How to know if your child has norovirus
Managing Stomach Viruses in Your Child: Symptoms, Treatment, and Remedies
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welcome to pete's doc talk tv i am dr
mona amin a board-certified pediatrician
and mom and today we're talking all
about stomach viruses what are the
symptoms what do you do about it at home
and when to seek medical attention this
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and here we go
common reasons for vomiting and diarrhea
include a stomach virus stomach bug or
viral gastroenteritis these are all
synonymous terms you can also have
vomiting and diarrhea from a bacterial
infection this would be something like
shigella or salmonella food poisoning
can also cause vomiting and diarrhea and
in rare instances parasites these are
the infectious reasons of vomiting and
diarrhea and of course there are other
reasons that a child can have this as
well but i'll go over more red flags
that would warrant an evaluation if your
child is having stomach symptoms such as
vomiting or diarrhea a stomach bug is
called viral gastroenteritis and this
basically means that there's
inflammation in the stomach or the
intestines symptoms can be vomiting
diarrhea or both symptoms can be
short-lived or they can linger with your
child saying that they feel nauseous for
even days or a week or more after the
symptoms improve common viruses that can
cause viral gastroenteritis include
enterovirus rotavirus norovirus and
adenovirus when it's a virus it doesn't
really matter which virus is causing the
symptoms because the management is the
same which is something called
supportive care because it's a virus
there's no treatment for example copin
19 which is caused by the sars cove 2
virus can cause stomach upset in some
children which can include vomiting and
diarrhea so it's important that if your
child is having vomiting and diarrhea
symptoms that you speak to your child's
pediatrician to determine if covenanting
testing is needed food poisoning is
actually different than a stomach bug or
stomach virus food poisoning is actually
caused by a bacteria commonly staph
aureus and parents will often come in
when their child has a viral symptom of
a stomach bug and they'll say oh my
child must have ate something bad now in
the end the management is the same but a
stomach bug and food poisoning is very
different to me in terms of how it
presents
food poisoning is usually caused by
foods that are left out for too long
these are foods such as pasta salads
things with mayonnaise in it
things that have avocado in it if that
is left out for too long that can cause
this bacteria to overgrow releasing the
toxin that can cause food poisoning the
symptoms of food poisoning usually go as
such you enjoy the meal you don't even
realize that it tastes funny and then
four to six hours later you're having
vomiting and or diarrhea after you expel
that toxin from your body you actually
feel better you feel like you're ready
to eat again you don't have that typical
lingering nausea that can happen with a
stomach virus or a stomach bug that is
the differentiation now it's true that
some stomach viruses can be just a
24-hour thing but usually a stomach
virus has that lingering nausea i don't
really feel like eating those are the
common things that i hear versus food
poisoning once you get that food out of
your system you're feeling ready to eat
again and like i said even though they
are caused by different mechanisms one
is a toxin from a bacteria and the other
is a virus the management is essentially
the same viral gastroenteritis is
inflammation in the lining of the
stomach or intestines gastroenteritis as
a term can be caused by viruses but it
can also be caused by bacteria in
children ninety percent of the time we
do see it caused by a virus symptoms
include vomiting diarrhea irritability
nausea abdominal cramping low-grade
fever
headaches in a child who is not speaking
yet they may be very fussy symptoms can
occur together where you see the
vomiting and diarrhea occur on the same
day at the same time or you can see one
alone or one happen before the other in
bacterial gastroenteritis we want to
monitor for a couple things if diarrhea
is persisting beyond two weeks your
clinician may want to check a stool
study to make sure it's not an ova a
parasite or a bacteria causing the
symptoms another big thing we want to
know is if the diarrhea is associated
with fever especially with blood in the
poop if there is blood in the poop we
would want to know right away so we can
determine if this is something that
needs an evaluation such as a stool
sample common bacteria that can cause
bacterial gastroenteritis can include
shigella salmonella ursinia
campylobacter and e coli depending on
the age and clinical presentation of
your child if they have bacterial
gastroenteritis they may or may not need
antibiotics in an older child who is
clinically well sometimes we don't need
to prescribe these medicines so it
really is based on a case by case basis
so are these things contagious well food
poisoning is caused by a food that the
person eats and develops the symptoms so
that won't be contagious if you
accidentally touch the vomit or poop of
someone that you're helping out but
viral gastroenteritis is very contagious
that means the secretions that we
release from our body whether it's mucus
whether it's poop whether it's vomit is
contagious so it's really important to
remember that yes a viral
gastroenteritis picture can be very
contagious so we want to take as many
precautions in the home to prevent the
spread the best thing we can do is wash
our hands after taking care of someone
who may have these symptoms or if we
have these symptoms as well
disinfecting surfaces with bleach-based
products can also help i typically don't
need a family to use bleach-based
