Toddler and Baby Diarrhea and Vomiting- Gastroenteritis

Toddler and baby diarrhea and vomiting are usually caused by a viral infection - we call this gastroenteritis. The usual viruses causing gastroenteritis are:

• rotavirus
• enterovirus
• viruses that also cause upper respiratory infections

Do you always get vomiting with gastroenteritis?

No, sometimes children just get diarrhea.

Are there any other symptoms with gastroenteritis?

There may be fever as well as vomiting and/or diarrhea. Some children also get respiratory symptoms, like a runny nose.

Should I be worried if my child has bright green diarrhea?

Bright green diarrhea usually occurs if children have not eaten for a few days. The bile that is normally produced has nothing to work on so comes out unchanged in the poop (poo). Give your child some food - this should sort out the problem.

What is the treatment for toddler and baby diarrhea and vomiting?

The treatment of gastroenteritis is supportive - just keep the fluids up so your child doesn't get dehydrated.

• If you have a baby and you are breast-feeding, keep breast feeding as usual. If your baby is thirsty between feeds, you can give her some extra oral rehydration fluid in between feeds to make up for losses in the baby diarrhea.
• If you have an older child, she may just need extra oral rehydration fluid as well as her normal diet.
• If you have a child who is vomiting, give oral rehydration fluids until the vomiting settles and then restart the normal diet.
• If your child is dehydrated and can't keep fluids down because of vomiting, you may need to seek medical attention. Doctors may give a dose of ondansetron to settle the vomiting.

What is oral rehydration fluid?

Oral rehydration fluid is a special mix of water, glucose (sugar) and electrolytes like salt. It is specially formulated to help toddler and baby diarrhea and vomiting settle and keep the blood chemistry stable.

You can buy oral rehydration fluid at your local pharmacy - (Gastrolyte, Dioralyte, Pedialyte, Rehydralyte).
You should not use normal drinking fluids (like Lemonade or Cola) to rehydrate your child for any length of time.

How much oral rehydration fluid should I give my child?

As a guide, give 10 - 20 ml of oral rehydration fluid per kilogram weight per hour over the first few hours (4 or 5 hours). 30 ml is equivalent to 1 ounce (oz).

• 1 year old will be about 10 kg - give 100 - 200 ml (about 3 - 7 oz) of oral rehydration fluid every hour.
• 2 year old will be about 12 kg - give 120 - 240 ml (about 4 - 8 oz) of oral rehydration fluid every hour.
• 3 year old will be about 14 kg - give 140 - 280 ml (about 5 - 9 oz) of oral rehydration fluid every hour.
• 4 year old will be about 14 kg - give 160 - 320 ml (about 5 - 10 oz) of oral rehydration fluid every hour.

Lemonade ice blocks (ice lollies) are a good way to get fluid into a toddler.

What should I do if my child is vomiting the oral rehydration fluid?

Give small amounts frequently. This may mean a spoonful every few minutes. A small amount of fluid is more likely to be absorbed.

How long does the toddler and baby diarrhea and vomiting last?

The diarrhea can last for a few days. The vomiting usually settles faster (within a day). It doesn't matter if your child still has diarrhea for a few days as long as she is drinking enough fluid and not getting dehydrated and her diarrhea is getting better every day.
Things should be back to normal by 7 days.

Are antibiotics needed for toddler and baby diarrhea and vomiting?

No. Gastroenteritis is usually caused by a virus and so antibiotics won't work. Antibiotics can make diarrhea worse as well so they are only given if a bacterial cause is found for the toddler or baby diarrhea.

How would I know if a bacteria was causing toddler or baby diarrhea and vomiting?

Sometimes, gastroenteritis is caused by a bacteria. When this occurs, there is often blood in the diarrhea. If your child has blood in her diarrhea, see your doctor. If the diarrhea is not settling after a week, see your doctor as your child may need a stool (poop, poo) specimen sent to the lab to look for bacteria.

What causes dehydration?

Your child can get dehydrated because she is losing more fluid that she is keeping in. You can give more oral fluids but sometimes, children will need intravenous (iv) treatment to overcome dehydration as the toddler or baby diarrhea and/or vomiting will be producing more losses than can be replaced by mouth.

How will I know if my child is dehydrated?

If your child is dehydrated, she will:

• be very lethargic and not interested in her surroundings
• have very sunken eyes and a very dry mouth
• feel cold to touch - press your thumb over her breast-bone for 5 seconds until the skin goes white. Take your thumb off and count in seconds until the color returns to the skin. (1000-1, 1000-2, 1000-3 etc is equivalent to 1 second, 2 seconds, 3 seconds etc). If the color has not returned within 3 seconds (1000-1, 1000-2, 1000-3), she needs urgent medical attention

If my child is not dehydrated, when should I start food again?

You can start food again as soon as your child can tolerate it - so usually within a few hours of her starting to vomit. You can usually give the normal diet. Foods that are tolerated well in gastroenteritis include:

• bananas
• rice
• apples or applesauce
• toast or plain biscuits

Do I need to give a lactose-free (dairy-free) diet after gastroenteritis?

This is not usually necessary. Occasionally, children get a temporary intolerance to lactose (milk sugar) after gastroenteritis. If there is persistent and frequent toddler or baby diarrhea after gastroenteritis, see your doctor who can do a sugar test on the stool (poop, poo) looking for reducing substances - if the test is positive, you will need to give your child a lactose-free milk for a few months, until the intolerance settles.

When should I get medical help?

You should see your doctor if your child:

• is very lethargic and not interested in her surroundings
• has very sunken eyes and a very dry mouth
• feels cold to touch - press your thumb over her breast-bone for 5 seconds until the skin goes white. Take your thumb off and count in seconds until the color returns to the skin. (1000-1, 1000-2, 1000-3 etc is equivalent to 1 second, 2 seconds, 3 seconds etc). If the color has not returned within 3 seconds (1000-1, 1000-2, 1000-3), she needs urgent medical attention
• seems ill
• is very pale
• has severe abdominal pain
• has bloody diarrhea
• has bright green bile stained vomiting
• still has diarrhea that is not settling after 7 days

Are there any treatments to stop vomiting in gastroenteritis?

Yes, in children with gastroenteritis, a single dose of ondansetron has been shown to improve symptoms and help them drink enough fluids.

This is usually given in the emergency room when children are already dehydrated enough to have sought medical attention. Studies have shown that it reduces the need for admission to hospital.

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