in, nothing out, right? Unfortunately, that's just not the case. Children can continue to vomit and have diarrhea for several days, even if they are not eating or drinking. Therefore, experts currently say to go ahead and try to feed your child through this phase, if possible. However, sometimes they just won't keep anything down. Or, whatever they take in comes right out the other end. When that happens, we have to try other measures.
I tell parents to give clear liquids for 24 hours, then a BRAT diet (which will be explained in detail) for the next 24 hours, then a bland diet for the next 4-5 days. Theses children should have no fried foods, no spicy foods and no dairy, except for yogurt with active cultures, for 1 week. This is the overview. The devil is in the details.
The first 24-48 hours is the hardest part. The clear liquids need to be given frequently and in small amounts. It is labor intensive and thankless. Not all clear liquids are good choices. For example, water doesn't seem to stay down well in most children. Clear soda or ginger ale works much better. Dark soda can also be given (but is not a first choice, it doesn't stay down as well), and the soda does not need to be flat or room temperature for most children. However, any child can be an exception. Soda provides sugar, which these children need, as they are not eating. Soup broth is another good choice. It provides potassium, an important electrolyte. Clear juices, such as white grape juice can also be given. Avoid apple and pear juice. The sugar in these juices is not well absorbed and can cause increased diarrhea. Gelatin that has not solidified is used by many people, and that's fine. Just keep in mind that it may change the color of your child's stools. Also, remember that if you cannot read through the liquid, it is not a clear liquid.
When you start your child on clear liquids, the amount and timing can be very important. I recommend 1 tablespoon (T) every 15 minutes for the first hour; 2T (1 oz) every 15 minutes for the second hour; 3T every 15-20 minutes the third hour, and 4T (2 oz) every 30 minutes the fourth hour. I don't recommend going over 2 oz at a time the first day. Keep in mind that this is not likely to go smoothly. Your child will most likely vomit long before you get to the fourth hour. When this happens, stop, wait 1-2 hours and start over at 1 tablespoon.
Your child is not going to be happy when you are restricting their fluids. They are probably going to throw temper tantrums and push your buttons. Try to remember that they would be much less happy if they were vomiting constantly. The second day, you can start them on a BRAT diet. You can do this even if the vomiting hasn't stopped completely. BRAT isn't a reflection on your child. It stands for Bananas, Rice, Applesauce, Toast and crackers. These are bland foods that are unlikely to trigger vomiting, but also bind up the stool and slow down diarrhea. Offer these foods in small amounts frequently throughout the day. If your child doesn't like all of these foods, then just offer the ones he or she likes. Hopefully, they will like some of them.
Over the next several days, add in more bland foods. Adding protein will help your child recover faster. As stated above, avoid fried foods, spicy foods and dairy for one week. The exception to that is yogurt with active cultures. Keep in mind that chicken nuggets are fried before they are frozen and placed in the freezer section.
If you are one of the lucky parents who is able to feed their child through the initial stages of stomach flu, start with the BRAT diet. Then add bland foods slowly over the next several days. You will still need to avoid fried foods, spicy foods and dairy, except for yogurt. Other comfort measures include comfortable clothing for the fever and warm baths for the abdominal pain and cramping.
Call your physician for vomiting that shoots 5' across the room, or for vomiting that is green or contains blood. If the vomit contains little particles that look like coffee grounds, that could be dried blood. That is another reason to contact your physician. Always call for abdominal pain that is limited to the right lower side of the abdomen, as this may be a sign of appendicitis. Consider talking to your healthcare provider in advance, as they may have specific guidelines for how soon to call based on your child's age, urine output and underlying conditions.
Dr Nan N
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home
http://FiresidePediatrics.com
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