Doctors’ Notes



First, I’d like to dispel a common myth: there is no “stomach flu.”

The true “flu,” or influenza, causes high fever and mostly respiratory symptoms, although it can occasionally cause vomiting and diarrhea. Most of the vomiting and diarrhea-inducing viruses are NOT the “flu” — and, therefore, the flu shot you (hopefully) got will not prevent them! It’s just a little pet peeve of mine when I hear that statement.

Many viruses that attack the GI system cause vomiting as a first symptom. Of course, this can be very distressing to kids (and adults) of all ages, especially when they’re too young to anticipate what’s going to happen or to express what they’re feeling. Little ones have an amazing propensity to vomit anywhere, anytime without warning, which is why I’m not replacing my 30+ year old couch until all my children are old enough to vomit in an appropriate receptacle.

Go Slow to Avoid Dehydration

The big concern with vomiting and diarrhea from a stomach virus is the chance of dehydration. When ill with a GI bug, children can vomit multiple times over many hours. The best thing to do when this is happening is to prepare to GO SLOW when offering anything to your child to drink.

When about an hour has passed since the last episode of vomiting, offer JUST SIPS of a clear fluid such as pedialyte, water, or breastmilk. We’re talking 1 tsp every 5 minutes. (I really do mean SLOW.) Beware, however, that children will often be thirsty at this point and will want to guzzle a large amount of fluid. If they’re permitted to do this, you’ll probably be cleaning it up off your floor before too long!

If your child is resistant to taking in fluids, try something other than the usual cup/bottle, such as a medicine syringe or dropper, or even a teaspoon. Little sips (even as small as 1 tsp or 5 ml) over time can really add up and prevent dehydration. At this point, if your child has a fever (which often comes along with it), you do not need to give medicine for this. The medicine will probably not stay down anyway, and fever is not dangerous, so it’s best to hold off. (See my Note on Fever.)

More Fluids & Foods: Stay Slow!

If the first sips stay down, continue the clear fluids. After, say, 8 hours without vomiting — not that there is exact science to this, but that length follows conventional wisdom — you can offer regular fluids (including formula or milk) as well as solids.

Similar to the fluids, start slow with solids, offering easy-to-digest things such as crackers, dry cereal, simple soups and dry toast (or baby food). Again, they may be hungry and asking for macaroni and cheese. Don’t do it!

Start slow, and they’ll have a better chance of keeping it down. You can advance the solids as your child tolerates them. If he/she vomits again, start back with the clear fluids. Depending on the age and medical history of your child, we may be able to prescribe a medication to reduce nausea and vomiting. Please call the office, and one of the providers will help decide if that is appropriate.

Signs of Dehydration

• Mild vomiting and diarrhea, even with decreased fluid intake, usually does not cause dehydration. Signs of dehydration include:

• Decreased urine output (we like to see a wet diaper or urination at least every 8 hours, which of course is usually much less than their normal)

• Dry tongue and inside of the mouth

• Dry eyes with decreased or absence of tears

• Irritability or fatigue.

If your child is still playful and active, he or she is not dehydrated. If you’re concerned your child may be dehydrated, please call the office.

Fortunately, the vomiting stage of these illnesses usually lasts only 24-48 hours, though mild vomiting (and diarrhea) can occur intermittently for up to about a week. (For more info, see Dr. Wolynn’s Note on Dehydration.)

Handwashing & Prevention

As you probably know from unfortunate experience, these viruses are typically very contagious. If you’re caring for a child with vomiting and diarrhea, wash your hands frequently. A little disinfectant on hard surfaces never hurts. Though I’m no germaphobe, cleaning the shopping cart handle or restaurant high chair is a good idea. Wash all soiled clothes in hot water and be extra careful to keep the diaper changing areas clean. And, wash your hands. Did I already mention that?

In my book, this illness is definitely a reason to cancel those play dates and stick close to home.

Final Thoughts

Your child can return to school or day care when they are back to eating their usual diet, have no further symptoms, and are back to a normal activity level so they can participate as usual.

(This also seems like a good time to remind you that one of the nastiest GI bugs, Rotavirus, is prevented about 85% of the time by a routine childhood vaccine!)

As always, call us with any questions or concerns. And keep washing those hands!

Dr. Amy Maddalena has been a Kids Plus Provider since 2006.