products on an everyday situation but
stomach viruses are extremely contagious
so if there is someone in the family who
has it it may be beneficial to use these
items on shared surfaces if your child
has symptoms of a viral gastroenteritis
we would want to keep them home for 24
hours fever and medicine free this means
things like no tylenol or no motrin we
want to make sure that they are okay
without a fever before we send them back
into school or daycare
in terms of diarrhea the daycare or
school would want a few things if it's a
potty trained child we want them to not
be having any accidents if it is a
non-potty trained child we want to make
sure that they're not having accidents
that overflow outside of their diaper
and of course we want them to be
hydrated and clinically better so if
you're feeling like they're better and
you feel comfortable sending them and
they are fever-free for 24 hours and not
having any accidents they can go back to
school one of the biggest things to
remember is that it is really hard
taking care of a sick child especially
when they're vomiting and having
diarrhea when you start to see your
child wretching you know making that
sound that they're about to vomit it can
actually induce vomit in you so i want
you to know that you're not alone if you
get that gag feeling if you're feeling
nauseous while you're having to clean it
up the virus will get better their
illness will get better and if they
don't you're going to seek medical
attention and we'll go over that the key
to managing a stomach virus is focusing
on hydration i can't tell you how many
times i have parents in my office whose
child has vomiting and diarrhea and the
parent is so upset that the child is not
eating and i want to remind you that
even for us if you are having vomiting
and diarrhea but especially vomiting you
are not going to want to eat a big meal
when we're sick also food is not a
priority but liquids are we can go many
days without food but we cannot go hours
and days without hydration it is really
important to focus on hydration you're
going to still offer the food but you
have to remember that they may not want
it and i'm going to go over some tips on
how you can introduce hydration and
meals if you need to with liquids focus
on the preferred liquid so if it's an
infant you're going to focus on breast
milk or formula if they're not taking
their preferred liquid then you'll speak
to your child's pediatrician if your
child is under one years old to
determine if they need something like
pedialyte if your child is under one and
not taking their preferred liquid i want
you to speak to your child's clinician
because i want to make sure that we
assess their hydration before deciding
if something like pedialyte is necessary
if your child is over one you also
continue to do their preferred liquid
ideally this will be water breast milk
if they're still breastfeeding diluted
gatorade
or pedialyte but remember the diluted
gatorade and pedialyte is if they're not
taking water and if they're not taking
breast milk if they're still
breastfeeding one of the biggest
mistakes i see is that after a child
vomits we immediately want to give them
liquids right away but think about the
last time you've had vomiting your body
is still nauseous we want to wait a
little bit before we offer liquids so
you can use something called the 20 20
rule wait 20 minutes before you offer
anything so if your child vomits at noon
wait until 12 20 before you offer
20 mls of their preferred liquid you can
even start a little bit lower if you
want if they tolerate that you can give
a little bit more the next time in about
another 10 to 20 minutes so 20 mls wait
a little bit
20 mls but start slow if we immediately
give them liquids right after they vomit
or if we allow them to guzzle down
liquids right away we're going to see
that vomit come back up we want their
body to settle a little bit and by using
that 20 20 rule you're going to assure
that you're getting hydration into them
in these small amounts but you're
building up as they tolerate the liquids
the goal is small frequent feedings and
you can use a medicine cup to measure
this out or you can use a syringe
whatever works for you and if you want
to start with a smaller volume than 20
mls that is perfectly fine if it's an
infant you can take them to the breast
or offer formula from a bottle but start
with a lower volume than they are
normally getting and make sure you wait
at least 20 minutes after a vomit
episode if your child is hungry start
slow of course i want them to eat if
they're hungry but sometimes their eyes
don't really understand that they're
still nauseous so they'll eat and eat
and eat but it'll all come back at us so
we want to also use that same rule with
hydration if they're hungry you can
start 20-30 minutes after a vomiting
episode with some food my advice is to
start with hydration first to make sure
that they tolerate that if they are
saying that they're hungry start with a
small amount of food you don't need to
make it completely bland but i want to
make sure that it does not have anything
spicy
acidic or fried because those things can
be a little bit aggravating to a child
with a stomach virus so any other food
is okay bland is better because we don't
want too much flavor or spice when their
stomach is healing but offer a small
amount if they do well you can add a
little bit more later so your schedule
may be a little bit off when they're
having a stomach bug maybe you normally
have three meals and two snacks but when
they're having a stomach bug you're
gonna have a little bit of leeway here
offer what they need start slow and
smaller volume and build up as tolerated
if your child is having diarrhea i would
monitor giving them a dairy or sugary
drinks sometimes these liquids can cause
