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Monthly Topic
Vomiting
There are many causes of vomiting, from
infections to upset stomachs due to food intolerance. Below is a general plan
used to treat many causes of vomiting, and it is designed to replace the fluids
and electrolytes that are lost. The main concern with vomiting is dehydration.
The following should be offered but not forced:
- Begin with a period of NOTHING BY MOUTH for two hours.
For infants on just breastmilk or formula, skip to number six below.
- Next, give 1-2 tsp of an electrolyte solution (pedialyte,
Gerber Pediatric Electrolyte Solution, Pediapops) every 15 minutes. In older
children/young adults Gatorade is an acceptable alternative.
- If this is tolerated for 2 hours, then the volume may
increase to 1-2 ounces every 15-30 minutes.
- If the above is tolerated without vomiting for 2-4 hours,
then small amounts of bland foods may be offered. Examples of bland foods are
bananas, rice, applesauce, toast, grits, and saltines. Try to avoid butter and
greasy foods as this will upset the stomach.
- Slowly progress the diet to have your child back to
his/her regular diet by 24-36 hours. If persistent vomiting occurs at any
point, start over at number 1.
- For infants, follow steps 1-3. After 6-8 hours of
tolerating the electrolyte solution, resume breastfeeding small frequent
feedings. For formula fed babies, progress to ¼ strength formula
(¼ formula + ¾ electrolyte solution) and slowly advance to full
strength formula in 24-36 hours.
This plan requires 1-2 days. Do not rush it. Danger
signals include high fever (over 102F), pain, prolonged vomiting (over 8
hours), extreme sleepiness (unless it's bedtime), blood or bile (green) in the
vomit, severe headache, severe abdominal pain, stiff neck, rash, painful
urination, significant ill appearance…..Please call our office if these
symptoms occur with vomiting.
Also please be alert for signs of
dehydration, which include decreased salvia (check inside the mouth for
moisture) and decreased urination (no urine produced in 8 hours). A sunken
fontanel sometimes occurs with infants in the event of dehydration. If you
suspect your child is dehydrated, please contact our office.
Diarrhea
Diarrhea is a common
problem in pediatrics at any time of year. Most commonly, this symptom is due
to viruses, which do not respond to antibiotics. If your child is having both
vomiting and diarrhea, it is important to stop the vomiting first. For
instructions on vomiting, please refer to the above section.
The
primary concern with diarrhea is dehydration. If your child is not vomiting or
the vomiting has stopped, there are no specific dietary restrictions for the
diarrhea. Drinks that are high in sugar content are best avoided, as they will
make the diarrhea worse (juice, soda, kool-aid, tea…). In infants and
children over 6 months of age, some foods may help slow diarrhea such as
bananas, cooked carrots, yogurt with "live, active cultures". If the diarrhea
lasts longer than 7-10 days, a trial of eliminating lactose-containing diary
products from the diet for 1-3 weeks may be warranted. Some children will
become transiently lactose-intolerant after a prolonged episode of diarrhea.
Temporary avoidance of lactose-containing dairy products will usually clear
this up.
If your child goes more than 8 hours without urinating, his/her
mouth is not very moist, or you notice more than one episode of blood in the
diarrhea then you need to call our office. Also, antidiarrheal medicines are
not recommended, as they may cause the intestines to become obstructed and
usually prolong the illness. |
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