Common illnesses: Vomiting in children

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Overview of Vomiting
Most vomiting is caused by gastroenteritis, a viral infection of the gastrointestinal tract. Thankfully, these infections are usually short-lived and are more disruptive than damaging. Your most important intervention may be your bedside manner - vomiting is frightening for young children and exhausting for children of all ages. Supplement the following time-tested routines with plenty of reassurance.
• Rest the stomach. This may be easier said than done with a small child, who doesn't understand what's happening and is longing for a big drink of water. Try to wait a few hours, and then offer small sips of water, ice chips, or a cold, wet washcloth to suck.
• If sips of water are not tolerated, you may wish to consult your doctor about an over-the-counter nausea medication. If your doctor approves, ask about the correct dose for your child.
• If sips of water are tolerated, slowly increase the amount of liquids you give your child. Then you can try other clear liquids. Milk and milk products should be avoided.
• Introduce foods gradually. Wait for your child to say she's hungry, and then start with dry toast or crackers.
• Your school-age child will probably tell you when she is ready to eat heavier food, and you can generally trust her judgment and give her what she asks for. With a younger child, stick with bland, starchy foods like potatoes and rice until you're sure she's out of the woods.
When Should You Call the Doctor?
The greatest risk of vomiting due to gastroenteritis is dehydration. Call your doctor if your child has diarrhea, refuses fluids, is not urinating, cries without tears, has a dry mouth, or seems confused. You should also call if vomiting persists more than two days, which increases the risk of dehydration.
The following symptoms may indicate a condition more serious than gastroenteritis and require immediate medical attention:
• projectile vomiting in an infant
• vomiting accompanied by fever
• repeated vomiting of green or yellow bile
• stomach feels hard and bloated in between vomiting episodes
• vomit resembles coffee grounds
• vomiting blood
• vomiting follows head injury
• vomiting during recovery from a viral infection

Treating Diarrhea and Dehydration
Most children should continue to eat a normal diet including formula or milk while they have mild diarrhea. Breastfeeding should continue. If your baby seems bloated or gassy after drinking cow's milk or formula, call your pediatrician to discuss a temporary change in diet. Special fluids are not usually necessary for children with mild illness.
Children with moderate diarrhea can be cared for easily at home with close supervision, special fluids, and your pediatrician's advice. Your pediatrician will recommend the amount and length of time that special fluids should be used. Later, a normal diet can be resumed. Some children are not able to tolerate cow's milk when they have diarrhea and it may be temporarily removed from the diet by your pediatrician. Breastfeeding should continue.
Special fluids have been designed to replace water and salts lost during diarrhea. These are extremely helpful for the home management of mild to moderately severe illness. Do not try to prepare these special fluids yourself. It is too easy to get confused by some of these complex recipes. You could accidentally make a bad fluid for your baby. Use a fluid that is made by one of the reputable manufacturers. The three most widely available products that you will find in nearly every pharmacy are:
• Pedialyte (Ross Laboratories)
• Infalyte (Mead Johnson Nutritionals)
• ReVital (PTS Labs)
Other brands of special fluids are available and equally effective. Many drug stores have their own generic brands of special fluids. Ask the pharmacist for assistance.
If a child is not vomiting, these fluids can be used in very generous amounts until the child starts making normal amounts of urine again.
If your child develops severe diarrhea, he may require IV fluids in the emergency department for several hours to correct dehydration. Usually hospitalization is not necessary. Immediately seek your pediatrician's advice for the appropriate care if symptoms of severe illness occur.
While this illness runs its course, here are some general do's and don'ts that you should keep in mind:
DO
• Watch for signs of dehydration which occur when a child loses too much fluid and becomes dried out. Symptoms of dehydration include a decrease in urination, no tears when baby cries, high fever, dry mouth, weight loss, extreme thirst, listlessness, and sunken eyes.
• Keep your pediatrician informed if there is any significant change in how your child is behaving.
• Report if your child has blood in his stool.
• Report if your child develops a high fever (more than 102ºF or 39ºC).
• Continue to feed your child if she is not vomiting. You may have to give your child smaller amounts of food than normal or give your child foods that do not further upset his or her stomach.
• Use diarrhea replacement fluids that are specifically made for diarrhea if your child is thirsty.
DON'T
• Try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.
• Prevent the child from eating if she is hungry.
• Use boiled milk or other salty broth and soups.
• Use "anti-diarrhea" medicines unless prescribed by your pediatrician.

© Copyright 2000 American Academy of Pediatrics

How the Flu Is Spread
The flu spreads very easily, especially in preschool and school-age children. Adults are then easily exposed and can get the disease. The virus is usually transmitted just as symptoms begin or in the first several days of the illness.
The flu is spread from person to person in various ways:
• Direct hand-to-hand contact
• Indirect contact - for example if your child touches an infected surface like a toy or a doorknob and then puts her hand to her own eyes, nose, or mouth
• By virus droplets being passed through the air for example, from coughing or sneezing
You can take steps to reduce your family’s chances of catching the flu. Good hygiene is the best way to prevent the flu from spreading to other family members. If your child has the flu, the following will help prevent its spread:
• Teach your child to cover her mouth and nose when coughing or sneezing. If your child is old enough, teach her how to blow her nose properly.
• Use facial tissues for runny noses and to catch sneezes. Throw them away in the trash after each use.
• Avoid kissing your child on or around the mouth or face, though she will need plenty of hugs while she is sick.
• Make sure everyone washes their hands before and after coming in close contact with someone with the flu.
• Wash dishes and utensils in hot, soapy water or in the dishwasher.
• Do not let children share pacifiers, cups, utensils, washcloths, or towels. Never share toothbrushes.
• Use disposable paper cups in the bathroom and kitchen.
• Disinfect. Viruses can live for more than 30 minutes on doorknobs, toilet handles, countertops, even on toys. Use a disinfectant or soap and hot water to keep these areas clean.
• Do not smoke around your child. Children who are exposed to tobacco smoke cough and wheeze more and have a harder time getting over the flu.






Note: children's health