Texas Vacation

This week’s guest columnist is Dr. Wesley Adams, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

“Dad, pull over!”  Driving across West Texas is a loooong drive, the view unbroken flat nothingness. When I was 11 years-old, that drive got even longer. Relatives we had just visited apparently blessed me with gastroenteritis- I suddenly had gurgling guts. Yes, the lone prairie holds no romance for me, no visions of cowboys strumming guitars by campfires; just the memory of many rest stops.

Most vomiting and diarrhea illnesses, “gastroenteritis” in doctor-speak, are caused by viruses we catch from one another.  It usually only lasts a day or two, but it can last a week in some unfortunate kids. Sometimes when parents see large volumes of diarrhea pouring out of their child, they get scared. They’re worried, of course, about dehydration. Still, most get through even a week of misery without needing IV hydration in the Emergency Department. As long as your child’s drinking and not vomiting, she’ll typically absorb enough fluids to keep up with the, um, output.

How do you know if your child is hydrated?  If their mouths are moist, they make tears when they cry, and they pee at least once or twice per day, then they’re okay. If your kid’s mouth is getting dried out inside, he’s moaning but not crying tears, or hasn’t urinated for 12 hours, get checked out. Sometimes with babies and littler kids, there’s so much diarrhea that you can’t tell if their making urine.  In that case you have to go by  tears, mouth moisture, and energy level.

If your child’s only having diarrhea and not vomiting, anything they’ll drink is fair. We used to say don’t give milk with diarrhea, or avoid certain foods, but now we say “feed through” diarrhea.  The sooner your child’s on his regular diet, the sooner her guts will get “back in balance.”  Good things to eat are bland starchy foods easy on the stomach. Certainly avoid heavy greasy foods, like fast food, and high sugar liquids like straight juice or soda. Too much sugar acts like a laxative, and we certainly don’t need that!

Fortunately for my “trail of tears” diarrhea experience across Texas, I didn’t vomit. My 4 year-old patient Eden wasn’t so lucky. She vomited for 4 days before her parents decided she wasn’t okay. What did their home smelled like!? To her parents’ credit, she tolerated some fluids at first; but later spewed so frequently that the tiniest sip wouldn’t stay down. When her tears stopped, despite crying with stomach cramps, they came in.

The majority of gastroenteritis (a.k.a. stomach virus) can be managed at home. Like we said above, if your child urinates once or twice daily, has a moist mouth, and makes tears, he’s okay. If he’s becoming progressively more listless, has a dried out tacky mouth, stops making tears, has sunken eyes, and hasn’t urinated in 12 hours, you’re losing ground.

Some parents panic at one vomit.  After all, it’s gross, and dramatic- all that wretching and cramping!. Fortunately, most kids only vomit once or twice, and then settle down and tolerate fluids. The best strategy to keep kids hydrated is go slow. Don’t force them to drink right after they hurl- it takes an hour or so for stomachs to calm down. Then start with small amounts of clear fluid.  An ounce or two of dilute juice, like apple juice cut half-and-half with water, is a good start. If that small amount stays down, half an hour later give some more.

After a few hours, you can increase fluid volume.  Some parents worry that their child is starving, and start foods right away too. Rest assured, your child won’t waste away going a few days without food. Don’t give solids, or thick fluids like milk, for at least 6 hours after vomiting- kids’ stomachs won’t handle that freight. But if they’re tolerating fluids after that long, then small amounts of bland, starchy things are okay- crackers, toast, bananas.

In these COVID times, we’re hopefully now all aware that clean hands prevent Coronavirus from spreading. The same goes for stomach viruses. Make sure you and your kids wash hands after using the bathroom. One sick kid per household is enough!

The Mundane Epidemic

The big medical news recenlty is either about Influenza (the “flu” you get a flu shot for), or measles, which has had recent national outbreaks in undervaccinated communities.  However, we’re also having a local outbreak of “stomach virus”.  Though it’s certainly a more pedestrian illness than measles or influenza, try telling that to the parents of kids who re-enact the pie-eating-contest-vomit-fest from the movie Stand By Me.

Vomiting is distressing.  It’s just plain disgusting, and many parents get nauseated themselves at the sight.  And they have to clean it up!  Nausea and vomiting are miserable for kids too- it feels lousy.  Parents often have a more profound worry- what if he won’t stop vomiting and gets dehydrated?  That’s when they come to the Emergency Department.

Most vomiting lasts only a half day or so.  However, parents often panic at the first vomit: it seems like so much!  In their disgust, they overestimate the actual volume, seeing the kid from that movie spewing gallons of blueberry smush.  Then after a few more vomits, parents worry about intake, and push too much liquid, or worse, food.  This taxes the stomach, and more yakking ensues.

However, kids do have some reserve; there’s time to work this out.  After vomiting, wait an hour for the stomach to settle.  Then start small amounts of fluids like pedialyte, sports drinks, or dilute juices.  This means just an ounce or two.  Wait a half hour, then give another few ounces.  Then another.  When those little bits are staying down, then gradually increase the volume.  Your child may start begging for more as she starts to feel better, but be strong and be patient- better to hold down a little than throw up a lot.

This method, called Oral Rehydration Therapy, is one of the greatest medical inventions.  It seems simple, but before ORT, the pediatric death rate from third world cholera and dysentery epidemics was astounding.  These are much more violent infections than their benign American counterparts, and doctors were amazed how many kids could “feed through” these illnesses without needing expensive and scarce IV treatment.

