The quick and dirty on "The Stomach Flu"

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For those of you literally in the thick and thin of vomiting and diarrhea right now, I wanted to review "gastroenteritis" or the stomach virus.  Many people call this the "flu" but it should not be confused with influenza.  Unfortunately, your annual flu shot will do nothing to prevent this awful illness.

According to the CDC, acute diarrhea accounts for more than 1.5 million outpatient visits, 200,000 hospitalizations, and approximately 300 deaths per year.  Diarrhea is defined as 3 or more  loose or watery stools per day (or more frequent passage of stool than is normal for the individual).  Stool patterns differ among children so it is important to note that diarrhea needs to represent a change from normal. (Frequent passage of formed stools is not diarrhea.)

Acute Gastroenteritis usually presents with diarrhea, vomiting, fever(sometimes), decreased appetite, and abdominal cramps. Vomiting followed by diarrhea may be the initial presentation or vice versa. However, when vomiting is the only presenting sign, other illnesses such as diabetes, appendicitis, metabolic disorder, urinary tract infection, meningitis, gastrointestinal obstruction, and ingestion need to be considered.

Viruses cause the majority of cases in children and are noted to have lower grade fevers(when present) and watery diarrhea without blood. Bacterial infections may result in damage to the intestine and lead to inflammation and blood as well as higher fever. Any child with high fever(>102) or blood in the stool should be evaluated immediately.

Most cases of gastroenteritis in children do not require the use of medications. The first step in management is at-home fluid replacement.   At the earliest signs of symptoms, the goal is to begin giving your child a oral rehydration solution such as Pedialyte(or if they don't like that, G-2 Gatorade).  These solutions are actually preferred over IV fluids in mild to moderate dehydration. ( We do NOT recommend juice, coke, ginger ale, excessive water or jello).

When your child is vomiting, it is sometimes difficult to keep any liquids down.  The goal is to start with a teaspoon every 3 minutes for 1 hour and then 1 tablespoon every 3 minutes for the 2nd hour then small frequent sips.   If the vomiting recurs, go back to 1 teaspoon and start the process over.

You should have your child evaluated when there is no urination in 6-8 hours (for children 2 or under) or in 8-10 hours(for children older than 2).  Your child should also be evaluated if the vomiting lasts for > 24 hours, is green/red, or if there is worsening abdominal pain. Your child should also be seen if the diarrhea turns black or red or lasts longer than 10-14 days.

As mentioned before, medications are usually not used or recommended for most cases of gastroenteritis.  Anti-diarrhea agents (ex: kaopectate) are not recommended because of risk of side effects such as drowsiness, worsening nausea, and ileus (complete stopping of the bowl).

For children with severe vomiting, we will occasionally use medications such as Zofran. However, they must be used with caution and only after discussion with a doctor. We will usually recommend a child being seen prior to Zofran use due to the need to rule our more serious causes of vomiting such as diabetes and urinary tract infections.

Probiotics are also sometimes recommended for diarrhea illnesses. Probiotics are live microorganisms that potentially benefit by promoting a balance in intestinal flora.  Lactobacillus rhamnosus GG, Bifidobacterium lactis, and Streptococcus thermophilus are the most common ones studied.   Randomized control studies have shown some support for L. rhamnosus GG.  These seem to be more effective when used at the early signs of illness.

Note:  All comments are welcome on the blog, but please do not post medical questions. I am, unfortunately, unable to respond to personal medical questions through this website.   Thank you for understanding!

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