Ew, I Don't Eat Bugs!

This week's guest columnists are Marie Baker, MD, and Caitlin McDaniel, MD, family practice residents at Ochsner University Hospital & Clinics.

My 3-year-old came to me complaining, “My tummy hurts.” I'm thinking she just doesn't want to go to sleep, so I tell her to get in my bed and I rub her tummy. She falls asleep, but then two hours later throws up on my bed and now feels hot. I take her temperature; it's 100.2. She looks miserable, so I try to say something comforting: “You just have a little stomach bug from school.” At that, she's suddenly alert and looks at me accusingly, “Ew, I don't eat bugs!”

A common theme of first-time school attendance is repeated coughs, colds and gastrointestinal viruses. Gastroenteritis is the medical term for my daughter's ailment, defined as increased stool frequency with loose consistency (diarrhea) and/or vomiting. Some kids get fevers and headaches, lose their appetite and act sluggish. The vomiting usually lasts half a day, the diarrhea 2 to 5 days.

Many parents are alarmed the first time their child vomits or has watery stools. First, it's really gross. But they also worry about dehydration. If your kid has only vomited a couple of times, settles down and is able to drink clear liquids, you're going to be okay. Diarrhea by itself also rarely dehydrates.

When to come in? If your child is vomiting for longer than 8 hours and won't hold down liquids for longer than 10 minutes, it's worth checking in with your doctor. If kids are also getting progressively sluggish, not drinking or getting up to pee, that's concerning. If they don't make urine for more than 12 hours, that's another good reason to visit.

When children have “stomach bugs” and vomit, some parents worry they'll starve. They think like the classic grandmother admonishment: “Eat! Eat! You're so thin!” In those grandmothers' defense, many grew up in impoverished settings, where starvation was a real thing. When parents bring vomiting children to the Emergency Department, we often hear, “He threw up, and then I gave him rice and gravy.” Not surprisingly, the child yaks that up too.

There are ways to make ER trips less likely. For starters, keep the kiddos hydrated. If they're nauseated and vomiting, food or thick liquids like milk or orange juice aren't going to stay down. They need time for their stomachs to settle, so don't give anything for a half hour or so. Then start with clear liquids.

The best liquids contain some sugar and a tiny amount of salt. Pedialyte is good for little babies, but older babies and children often don't like the taste - it's brackish. Try it yourself, you'll see! However, some adults, we've recently learned, drink Pedialyte as a recovery drink after workouts. Talk about ew!

Sports drinks with less sugar, like Gatorade G2, are a good option since the sugar in full-strength drinks can act like a laxative, worsening diarrhea. Clear fruit juices (like apple) are okay too, as long as you water them down.

When you start giving clear liquids, only give a few ounces at a time. Too much at one time might cause vomiting. If vomiting has stopped altogether, you can give larger amounts. No food for at least 6 hours is recommended. Don’t worry, your child won’t starve.  As long as they're making urine once or twice daily, you're going to be okay.