Diarrhoea and vomiting

Screaming baby, vomiting after feeding, can’t keep anything down, watery horrible nappies every hour or so. You feel tired and worried – read on for advice from paediatrician, Kerry Robinson

In the developing world, diarrhoea and vomiting claim the lives of five million children under the age of five every year. It is one of the biggest killers, and the main cause of death is dehydration. In recent years, simple re-hydration solutions have saved millions of lives, and they’re also the key to treating symptoms in the West.

If your child suddenly gets an attack of D&V, the most likely cause is a viral infection. The infection can involve the gut itself (gastro-enteritis), but children may also get diarrhoea and vomiting when they have an infection in a completely unrelated area, for example an ear infection.

You also need to consider two other possibilities:

  • Certain medicines can cause diarrhoea and vomiting – has your child recently started a course of antibiotics? These can cause D&V because, as well as killing the bad bacteria causing infection, they also kill all the good bacteria that normally live in our guts.
  • Overfeeding can cause diarrhoea and vomiting in small babies – are you simply giving too much too often?
When viral infections are the cause are there any other symptoms?

Yes. Fever and a rash commonly accompany gastro-enteritis in children. The rash is usually pink and disappears when you press on it (not like the rash in meningitis which does not disappear when you press on it).

The vomiting, rash and fever will probably stop after 24-48 hours. However, the diarrhoea may last up to two weeks.

What can you do?

Don’t try to stop the diarrhoea – just think about replacing the lost fluid. Even if they’re vomiting, give them drinks; small sips taken often is the key – very labour intensive but very effective. It’s really important not to let your child get dehydrated. Both water and salts are lost in the diarrhoea and vomit, so both of these need to be replaced, along with some sugar for energy. Ready made solutions like Dioralyte contain the right balance of sugars and salt, and flavoured varieties make them more palatable for small children.

Drugs to stop the diarrhoea are not a good idea in little ones. They usually help the symptoms but not the cause and are best avoided.

Should I continue feeding?

Babies – yes. If you’re breastfeeding you should definitely continue. Breast milk is easy to digest and also helps the healing. Bottle milk is also fine.

Toddlers – if your child is on solid foods you can still continue feeding, but it may make the vomiting worse. If feeding is making the situation worse, then just give Dioralyte and sips of water until they settle a bit. Steer clear of apple or prune juice, as these have a laxative effect and may make the diarrhoea worse.

Re-introducing food as early as possible is the key to quick recovery. Start with simple foods such as rice or eggs. It is a myth to avoid milk and dairy foods. Yoghurt is very good for diarrhoea. Yoghurts with live cultures are the ones that contain enzymes which break down sugars in the gut, thus enabling the body to absorb them, so these are the ones to give, when your child is ill.

Home made re-hydrating solutions…

It’s possible to make up your own re-hydration solution but be very careful to get the concentrations right. It’s important to follow the measurements accurately. Only use this if you can’t get to the shops to buy the ready prepared solutions.

1 litre of clean water (you can boil some water and then let it cool)
2.5grams (1/2 teaspoon) of salt
20-40g (4-8 teaspoons) of sugar

If the symptoms persist, how will I know if my child is dehydrated?

  • Thirst – the more thirsty your child is, the more dehydrated they are likely to be.
  • Amount of urine produced – this is an important thing to watch. If your child is vomiting and has diarrhoea, then they will be losing lots of fluid and so will produce less urine. The urine will be darker than usual, more concentrated, and will probably have a strong smell. It is very important to keep your child wee-ing to ensure the kidneys keep working. As long as some urine is being produced, there’s no need to panic, but if your child doesn’t wee for a whole day you should contact a doctor straight away.
  • How playful he/she is – if they’re listless or lethargic, the dehydration is probably affecting them and you should see a doctor.
  • Eyes – sunken, dark eyes indicate a severe level of dehydration.
  • Hands and feet – feel them and look at their colour. Warm pink extremities are healthy, cold mottled ones are not. When should I take my child to a doctor?
    • If there are signs of dehydration
    • If the vomiting lasts for more than two days
    • If there is severe abdominal pain (difficult to assess in little ones)
    • If the diarrhoea has blood in it
    • If the diarrhoea lasts for more than 14 days
    • If your child stops passing urine