My family is fortunate that we haven’t had many stomach viruses.  One time we did we were vacationing in New Mexico, and my wife and I had gotten a babysitter to go out to dinner.  When we got back, the babysitter looked like hell, having cleaned up vomit from our two daughters. Only our son seemed unaffected.  I went to tuck him in, and there he was with the covers pulled up to his chin.  “Dad, I hate to tell you this,” he piped in his 8 year-old voice, smiling sheepishly, “but I just had diarrhea.”  In the bed.

Parents are grossed out by diarrhea, just like with the vomiting we discussed above.  It can also be accompanied by painful cramps.  And like with vomiting, parents start to worry about dehydration, particularly when they feed the kid some fluids or food, and it seems to pour right out the back end.

Kids typically absorb enough fluids to get by though, even if it seems to run right through.  In fact, the quickest way to get your child better is get them on their regular diet as soon as possible.  They won’t feel like eating much at first, so like with vomiting, start with fluids like pedialyte for babies, sports drinks or dilute juices for older kids.  No full strength fruit juice- that sugar load can act like a laxative, and make diarrhea worse.

When your child can eat, back to their regular diet.  A generation ago we were told not to give milk with diarrhea, but now the thinking is when you’re eating your regular food, including milk and yogurt, your guts get “back in balance.”  No heavy, greasy foods like fast foods though, whose fat loads can also worsen diarrhea.

The best treatment for stomach viruses is prevention. Kids contract these bugs by putting contaminated fingers in their mouths (don’t go “ew,” you do too!).  Thus they should wash their hands before eating and after using the bathroom. If your child vomits more than 12 hours, or has diarrhea for more than 4 days, call your doctor for medicine that can stop vomiting.  Unfortunately, there’s not great medicine for diarrhea.  Pepto-bismol or Imodium may slow it down some, or help with the cramps, but they’re not miracle cures.  Typically you just need to….let it pass.

Water Works

This week’s guest columnist is Dr. Meighan Anderson, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

8 year-old Ted finished his last baseball game of the season.  To celebrate, mom and dad took the family to the new burger bar in town.  Ted picked the biggest burger on the menu, his attempts to devour it leaving everyone in stitches.  Dad thought the meat looked a little too pink, but didn’t want to interrupt the good time- it was probably fine.  Later back home, Ted yells from the bathroom: “It’s coming out like water!”  Then comes the sound of vomiting.

Diarrhea and vomiting are difficult topics for parents, because they’re gross, and it’s sometimes hard for parents to know when to worry.  It’s a big mess when it happens and they just want it over!  But the real questions are- does he need to go to the doctor?  Is this a stomach virus that will get better on it’s own, or something worse?  When will it end?  When do I worry about dehydration?

We see a lot of kids in the Emergency Department who, when they have one or two vomits or diarrheas, are rushed right in.  Then as the parent goes on about how sick their child is, the kid is dashing about the room, opening the drawers and jiggling the bed controls.  In fact, these are good signs that the child doesn’t have something bad, like a blockage, or appendicitis, or dehydration- walking, talking, and playing.  If the child is not eating, but is drinking, that’s another good sign.  Kids who make wet diapers and urinate, even if only once or twice per day, or make tears when they cry, are getting enough fluids to not worry about dehydration either.

Here’s the worrisome signs that your child needs to get seen- diarrhea with lots of blood, abdominal pain so bad they cry, and non-stop vomiting, like for hours and hours.  Finally, if kids are so lethargic that they have trouble staying awake, or even sitting up, you need to talk to a doctor.  These could be symptoms of worse things than a run-of-the-mill stomach bug, like appendicitis, blockages, severe infections, or serious dehydration.

Back to our story of Ted from above, having vomiting and diarrhea after eating undercooked hamburger.  He continued to vomit all night, into the next day, with diarrhea.  By the afternoon he’s looking like a limp dishrag- tired, pale, and sleeping a lot.  He also looks grey and sunken around the eyes.  TIme to visit the Emergency Department.

Dehydration is the most serious complication of vomiting and diarrhea.  Diarrhea alone usually doesn’t do it- if children drink and hold fluids down, dehydration is unusual.  Some parents worry that fluids are “running right through” a kid who drinks and then immediately has diarrhea.  However, kids typically absorb enough to get by.  “Feed through” diarrhea is the rule: keep it coming from the top, even if it seems to come right out the bottom.

However, if the child is also vomiting, or not drinking, dehydration is a worry.  Ted is showing us the signs- worsening fatigue, pallor and sunken eyes.  If he doesn’t make urine for 8-12 hours, that’s another clue that he needs to come in for IV fluids.

The best way to avoid dehydration is drinking clear liquids.  Fluids that contain some sugar and salt are most efficiently absorbed- sports drinks, or pedialyte for babies.  But don’t use full-strength fruit juices- they can worsen diarrhea.  To avoid vomiting, start with small amounts of fluid, to not challenge the stomach too much.  Give babies just a few ounces, older kids a half cup.  If that stays down after a half hour, give another little bit.  After a few hours where small amounts are staying down, you can give larger amounts.  Then about 6-8 hours after not vomiting, you can try bland starchy foods- rice, toast, crackers, bananas; nothing heavy like burgers, fries, or nuggets.

Your doctor can also prescribe Zofran over the phone, a medicine which can stop nausea and vomiting before it gets too far.  Antibiotics don’t help, and may worsen diarrhea.  They’re used only when tests on the stool indicate.

But if your kid is walking, smiling, and peeing, he’s not dehydrated.  Soon his body will shut off the Water Works, and the mess will finally end! 

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!


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.