Treating the Stomach Flu

By Gayle A. Roberts, CNP, MSN, RN

    As a mom of three, the words, "Mommy my tummy hurts," made me go on high alert. Nausea and vomiting, or the "stomach flu" as I called it, challenged my mom skills. Children complain of stomach discomfort (nausea) usually before a bout of throwing up or vomiting. In other words, that great dinner you made reappears! Retching, or contractions of the stomach muscles with little or no vomiting, is the worst for the child and hard to watch. Diarrhea (2 or more loose, watery  stools) usually comes within 12-24 hours after nausea and vomiting. Generally, children will vomit everything for 3-4 hours very frequently, then vomiting slows down and becomes less and less. Luckily, in most cases, vomiting stops in 24 hours or less.

     Causes of nausea and vomiting include the flu, ingestion of poisons, food poisoning, strep throat, ear infections, urinary tract infections and coughing, as swallowed mucous irritates the stomach. 

    The biggest concern of vomiting is that it can cause dehydration or the loss of fluid in the body. Needed electrolytes, such as sodium and potassium, that help to maintain body functions are lost. Children are most at risk of dehydration if they vomit 8 or more times in a 24 hour period, or if they vomit large amounts very frequently.

    Signs of dehydration include the following: a child who is very quiet and less active, has sunken eyes, is thinner in appearance, has a lack of attention, displays unusual sleepiness, has cool hands and feet, and/or has pale, dry lips and mouth. Dehydration should be suspected if a child urinates dark urine and less than every 2-4 hours (less than 6 wet diapers in 24 hours for infants). As a caregiver of a child, dehydration may be one of those times when you think your child just, "doesn't seem right." If you suspect dehydration, a call to your physician or a visit to the Trinity Hospital Twin City emergency department is in order.

    Nausea and vomiting are not fun for a child or for you. Be aware that children may vomit in the beginning, every time they eat or drink something. Things you should do to help include the following: 

• Stop all solid food in the initial period of vomiting to allow the  tummy to rest. Note when vomiting occurs, the amount, what it looks like and how often.
• Encourage clear liquids (liquids that you can see through).  Start by giving 1 teaspoon only every 15 minutes. Be aware that they may vomit after. If vomiting does not occur after the child drinks liquids, double the amount of fluids (2 teaspoons) every 15 minutes. Continue doing this until they are drinking normally. If vomiting does occur after liquids, allow the stomach to rest by stopping the liquids for a brief time (30 minutes to 1 hour). Then resume the liquids as noted (1 teaspoon). It is best to use electrolyte-replacing fluids such as Pedialyte or Gatorade (do not use the high energy Gatorade brands). Use your child’s favorite flavor if you can.
• After vomiting ceases (usually no vomiting for 4 or more hours) give dry foods such as crackers, pretzels, or dry toast. Work up to a normal diet as the child desires.

    It is a challenge to coax children to drink during vomiting. Use fun, colorful or fancy cups,  or offer popsicles. On rare occasions, I used "bribery" or the promise of a "prize" or small gift to get my children to "just drink a little bit." The prevention of dehydration is the main goal. 

    Make children as comfortable as possible during this time. They should lie down with the head elevated or lay on their sides. Provide a blanket and their favorite toy. Know that children may be afraid and need your reassurance that they will get better. Children over three can be taught to run to the toilet basin to vomit. If this is not possible, provide them with a large pan ( clean in dishwasher or with soap and hot water after use) or plastic bag that can be discarded.        

    After vomiting, the "yucky" taste can be rinsed out with water or mouthwash (tell them not to swallow). A cool or warm wash rag usually feels good after vomiting  and cleans the face. Your presence during vomiting spells will make the child feel secure. Know that as they feel better children will resume their busy lives quickly, and you should allow them to do so.

    You should seek the advice of your health care provider or seek emergency department care at any time you feel concerned, or feel that something does not seem normal. Most caregivers of children instinctively know when a child is not himself/herself. Remember that advice from your physician is as easy as calling your provider’s office. The caregivers will welcome your questions and be happy to help and advise you. Don't be "afraid" to bother them. Your caregiver would rather help you before serious problems occur. 

   Other signs of serious problems include the following:

• if you think your child is dehydrated,
• if there is blood in the vomit or if frequent vomiting or diarrhea continue after 24 hours,
• pain, warmth and tenderness of the joints, 
• neck pain or stiffness,
• excessive fussiness or irritability,
• a skin rash that looks like small bruises,
• rapid, difficult breathing,
• excessive sleepiness and inability to stay awake,
• and severe abdominal pain. 

   The stomach flu can be very contagious, meaning that you can get it too (and we all know caregivers of kids don’t have time to get sick). Frequent hand washing by all household members should be done. Luckily, children bounce back faster than adults. With observation and care, your child should be back to normal soon. This is a time when we are glad to see them doing anything, even getting into mischief!

Gayle Roberts is a retired nurse practitioner who volunteers for Trinity Hospital Twin City.