Managing Vomiting and Diarrhea in Kids

Parents often get confused about what to do when their kids start having vomiting and diarrhea. Do they give more to drink since they just vomited and are thirsty, even though they will probably just throw that up too? Or do they not let them drink, even though continued vomiting and diarrhea can quickly lead to kids getting dehydrated?

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
• resume feeding as soon as possible and provide early nutritional support
• avoid routine antibiotics as a treatment, as gastroenteritis is commonly caused by viruses
• avoid antidiarrheal medications in young children

While you first concentrate on getting them to drink a lot of fluids so that they don't become dehydrated, once they are keeping fluids down, you can quickly advance them back to their regular diet.

Parents often give water or juice to their kids when they have diarrhea or vomiting, but it is best to use an oral rehydration solution (ORS) instead. These have the right mix of sugar and electrolytes to best help your child, while the high amount of sugar and lack of sodium in other fluids, like apple juice, might actually make your child worse.

Although the World Health Organization Oral Rehydration Solution (WHO-ORS) is the gold standard for managing acute gastroenteritis, 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, although some brands do taste better than others.

The biggest mistake that parents make when their kids have diarrhea and vomiting, next to giving the wrong fluids, is being too aggressive and giving their children too much to drink at one time. Especially if your child is vomiting frequently, instead of letting them drink whatever they want, you should limit them to just a teaspoon at a time, using a syringe, medicine dropper, or an actual teaspoon. You can then 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. A Pedialyte popsicle might also be a good 'fluid' to start with if your child doesn't want or can't drink anything else.

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

Children with:

• Minimal or no dehydration should get about 2-4 ounces of ORS for each episode of vomiting or diarrhea if they are less than 22 pounds and 4-8 ounces if they are over 22 pounds. Keep in mind that 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, should get about 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 and 4-8 ounces 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.

Although many cases of gastroenteritis, with diarrhea and vomiting, can be treated at home, you should seek medical attention if you are unable to care for your child at home, especially if your child is less than 6 months old, refuses to drink any ORS, continues to vomit frequently, has severe dehydration, fever, a change in mental status (like being lethargic or irritable), or bloody diarrhea, or if his level of dehydration continues to worsen.

It is often recommended that parents not feed their child, offer a BRAT diet (bananas, rice, applesauce, and toast), or otherwise limit their child's diet when they are sick. Unless your child is vomiting a lot or simply doesn't want to eat, that usually isn't necessary, though.

Especially if your child just has diarrhea and/or occasional vomiting, you should:

• Continue to breastfeed
• Continue to formula feed your infant, using full strength formula, once they are rehydrated
• Get back to an age-appropriate unrestricted diet as soon as possible
• Avoid restricting milk (lactose) in your older child or making changes to your infant's formula
• Avoid foods with a lot of added sugars, like fruit drinks, fruit juice, and carbonated soft drinks

What about probiotics? Although often used, they are likely often overused when kids have vomiting and diarrhea.

Zofran, an anti-vomiting medicine is an option for some kids who are vomiting to help avoid dehydration.