a secondary intolerance to these items
what happens when we get a viral
gastroenteritis is the virus can strip
our intestinal and stomach lining of all
of those good bacteria
temporarily that help break down dairy
and sugary drinks so if you're giving
your child dairy or sugary drinks and
they have diarrhea and you feel like the
diarrhea is persisting i would try to
switch to something like water pedialyte
diluted gatorade that has less sugar
because we don't want to exacerbate the
diarrhea symptoms if your child is in
pain it's okay to medicate them with
motrin or tylenol which is ibuprofen or
acetaminophen if your child is under one
year of age and is in a lot of pain it's
best for us to have you seek medical
attention i personally recommend
acetaminophen over ibuprofen if a child
is not eating because sometimes
ibuprofen can cause irritation to the
stomach lining although you are managing
this at home it is really important to
know when to seek medical attention and
the biggest thing is dehydration some
signs of dehydration include decreased
urine output which means less diapers or
if your child is potty trained less time
going to the toilet
dry tongue and mucous membranes dry eyes
and no tears sunken soft spot in babies
slow capillary refill which is when you
press the tip of your child's finger and
it takes a long time more than two
seconds for the color to return so if
that happens they may show a sign of
dehydration if any of these things are
happening with reduced oral intake of
liquids it's important to seek medical
attention another very important sign
that we need to see your child for is if
your child is having severe abdominal
pain of course i mentioned that stomach
viruses can cause vomiting and or
diarrhea but if a child is in a lot of
discomfort where they're doubled over in
pain the vomiting and diarrhea does not
alleviate any of that pain and that pain
persists your child needs to be
evaluated to make sure we do not need
any imaging or further evaluation other
signs that your child needs to be
evaluated your child is younger than two
months of age there is blood in the
vomit or dark green vomit there is blood
in the stool that's persistent meaning
more than one episode yellowing of the
eyes or skin which can be a sign of
jaundice or an obstruction in the
biliary tract
or your child has an underlying medical
condition where vomiting would be a
concern the mainstay in management of a
stomach virus is hydration so follow the
tips that i already mentioned but if
your child is not keeping liquids down
or so nauseous where the sight of a
liquid even using that 20 minute rule is
making them vomit more it's important to
seek medical attention if that is
happening your child's clinician or the
er may recommend a medicine called
zofran or undance-a-tron this is a
medicine that's an anti-nausea or an
anti-ammetic medicine depending on the
age of the child this medicine can be
administered in different ways it's
available in liquid form that they
swallow it can be administered as a pill
that the child puts underneath their
tongue or a pill that is swallowed it
can be given every six hours and i think
it's useful if a child is not able to
keep liquids down i usually don't really
recommend this medicine if the child is
able to keep liquids down because that
is the goal but it is okay to take it if
your child is super uncomfortable with
the nausea i just feel like less meds
are better but if a child really needs
it because they are not drinking or the
sight of liquids make them nauseous it's
important to consider taking this
medicine to keep them hydrated if your
child is dehydrated and you seek medical
attention your child's clinician or the
er will evaluate if your child needs
zofran
and they'll do something called a po
challenge a po challenge is something
where we offer liquids in a clinical
setting to see if they can handle it if
your child is extremely dehydrated or
not taking the po challenge then they
may need iv fluids iv fluids will help
replenish the fluids lost from diarrhea
and vomiting in some cases children will
get this in the er and be able to go
home in other situations the child may
need to be admitted into the hospital
for further observation to make sure
their hydration status is okay to
prevent stomach viruses the best thing
we can do is wash our hands if your
child has vomiting and is in school or
child care it's important to keep them
home until they are symptom free for 24
hours and fever and med free for 24
hours it's also important to prevent
food poisoning to manage safe food
handling this means washing our hands
before and after cooking it means being
mindful of items that may be on kitchen
surfaces and cleaning those surfaces
after we cook
and also in terms of preventing the
spread in the home of stomach viruses we
can also clean and disinfect surfaces
remember what i said i do not need you
to disinfect every day when children are
not sick but when there's a stomach
virus going through the home to prevent
other children or adults from getting
the virus cleaning surfaces can really
help the most important take home is
focus on hydration remember to wait that
20 minute roll before we offer any
liquids and when you're thinking about
feeding your child after vomiting and
diarrhea remember that hydration is the
priority we can offer food to our child
keep it bland and not too exciting like
spicy sour or fried but we really want
to focus more on hydration i know it can
be really stressful when your child is
sick and you just want them to eat
because you feel like eating will give
them strength but in the setting of
illness especially a stomach virus that
is the last thing on their mind so focus
on hydration and know the signs that you
need to seek medical attention thank you
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