Managing Vomiting and Diarrhea in Kids

Parents often can't decide how much and which types of food and drink to give to a child who has been vomiting and having diarrhea. Kids can get dehydrated and thirsty when they are sick, but they may also throw up or have diarrhea right after eating or drinking. Here are some quick guidelines that will help you as you take care of your child when they have the stomach flu.

Treatments for Vomiting and Diarrhea

In general, when your child is vomiting a lot or has diarrhea from something like a stomach virus (gastroenteritis), you should:

• Give them fluids to avoid dehydration or help them get rehydrated.
• Once the child is able to keep fluids down, resume feeding to provide nutritional support.
• Avoid antibiotics as a treatment, because gastroenteritis is commonly caused by viruses, which aren't treated with antibiotics.
• Avoid antidiarrheal medications in young children.
• Zofran, an anti-vomiting medicine is an option for some kids who are vomiting to help avoid dehydration.

Recommended Fluids for Vomiting and Diarrhea

Parents often give water or juice to their kids when they have diarrhea or vomiting, and you can also use an oral rehydration solution (ORS).

Oral rehydration solutions have a good mix of sugar and electrolytes. The high amount of sugar and lack of sodium in fluids like apple juice might actually make your child worse. Similarly, Gatorade's high sugar content makes it controversial when used for diarrhea or vomiting.

The World Health Organization Oral Rehydration Solution (WHO-ORS) is the gold standard for managing acute gastroenteritis, and many parents and pediatricians use commercially available solutions such as Enfalyte or Pedialyte.

They are available in most supermarkets and drug stores without a prescription and come in good-tasting flavors. Your child might prefer some flavors over others.

How Much Fluids to Give a Vomiting Child

If your child is vomiting frequently, limit fluids to a teaspoon at a time, using a syringe, medicine dropper, or a teaspoon to measure the dose. You can gradually increase the amount you give at each time as your child begins to keep it down.

A good starting point is a teaspoon (5ml) or tablespoon (15ml) of fluid every five or ten minutes for the first hour or two, increasing to a few tablespoons at a time once the vomiting decreases and your child is keeping the fluids down well.

The total amount of fluids you should aim to give depends on how dehydrated your child is.

Children with:

Minimal or no dehydration

• 2-4 ounces of ORS for each episode of vomiting or diarrhea if they are less than 22 pounds
• 4-8 ounces if they are over 22 pounds

One ounce is the same as 30ml, so even if you are just giving your child one tablespoon (15ml) every five or ten minutes, you can very quickly get up to 4 ounces (120ml).

Mild to moderate dehydration, with decreased urine output, dry mouth, decreased tears, and a 3-9 percent loss of body weight

• 25 to 50ml (a little less than 1 to 2 ounces) of ORS per pound of body weight over 2-4 hours.
• In addition, they will also need 2-4 ounces of ORS for each episode of vomiting or diarrhea if they are less than 22 pounds
• 4-8 ounces of PRS for each episode of vomiting or diarrhea if they are over 22 pounds to replace ongoing losses.

Severe dehydration, with greater than a 9 percent loss of body weight, fast heart rate, deep breathing, parched mouth, deeply sunken eyes, absent tears, minimal urine output, and cold mottled extremities, will need immediate medical attention and IV fluids. They can then be changed to ORS once they start improving.

Feeding Through a Stomach Virus

It is often recommended that parents offer a BRAT diet (bananas, rice, applesauce, and toast) when they are sick. Many children will crave water and crackers or other bland foods when they are sick, and it's usually ok for them to take sips and eat small bites whenever they feel like they can.

If your child just has a few episodes of diarrhea and/or occasional vomiting, you should:

• Continue to breastfeed
• Continue to formula feed your infant, using full-strength formula, once they are rehydrated
  
• It's best to avoid dairy for a few days
• Avoid foods with a lot of added sugars, like fruit drinks, fruit juice, and carbonated soft drinks

Once they start to feel better, your child can get back to an age-appropriate unrestricted diet as soon as possible.