Child Vomiting With Diarrhea: What to Give, When to Go

It's 2 a.m. and the hallway light is still on. Your four-year-old has thrown up three times since dinner, and the last trip to the bathroom came with diarrhea too. You handed her a big glass of apple juice so she wouldn't "dry out," and ten minutes later every drop came back up. Now she's curled up on the couch, pale and quiet, and you're wondering whether this can wait until morning or whether you need to grab the car keys.

Most of the time, a child with vomiting and diarrhea has viral gastroenteritis, what many families call a "stomach bug." It usually runs its course in a few days. The real danger isn't the virus itself but the water and salts the body loses from both ends. Young children dehydrate much faster than adults, so your main job is to replace fluids the right way and learn to read the warning signs.

Why the juice came right back up

An irritated stomach can't handle big amounts. Pour in a lot of liquid at once and the stomach stretches, cramps and sends it all back. The approach the AAP and the CDC recommend is the opposite of what our instincts tell us: a little, and often.

• Give the stomach a short break after the last episode of vomiting
• Start with very small sips, using a teaspoon, a needle-free syringe or a medicine cup
• Repeat every few minutes, even if it feels like you're getting nowhere
• If those stay down, slowly offer a bit more; if she throws up again, pause and go back to tiny sips

It can feel painfully slow, yet a child who keeps down small sips for an hour ends up with more fluid than one who gulps half a glass and loses it.

What to offer, and what to hold off on

The best choice is an oral rehydration solution, the electrolyte drink sold at pharmacies and grocery stores as a ready-made liquid, a powder or frozen pops. It has the balance of water, sugar and salts the gut absorbs best. Ask at your pharmacy and follow the package directions; if you're unsure how much is right for your child's age, check with the medical team rather than guessing.

If your baby is breastfed, keep nursing: breast milk is still the best food for them, and shorter, more frequent feedings tend to go down easier. Formula-fed babies usually stay on their regular formula unless you're told otherwise.

While the diarrhea lasts, it's better to avoid:

• Fruit juice, soda and sports drinks, since the sugar can make diarrhea worse
• Large amounts of plain water for babies, because it doesn't replace lost salts
• Heavily sweetened chamomile tea, thick atole or loaded home remedies
• Anti-diarrhea or anti-nausea medicine from your cabinet, unless the medical team recommends it for your child

Once the vomiting stops, food can come back. There's no need for days of plain rice and toast; the AAP suggests returning to normal meals early, in small portions: rice, noodle soup, chicken, banana, potato, tortillas. Save greasy, fried and very sugary foods for later.

How to tell if your child is getting dehydrated

Use this table to figure out where things stand. If you're torn between two columns, go with the more serious one.

With babies, also check the soft spot on top of the head: if it looks sunken, that's a sign of dehydration that shouldn't wait.

Signs that mean go now

Head to the nearest emergency room or call 911 if your child:

• Is younger than three months and has a fever
• Is very limp, confused or barely waking up
• Has a swollen, hard belly or pain so strong they won't move
• Vomits green, bloody or something that looks like coffee grounds
• Started vomiting after a bump to the head
• Has a stiff neck along with a fever
• Has gone many hours without peeing or has cold, blotchy hands and feet

When to bring your child to the clinic

Not every bout of vomiting and diarrhea needs a visit, but it's worth having our medical team take a look when:

• Vomiting continues past a day, or diarrhea drags on for several days without improving
• A fever won't come down, or your child keeps complaining of belly pain that won't go away
• You notice mucus or a little blood in the stool
• Several people at home got sick the same way, or the family came back from a trip with upset stomachs
• You can't tell whether what they're drinking keeps up with what they're losing

During the visit we check weight, vital signs, mouth, skin and belly, and we ask how many times your child has peed. Vomiting doesn't always start in the stomach: in kids, strep throat sometimes shows up as nausea and a tummy ache, and a rapid strep test confirms it in a few minutes. A urinary tract infection can also cause vomiting and fever without any complaint of burning.

If diarrhea lingers or parasites or bacteria are suspected, the medical team may order a stool test; we hand you the container and explain how to collect the sample at home. When it's important to see how salts or kidneys are holding up, blood tests may be ordered. And if your child needs medication, just tell us the pharmacy closest to you and the e-prescription goes straight there, so you're not juggling paperwork with a sick kid on your hip.

Keeping the whole household from catching it

Stomach viruses such as norovirus spread with ease in homes where siblings, cousins and grandparents share the same roof. A few steps that actually help:

• Wash hands with soap and water after every diaper change or cleanup; alcohol gel does little against norovirus
• Clean the bathroom, door handles and any floor where your child threw up with a bleach-based disinfectant, following the label
• Wash soiled clothes and sheets separately in hot water
• Whoever is sick shouldn't cook for everyone else while symptoms last
• Give each person their own cup and towel for those days

Your child can go back to school or daycare after a full day with no fever, no vomiting and no diarrhea, once they're eating and drinking normally again.

On Kuykendahl, when the night runs long

Plenty of north Houston families walk in after a night like this one, child wrapped in a blanket, wondering if they handled it right. Jot down how many times your child vomited, how many bowel movements there were and the last time they peed; those three details tell us more than any description. We're open every day until 9 PM: you can walk in or call (281) 789-0484 to let us know you're on your way, and if you don't have insurance, we tell you the price before we examine your child.