The Mundane Epidemic

The big medical news recenlty is either about Influenza (the “flu” you get a flu shot for), or measles, which has had recent national outbreaks in undervaccinated communities.  However, we’re also having a local outbreak of “stomach virus”.  Though it’s certainly a more pedestrian illness than measles or influenza, try telling that to the parents of kids who re-enact the pie-eating-contest-vomit-fest from the movie Stand By Me.

Vomiting is distressing.  It’s just plain disgusting, and many parents get nauseated themselves at the sight.  And they have to clean it up!  Nausea and vomiting are miserable for kids too- it feels lousy.  Parents often have a more profound worry- what if he won’t stop vomiting and gets dehydrated?  That’s when they come to the Emergency Department.

Most vomiting lasts only a half day or so.  However, parents often panic at the first vomit: it seems like so much!  In their disgust, they overestimate the actual volume, seeing the kid from that movie spewing gallons of blueberry smush.  Then after a few more vomits, parents worry about intake, and push too much liquid, or worse, food.  This taxes the stomach, and more yakking ensues.

However, kids do have some reserve; there’s time to work this out.  After vomiting, wait an hour for the stomach to settle.  Then start small amounts of fluids like pedialyte, sports drinks, or dilute juices.  This means just an ounce or two.  Wait a half hour, then give another few ounces.  Then another.  When those little bits are staying down, then gradually increase the volume.  Your child may start begging for more as she starts to feel better, but be strong and be patient- better to hold down a little than throw up a lot.

This method, called Oral Rehydration Therapy, is one of the greatest medical inventions.  It seems simple, but before ORT, the pediatric death rate from third world cholera and dysentery epidemics was astounding.  These are much more violent infections than their benign American counterparts, and doctors were amazed how many kids could “feed through” these illnesses without needing expensive and scarce IV treatment.

My family is fortunate that we haven’t had many stomach viruses.  One time we did we were vacationing in New Mexico, and my wife and I had gotten a babysitter to go out to dinner.  When we got back, the babysitter looked like hell, having cleaned up vomit from our two daughters. Only our son seemed unaffected.  I went to tuck him in, and there he was with the covers pulled up to his chin.  “Dad, I hate to tell you this,” he piped in his 8 year-old voice, smiling sheepishly, “but I just had diarrhea.”  In the bed.

Parents are grossed out by diarrhea, just like with the vomiting we discussed above.  It can also be accompanied by painful cramps.  And like with vomiting, parents start to worry about dehydration, particularly when they feed the kid some fluids or food, and it seems to pour right out the back end.

Kids typically absorb enough fluids to get by though, even if it seems to run right through.  In fact, the quickest way to get your child better is get them on their regular diet as soon as possible.  They won’t feel like eating much at first, so like with vomiting, start with fluids like pedialyte for babies, sports drinks or dilute juices for older kids.  No full strength fruit juice- that sugar load can act like a laxative, and make diarrhea worse.

When your child can eat, back to their regular diet.  A generation ago we were told not to give milk with diarrhea, but now the thinking is when you’re eating your regular food, including milk and yogurt, your guts get “back in balance.”  No heavy, greasy foods like fast foods though, whose fat loads can also worsen diarrhea.

The best treatment for stomach viruses is prevention. Kids contract these bugs by putting contaminated fingers in their mouths (don’t go “ew,” you do too!).  Thus they should wash their hands before eating and after using the bathroom. If your child vomits more than 12 hours, or has diarrhea for more than 4 days, call your doctor for medicine that can stop vomiting.  Unfortunately, there’s not great medicine for diarrhea.  Pepto-bismol or Imodium may slow it down some, or help with the cramps, but they’re not miracle cures.  Typically you just need to….let it pass.