Texas Vacation

This week's guest columnist is Dr. Wesley Adams, a Family Practice resident at the University Hospital and Clinics here in Lafayette. "Dad, pull over!"  Driving across West Texas is a loooong drive, the view unbroken flat nothingness. When I was 11 years-old, that drive got even longer. Relatives we had just visited apparently blessed me with gastroenteritis- I suddenly had gurgling guts. Yes, the lone prairie holds no romance for me, no visions of cowboys strumming guitars by campfires; just the memory of many rest stops. Most vomiting and diarrhea illnesses, "gastroenteritis" in doctor-speak, are caused by viruses we catch from one another.  It usually only lasts a day or two, but it can last a week in some unfortunate kids. Sometimes when parents see large volumes of diarrhea pouring out of their child, they get scared. They're worried, of course, about dehydration. Still, most get through even a week of misery without needing IV hydration in the Emergency Department. As long as your child's drinking and not vomiting, she'll typically absorb enough fluids to keep up with the, um, output. How do you know if your child is hydrated?  If their mouths are moist, they make tears when they cry, and they pee at least once or twice per day, then they're okay. If your kid's mouth is getting dried out inside, he's moaning but not crying tears, or hasn't urinated for 12 hours, get checked out. Sometimes with babies and littler kids, there's so much diarrhea that you can't tell if their making urine.  In that case you have to go by  tears, mouth moisture, and energy level. If your child's only having diarrhea and not vomiting, anything they'll drink is fair. We used to say don't give milk with diarrhea, or avoid certain foods, but now we say "feed through" diarrhea.  The sooner your child's on his regular diet, the sooner her guts will get "back in balance."  Good things to eat are bland starchy foods easy on the stomach. Certainly avoid heavy greasy foods, like fast food, and high sugar liquids like straight juice or soda. Too much sugar acts like a laxative, and we certainly don't need that! Fortunately for my "trail of tears" diarrhea experience across Texas, I didn't vomit. My 4 year-old patient Eden wasn't so lucky. She vomited for 4 days before her parents decided she wasn't okay. What did their home smelled like!? To her parents' credit, she tolerated some fluids at first; but later spewed so frequently that the tiniest sip wouldn't stay down. When her tears stopped, despite crying with stomach cramps, they came in. The majority of gastroenteritis (a.k.a. stomach virus) can be managed at home. Like we said above, if your child urinates once or twice daily, has a moist mouth, and makes tears, he's okay. If he's becoming progressively more listless, has a dried out tacky mouth, stops making tears, has sunken eyes, and hasn't urinated in 12 hours, you're losing ground. Some parents panic at one vomit.  After all, it's gross, and dramatic- all that wretching and cramping!. Fortunately, most kids only vomit once or twice, and then settle down and tolerate fluids. The best strategy to keep kids hydrated is go slow. Don't force them to drink right after they hurl- it takes an hour or so for stomachs to calm down. Then start with small amounts of clear fluid.  An ounce or two of dilute juice, like apple juice cut half-and-half with water, is a good start. If that small amount stays down, half an hour later give some more. After a few hours, you can increase fluid volume.  Some parents worry that their child is starving, and start foods right away too. Rest assured, your child won't waste away going a few days without food. Don't give solids, or thick fluids like milk, for at least 6 hours after vomiting- kids' stomachs won't handle that freight. But if they're tolerating fluids after that long, then small amounts of bland, starchy things are okay- crackers, toast, bananas. In these COVID times, we're hopefully now all aware that clean hands prevent Coronavirus from spreading. The same goes for stomach viruses. Make sure you and your kids wash hands after using the bathroom. One sick kid per household is enough!