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“My child has diarrhea and vomiting! What should I do?”
Facts and advice about gastroenteritis written by pediatricians.
Diarrhea and vomiting in children are almost always due to gastroenteritis, a viral infection also known as the stomach flu or winter vomiting. Stomach viruses are highly contagious. A great deal of the viruses are found in both the stools and vomit of the sick person and they are mainly transmitted by direct contact. The incubation period for gastroenteritis varies between one to four days depending on the virus.
How is gastroenteritis transmitted?
Each time a sick person vomits or has diarrhea, there are a lot of viruses present. The most common stomach virus in Sweden is calicivirus, which is divided into noro- and sapovirus. They cause what is called winter vomiting, the stomach illness that occurs most commonly in winter. But the infections are found all year round. The Public Health Agency publishes weekly reports of the situation in Sweden.
The viruses are transmitted through direct contact with the vomit or diarrhea, onto hands or clothes then transmitted to the foods you eat, or other items you touch. It doesn’t sound nice, does it? To reduce the risk of infection as much as possible, it is important to wash your hands. It’s very important you wash your hands. One more time, wash your hands! This is especially after using/visiting the toilet and diaper changes and after vomiting and touching dirty laundry. Wash your hands before handling food and cooking. Hand sanitizer is not effective against viruses, so use soap and water and paper towels. This is perhaps my best tip to prevent the spread of infection in the family – wash your towels at 60 degrees and put them in the closet until everyone is healthy.
Incubation period for gastroenteritis
The incubation period for gastroenteritis varies according to the virus. Winter vomiting is caused by norovirus or sapovirus. For norovirus, the incubation period is about one day and for sapovirus, it is about 1.7 days. Rotavirus has approximately 2 days incubation period while astrovirus has 4 days incubation period.
Are you contagious before the winter vomiting disease breaks out (or during the incubation period)?
No, you do not infect anyone before the winter vomiting disease has broken out. The problem is, though, that you do not know when it will break out until you vomit for the first time. That’s when you are definitely contagious. As an adult, you might be able to run away and control your vomit, thus minimizing the risk of spreading the infection. But a child will vomit where ever they are, and risks infecting others.
How long after the gastroenteritis am I contagious?
You can definitely transmit the virus while you are vomiting and experiencing diarrhea. A general recommendation worth following is that you should stay home from school and work until 48 hours after symptoms disappear. However, it is worth knowing that the stomach virus can be present in the stools a long while after symptoms disappear. But there is nothing you can do about that.
How do you know if you have gastroenteritis?
If you experience intense vomiting, diarrhea and fever, the diagnosis is quite obvious. It is gastroenteritis. If your child only has diarrhea and fever but no vomiting, it is also likely to be gastroenteritis.
What about just vomiting, is that considered gastroenteritis?
If it’s only vomiting, it can be gastroenteritis, but not necessarily. If you were exposed to gastroenteritis and the vomiting comes suddenly, perhaps along with a fever, then it is probably a viral stomach infection.
Watch out for the combination of vomiting and headache. Certainly, headaches can be a symptom of dehydration due to gastroenteritis, but it can also be a sign of elevated pressure in the brain. So if the headache is a distinctive symptom – seek a doctor urgently for assessment.
An isolated case of vomiting can be gastroenteritis, but it’s hard to know. You can make an overall assessment of the circumstances when deciding how long you isolate the child from kindergarten, etc.
Fever and CRP (C-reactive protein) in gastroenteritis
Often, but not always, you will have a fever with gastroenteritis. The fever can be high and that’s when it is really important to remain hydrated. CRP (a protein indicative of an infection) can be normal (<5) or elevated, and sometimes greatly elevated. A CRP over 50 in a child with gastroenteritis and bloody diarrhea may be caused by a bacteria. But it can also be caused by other viruses (e.g. adenovirus often produces CRP over 100). It is often pointless to test CRP in a child with gastroenteritis, when the diagnosis is clear regardless.
Vomiting in children with diabetes
Vomiting in children with diabetes is acid poisoning (diabetes ketoacidosis) until proven otherwise. Check blood sugar levels and ketone levels, then follow the treatment plan from your diabetes clinic regarding your insulin doses when ketone levels are high. If ketone levels are not decreasing as they should or you are unsure – seek emergency medical care. If you have an emergency phone number to the diabetic pediatrician, call them. Otherwise, go to the emergency room. If your child is badly affected, call an ambulance.
If your child starts vomiting intensely after a period of being very thirsty, urinating and drinking a lot, then it may be a new illness related to their diabetes. Seek emergency medical care immediately for examination and receive emergency treatment. Diabetes with acid poisoning is a life-threatening but treatable condition.
Treatment of gastroenteritis
With gastroenteritis, all you need to think about is that the child receives enough fluid. Fluid replacement is so important that we have our own post about it.
Medications for gastroenteritis
Fluid replacement is the most important therapy for gastroenteritis. In the children’s emergency room, you are often given a medication called Zofran or Ondansetron to stop the vomiting. It is not formally approved as a medication for winter vomiting, but often prevents vomiting effectively. It is prescription-only and there is no tradition of prescribing it for home use in Sweden.
If there’s copious diarrhea, give an anti-diarrheal medication. Hidrasec is recommended for young children. This reduces secretions from the intestine. It is on prescription but fairly new on the Swedish market, so you may need to ask your doctor specifically to prescribe it.
How long does gastroenteritis last?
Viral gastroenteritis can last anywhere from one day to three weeks. If you have had severe, prolonged diarrhea, it may be worth asking the doctor for Hidrasec to reduce loss from the bowels. But if you don’t have the medication, you will just have to wait it out. If you need to stay home from work to take care of your child for more than a week. Ask for a medical certificate from the health center or an online doctor.
It is not easy to prevent winter vomiting. But keeping yourself and children at home during a bout of gastroenteritis and 48 hours after, is a good start. Not meeting people with obvious signs of gastroenteritis is another good tip. If possible, those who suffer from gastroenteritis should not cook for others (difficult if you aren’t single, but otherwise it is often possible). Throw away paper towels and plastic gloves after handling vomit and stools.
There is a vaccine against gastroenteritis that can be given to infants, the rotavirus vaccine. Since its introduction into the Swedish BVC programme (child healthcare program), the number of children who need to be cared for in hospital due to diarrhea and severe gastroenteritis has fallen sharply.