The Ugly Truth About the Runs

This week's guest columnist is Dr. Eric Guilbeau, a family practice resident at the University Hospital and Clinics here in Lafayette. Emma comes home from school and tells her mom that her belly hurts and she doesn't feel good.  Mom tells here to lie down and rest and she will feel better.  About 30 minutes later Emma yells for mommy!  When mom walks in she finds vomit in the bed, all over the pillow and sheets.  Mom grabs Emma and runs to the bathroom where Emma starts to vomit again, now with diarrhea.  After a day or two mom brings Emma to the Emergency Department because Emma has no energy and cannot eat or drink.  Emma is diagnosed with Gastroenteritis. Gastroenteritis is commonly known as "the stomach bug," "stomach virus," or even more simply "virus."  Sometimes people use "rotavirus" to mean all vomiting and diarrhea viruses, though rotavirus is just one of many viruses that cause these symptoms.  Viruses are microscopic chemical machines that invade the body.  They enter the body by the mouth through contaminated food or when the victim puts a contaminated hand in the mouth.  The viruses burrow into the body's cells, take the cells over, and start the fun. The signs and symptoms of gastroenteritis start about 1 to 3 days after the virus enters the body.  It takes that long, what we call the "incubation period," for the virus to spread and take over enough of your stomach and intestines to start the symptoms.  Thus if Emma touched an infected doorknob at school on Thursday and a few minutes later played with her lip, she could expect to start acting sick by Friday or Saturday. What can Emma then expect?  Watery diarrhea, vomiting and nausea, fever, headache, and fatigue.  Usually kids will vomit for the first half-day, then have diarrhea for a few days more.  However, it can be normal for symptoms to last 7 to 10 days!  Parents should seek help when the child has lots of pain, bloody diarrhea, or is dehydrated.  Parents should watch for worsening pain, increasing sleepiness, no urine for 12 hours, dry mouth, sunken eyes, no tears when crying. Sometimes when we tell a parent a diagnosis like Gastroenteritis, the parent gives us a skeptical look.  How can we know just by looking- shouldn't we run some tests?  Well, the vast majority of illnesses are diagnosed from the medical "history."  The history is simply the story of your child's illness.  When did he start getting sick?  How much did he vomit and have diarrhea?  Was he around other sick kids or family?  How is he acting now?  Is he making urine?  Then the doctor uses the physical exam to confirm what she thinks is the diagnosis, and further assess for signs of dehydration or more serious illness- dried out mouth, decreased circulation, tender stomach, patient responsiveness.  Tests are only necessary if the doctor is concerned about serious dehydration or a more serious illness that is masquerading as gastroenteritis, like appendicitis. How is gastroenteritis treated?  The most important management is preventing dehydration.  Most gastroenteritis is mild and can be treated at home: pedialyte and breast feeding for infants, dilute juices or sports drinks like Gatorade or Powerade (Gatorade G2 is particularly good) for older kids.  If your child cannot stop vomiting or has worsening dehydration, she might need IV fluids. Here are some home instructions for parents:  After the child stops vomiting, feed with only clear fluids as above for six to eight hours.  This lets the stomach settle before trying solid foods.  Ease back into eating after about 6 to 8 hours of the fluids; the stomach may not be ready for food or milk before then.  Avoid fatty or seasoned foods and let your child get plenty of rest.  The first two days of vomiting and diarrhea are not good times to rush your child back to school. Most importantly, teach your kids to prevent getting Gastroenteritis.  Teach them to wash their hands after using the bathroom and before eating.  Teach them not to put their hands in their mouth so much. When they do get sick, keep them home for to rest from school. Loving care at home is the best medicine.