Explosive Babies

This week’s guest columnists are Drs. Elizabeth Hunter and Alex Wolf, Family Practice residents at the University Hospital and Clinics here in Lafayette.

“Oh no, another one?” exclaimed mom as she inspected Jamie, her one year-old’s, diaper.  It was full to the brim and smelled horrendous, and this was the third since noon! It was 5:30 pm, the doctor’s office already closed. “What do I do now?”

This had never happened before.  Jamie was never sick. Mom looked up ”child with diarrhea” on the internet, tried to read the articles, but felt overwhelmed. However, Jamie, giggling and toddling around with her sippy cup, seemed to be taking it well. Mom wondered: What caused this?  Is she dehydrated?  Should I take her to the ER?

It’s a common parent scenario- your child’s pants explode and you begin to worry. Fortunately, most kids with diarrhea do well at home.  Step one, evaluate your child.  Is he playful, or at least awake and active?  Is he drinking? Is the inside of his mouth moist? If so, there’s little danger of dehydrating.

If however, she becomes progressively more sluggish through the day, starts vomiting, or begins to drink less and less, it’s time to call your doctor.  While making urine is the best sign that baby isn’t dehydrated, sometimes there’s so much watery diarrhea in the diaper that you can’t tell if there’s pee or not.  You have to go by those other signs.

Most diarrhea is caused by viruses caught from other kids, though too much fruit juice, antibiotics, or other infections can cause it too. Treating diarrhea is easy- keep the fluids coming, and food too.  If food and liquids look like their just running through baby and out the back end, keep it coming.  She will absorb enough fluids and nutrients to get by.  The slogan these days is “feed through” diarrhea.  Starchy foods are best- bananas, rice, toast.  Stay away from high sugar drinks like soda or fruit juice- these make for more acidy diarrhea, which makes diaper rashes worse.

You’re awakened in the early morning by a new sound: a gurgling from one of the kid’s bedrooms.  You rush in, flip on the light, and are greeted by the sight of a vomit-filled bed. Yuck!  While this is certainly a mess to clean up, more important worries crop up.  Is this just a stomach bug, or something worse?

Vomiting is an important protective mechanism, expelling toxins before they have a chance to harm us internally.  However, viruses often cause inappropriate vomiting. Rather than evacuating the virus, the virus uses vomiting to spread throughout the environment.  Like out of your child into her bed, potentially infecting you and your other kids.

When do you need the Emergency Department, when can you stay home?  Most kids who only have a few bouts stay hydrated.  What’s too much? Vomiting for more than 12 hours in a baby is worrisome.  For children between one and two years, 24 hours is getting too long; 48 hours for older kids.

It’s also concerning when your child stops drinking between bouts and becomes more lethargic- sleeping for longer periods and harder to arouse.  If he hasn’t urinated for more than 12 hours, it’s time to get seen.

While vomiting is usually viral and is over in a day, sometimes it’s a sign of worse trouble. If baby vomits dark green, that’s concerning for bowel obstruction, go in right away.  If she’s having bad pain, especially in the lower right side of her belly, that could be appendicitis.  If a baby under six month’s old has projectile vomiting, meaning vomit sailing clear out of the bed, that could be stomach blockage needing surgery.

Otherwise, vomiting can be treated at home.  After your child vomits, rest the stomach for an hour before letting him drink.  Then start with only small amounts of clear liquid.  Water is okay for older kids, but babies and toddlers do better with drinks like pedialyte, or low-sugar sports drinks like Gatorade G2.  Half a cup is plenty at first- if you give too much, it may push the stomach to vomit again.  You can switch to larger amounts later when the vomiting has stopped.

Don’t worry about food. Few children starve during vomiting.  Your child can go days without eating, so don’t panic when she doesn’t have an appetite- she won’t waste away within a few days!

When Vacation Follows You Home

This week’s guest columnists are Drs. Michael Johnson and Sam Defigarelli, Family Practice residents at the University Hospital and Clinics here in Lafayette.

The family returns from a cruise ship holiday in the Caribbean.  Everyone, including 10 year-old Gavin, had a blast.  He loved snorkeling, going down the waterslide on the ship, and even the exotic food at ports-of-call.  But even before the bags are unpacked at home, he says “Uh-Oh!” and runs to the bathroom, just in time for the watery explosion from below.

Traveler’s Diarrhea is a condition that develops soon after returning from trips to resource-limited countries.  Gavin has three potential whammies in his scenario.  These countries often don’t have sewage treatment, and snorkeling is a potential contact with contaminated run-off.  Cruise ships and water-parks are known risks for catching diarrhea.  And improperly prepared food could make him sick as well.

The biggest concern with diarrhea is dehydration.  Most only have a day or two of loose stools, but some also have nausea, vomiting, cramps, fever, or bloody stools.  When there’s lots of vomiting and diarrhea and worries about dehydration, kids should get seen.

Most kids only need home treatment- plenty of clear fluids like pedialyte for infants, sports drinks or dilute juices for older kids.  Avoid full strength fruit juices- these can worsen diarrhea.  For copious diarrhea, rehydration solution packets are available at pharmacies, to mix with clean water.  If kids aren’t having cramps, nausea, or vomiting, they can eat and have milk.  Bland starchy foods are best- fast food and other heavy greasy food can prolong symptoms.  We say ”feed through diarrhea;” don’t restrict food if they’re hungry!  The sooner they eat, the sooner their guts get back in balance.

You’ll want to control the spread of infection to you and your family, so that you aren’t cleaning up after multiple kids and feeling rotten yourself- a total nightmare!  Wash your hands frequently with soap and water- better than hand sanitizers.  Make sure kids aren’t touching or drinking after each other.

