Water Works

This week's guest columnist is Dr. Meighan Anderson, a Family Practice resident at the University Hospital and Clinics here in Lafayette. 8 year-old Ted finished his last baseball game of the season.  To celebrate, mom and dad took the family to the new burger bar in town.  Ted picked the biggest burger on the menu, his attempts to devour it leaving everyone in stitches.  Dad thought the meat looked a little too pink, but didn't want to interrupt the good time- it was probably fine.  Later back home, Ted yells from the bathroom: "It's coming out like water!"  Then comes the sound of vomiting. Diarrhea and vomiting are difficult topics for parents, because they're gross, and it's sometimes hard for parents to know when to worry.  It's a big mess when it happens and they just want it over!  But the real questions are- does he need to go to the doctor?  Is this a stomach virus that will get better on it's own, or something worse?  When will it end?  When do I worry about dehydration? We see a lot of kids in the Emergency Department who, when they have one or two vomits or diarrheas, are rushed right in.  Then as the parent goes on about how sick their child is, the kid is dashing about the room, opening the drawers and jiggling the bed controls.  In fact, these are good signs that the child doesn't have something bad, like a blockage, or appendicitis, or dehydration- walking, talking, and playing.  If the child is not eating, but is drinking, that's another good sign.  Kids who make wet diapers and urinate, even if only once or twice per day, or make tears when they cry, are getting enough fluids to not worry about dehydration either. Here's the worrisome signs that your child needs to get seen- diarrhea with lots of blood, abdominal pain so bad they cry, and non-stop vomiting, like for hours and hours.  Finally, if kids are so lethargic that they have trouble staying awake, or even sitting up, you need to talk to a doctor.  These could be symptoms of worse things than a run-of-the-mill stomach bug, like appendicitis, blockages, severe infections, or serious dehydration. Back to our story of Ted from above, having vomiting and diarrhea after eating undercooked hamburger.  He continued to vomit all night, into the next day, with diarrhea.  By the afternoon he's looking like a limp dishrag- tired, pale, and sleeping a lot.  He also looks grey and sunken around the eyes.  TIme to visit the Emergency Department. Dehydration is the most serious complication of vomiting and diarrhea.  Diarrhea alone usually doesn't do it- if children drink and hold fluids down, dehydration is unusual.  Some parents worry that fluids are "running right through" a kid who drinks and then immediately has diarrhea.  However, kids typically absorb enough to get by.  "Feed through" diarrhea is the rule: keep it coming from the top, even if it seems to come right out the bottom. However, if the child is also vomiting, or not drinking, dehydration is a worry.  Ted is showing us the signs- worsening fatigue, pallor and sunken eyes.  If he doesn't make urine for 8-12 hours, that's another clue that he needs to come in for IV fluids. The best way to avoid dehydration is drinking clear liquids.  Fluids that contain some sugar and salt are most efficiently absorbed- sports drinks, or pedialyte for babies.  But don't use full-strength fruit juices- they can worsen diarrhea.  To avoid vomiting, start with small amounts of fluid, to not challenge the stomach too much.  Give babies just a few ounces, older kids a half cup.  If that stays down after a half hour, give another little bit.  After a few hours where small amounts are staying down, you can give larger amounts.  Then about 6-8 hours after not vomiting, you can try bland starchy foods- rice, toast, crackers, bananas; nothing heavy like burgers, fries, or nuggets. Your doctor can also prescribe Zofran over the phone, a medicine which can stop nausea and vomiting before it gets too far.  Antibiotics don't help, and may worsen diarrhea.  They're used only when tests on the stool indicate. But if your kid is walking, smiling, and peeing, he's not dehydrated.  Soon his body will shut off the Water Works, and the mess will finally end!