Diarrhea and Vomiting

Most vomiting and diarrhea are due to a viral illness.  The key goal is keep the child hydrated.  The child may not eat well, but should continue to drink to maintain good hydration.  Dietary treatment usually is all that is needed.

Dehydration manifests first with no tears when crying.  Then, the inside of the mouth becomes dry (minimal saliva).   Followed by no urine for 8 hours in a child less than 1 year or no urine for 12 hours in an older child.  This is then followed by significant lethargy (not moving very much and/or interacting with parents).

Treatment of Vomiting:

The most important point is to keep the child well hydrated.  This is done with FLUIDS ONLY as described below.  As noted, NO solid should be given initially, because this will worsen the vomiting.

  1. For Infant and Children <24 Months
    Pedialyte (a commercially prepared sugar, electrolyte solution) should be used as below.  Breastfeeding infants may continue to breastfeed —otherwise avoid milk or formula.
  2. For Children >24 Months
    You use other fluids (use flat soda never diet soda, 1/3 strength diluted juice, popsicles, Gatorade, or diluted broth).  Older children can chew on ice chips.

First Hour:
Give sips slowly. Approximately 1 tablespoon every 15-30 minutes-No more.

Second Hour:
Increase to 2 tablespoons (1 ounce) every 15-20 minutes.

Subsequently:
Continue to increase by 1-2 oz an hour.

If there is no vomiting for 6 hours, the diet can be expanded with soft bland foods (examples are crackers, noodles, toast, applesauce, bananas, and infant rice cereal).  Avoid milk and other dairy products for 72 hours except in infants less than 6 months old.  If vomiting occurs begin therapy all over again.

Treatment of Vomiting and Diarrhea

Use vomiting therapy until vomiting has subsided.  Then use diarrhea therapy.

Treatment for Diarrhea without Vomiting

  1. For infants <12 months
    If using a milk based formula (e.g. Similac with Iron, Advanced Enfamil with Iron, Lipil, Carnation Good Start or others) change to a soy formula (e.g. Isomil, Prosobee) until diarrhea has resolved for 3 days, then the formula can be changed back to the original milk based formula.  If breast feeding or using soy formula (e.g. Isomil, Prosobee) or a protein hydrolyzed (eg Alimentum, Nutramagen or Progestamil) just continue feeds.
    The child may eat their regular diet except for juice.
  2. For children 12 months and older
    Use flat soda (never diet soda), 1/3 strength diluted juice, popsicles, Gatorade, or similar liquid.
    The child may eat a regular diet but no dairy products (milk, ice-cream, yogurt, cheese etc.) or full strength juice until the child is free of diarrhea for 3 days.

Call the office if

  1. If less than 12 months and vomits 6 times or for 6 hours.
  2. If 12 months or older and vomits 8 times or for 8 hours.
  3. If less than 12 months and refuses to drink for 6 hours.
  4. If 12 months or more and refuse to drink for 8 hours.
  5. If less than 12 months and diarrhea last longer than 48 hours.
  6. If 12 months or greater and diarrhea last longer than 4 days.
  7. Diarrhea >10 times/day.
  8. Vomits blood.
  9. Bloody diarrhea.
  10. Has abdominal pain constantly for 2 hours or more.
  11. Seems confused or delirious.
  12. Has a stiff neck.
  13. Has had a recent head injury.
  14. Appears dehydrated (see below).

Signs of Dehydration

  1. No tears.
  2. Dry inside of mouth.
  3. No wet diaper or urination for 8 hours in a baby less than 12 months.
  4. No wet diaper or urination for 12 hours in a child 12 months or older.
  5. Significant lethargy (not moving very much and/or interacting with parents).