Prevention while traveling is even better.  Only drink from unopened bottles.  Avoid ice- it could be made with contaminated water.  Eat food served hot, and avoid salads (ingredients washed how?).  And parents, alcohol won’t reliably sterilize water or ice, so avoid having your cold one on the rocks.

Here is a different scenario than above. It’s June, the annual family reunion picnic, with all the aunts, uncles, and cousins . The grills are going and the sides have been put out: coleslaw, potato salad, macaroni salad.  There is a lot going on: pick-up football, pets running about, tables knocked over, umbrellas and chairs being set up, conversations all around.  The hamburgers are late getting on the grill and the sides have sat in the sun.  Everyone’s hungry so the burgers are a little under-done, but so what?

Any dangerous situations in this story?  It’ not the football- it’s the mayonnaise-based sides warming in the sun, incubating bacteria like Staphylococcus.  And undercooked hamburger can contain E. coli, a potentially disastrous infection.

Food poisoning is all too common in children.  Usually it’s just some diarrhea for a day or two and maybe some vomiting if your unlucky.  However, food poisoning with certain bacteria can have worse consequences.  Staphylococcus (a.k.a.”Staph”) often has a quick onset, within hours of ingestion, and can lead to dehydration and fatigue, especially in younger children.  There are many strains of E. coli too, the worst of which can lead to Hemolytic Uremic Syndrome, a deadly disease involving kidney failure and coma.

Treatment of these bacteria infections isn’t just giving antibiotics.  In fact, sometimes antibiotics can make the symptoms worse.  There’s no treatment besides fluids and rest, and for the really sick kids, hospitalization.  So better to prevent infections than have them!

Safe food handling is paramount.  Always cook meat thoroughly, particularly ground meat.  Be careful of your meat source- meat from a single farm, ground in the store, is much safer than meat from multiple feed lots, pre-ground and packaged when it gets to the store.  Never leave mayonnaise-containing food unrefrigerated for more than one hour.  Be sure to wash vegetables and fruits thoroughly- they might be from fields fertilized with manure that contains E. coli.

So be careful when you travel, and when you cook at home.  An ounce of prevention is worth several pounds of diarrhea, when vacation follows you home!

 

+++++++++++

Running With The Runs

Today’s guest columnist is Dr. Jamie Collins, a Family Practice resident at the University Health Center here in Lafayette.

It was the start of a great day for Kevin.  It was Saturday and no school and no homework.  However, Kevin’s mom was on a mission to find a new couch for the living room and as a result, Kevin and his brothers were dragged from one furniture store to another.  At their last stop of the day, Kevin felt an uncomfortable stirring in his stomach, followed by watery sounds from below.  His mother told him to get off the couch he was sitting on, but too late. His pants erupted in a gurgling roar.

Diarrhea is one of the most common reasons children are brought to the doctor.  Children get diarrhea more often than adults.  Diarrhea is the body’s way of ridding itself of germs, and most episodes last from a few days to a week.  Diarrhea is defined as more stools than usual and more watery than usual.  The usual amount for infants is about 3 to 10 stools per day.  Breast fed infants have more and looser stool than formula-fed infants. Some infants can go 3-4 days without stooling, and that can be normal too.  Toddlers and older children usually go once or twice daily.  So if your breast-fed baby is having six watery stools per day, that’s not diarrhea, that’s normal!

The consistency and color of a child’s stool changes with age, and most color changes are normal.  Brown, yellow, green- all normal.  Diet changes can change the consistency.  Too much fruit juice makes for looser stools.  Stools that are all watery or full of mucus- that is not normal.  And white, bloody, or coal-black stools are not normal.

The most common cause of diarrhea in kids is infection from a virus, like rotavirus.  Other organisms such as salmonella or giardia, can cause diarrhea too.  Most diarrhea lasts from 3 to 14 days, and often comes with vomiting, stomach ache, headache, and fever.

The biggest concern about diarrhea is dehydration, which makes it important to keep your kid drinking.  For infants, keep the breast milk or formula coming.  It was once said that milk makes diarrhea worse.  However, it turns out that the sooner infants and children are on their milk and regular diet, the sooner they get better.  Today’s recommendation is to “feed through” diarrhea.  If it looks like what you are putting in the top is coming out the bottom, keep it coming!  Your child will absorb enough fluids and nutrients to get by.

If your baby is too ill to drink milk, then an oral hydration solution such as pedialyte or infalyte will help supply the fluids and electrolytes that are lost from diarrhea.  Older children can drink any clear liquid they like.  Popsicles are a good way to get fluids into a child who has been vomiting and needs to rehydrate slowly.

Here are things that make diarrhea worse: Drinking too much sugary fruit juice.  If your child will only drink juice when they are sick, cut the juice with half and half with water.  Antibiotics can also make diarrhea worse.  If your kid is already on an antibiotic and gets diarrhea, call your doctor to discuss whether to continue the medicine or not.  A full appetite is often the last behavior to return after an illness.  Children should be allowed to take their time returning to their normal eating.  Children usually tolerate bland, starchy foods better.

Dehydration is the most worrisome complication of diarrhea.  The signs of dehydration include dizziness and light-headedness, a dry sticky mouth, very little or no urine for a 12 to 24 hour period, no tears when crying.  If you think your child is dehydrated, call your doctor.

Parents of kids with diarrhea should avoid spreading infection.  Care with frequent hand washing and keeping sick kids out of school or daycare until the diarrhea is controlled are ways to limit the people exposed.  Hand washing is the best way to prevent the spread of diarrhea to others, and yourself!  Hand sanitizer is the next best way for disinfecting hands when a sink is not handy, but does not guard against all types of diarrhea.

I hope you’ve enjoyed all this poo-poo talk with your morning paper.  Now go wash those hands!