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!

Vomiting

DODGING VOMIT
I have gotten pretty good at dodging vomit over my years as a pediatrician. It only takes once or twice really to learn, after you have been hit.
“Gastroenteritis”, also called “stomach viruses,” “stomach flu,” or “rotavirus” is one of the most common kid illnesses.
You catch the virus (or occasionally bacteria)
from other people’s dirty hands or from food contaminated with the virus. In a day or two the virus “brews” inside you and you start with the vomiting and diarrhea, sometimes fever and headache. Usually the vomiting only lasts half a day or so, then you have four or five or more days of diarrhea.
Dehydration is the main way children get into serious trouble. Dehydration is when the body does not have enough water to provide good blood volume. The body’s organs begin to starve for lack of fluids, nutrients, and oxygen. Your kidneys try to hold on to what fluids you have, and you stop making urine. The signs of dehydration then become more obvious as your organs- your brain, your blood, your kidneys- sicken. You get sleepy and harder to arouse, you begin to breathe shallow and fast, your skin gets pale and grayish.
Most vomiting can be taken care of at home. If a child vomits, simply wait an hour or two for the stomach to settle down. Then start giving only clear fluids like sports drinks or pedialyte. Pedialyte is the very best to give for babies. If the child vomits again, relax. Wait another hour or two and try a small amount of fluid again. It usually takes a good eight to twelve hours for a child to really start to get dehydrated. When in doubt, call your doctor.
If your child has stopped vomiting and is taking clear fluids for six or so hours, then you can restart small amounts of bland food. If the child vomits then, stop for an hour or two and restart the small amounts of clear liquid.
If your child only has diarrhea, but is drinking ok, they typically won’t have dehydration. Children tend to absorb enough fluids even with lots of diarrhea. Keep the fluids coming. Also, science has shown that the sooner a child is back on their regular diet, the sooner the diarrhea goes away. So as soon as your child can take food, give it and keep it coming. Even if it looks if it is going “right through,” keep the food coming- your child again will absorb enough to get by.