It's high season for the so-called "stomach flu"—a viral form of gastroenteritis that causes vomiting as well as diarrhea.
Health authorities across the country have been reporting that a new and particularly nasty strain of norovirus has been swiftly making its rounds throughout North America this year, affecting both adults and young children in equal measure. As a dietitian and mom whose entire family recently succumbed to this wretched 48-hour virus (all at once, I might add), I offer the following tips for survival.
• Drinking: When vomiting is an issue, supportive care should focus on hydration rather than eating; this is especially true for infants and young children, who can become dehydrated relatively quickly.
For adults and children over age 5, sipping on very cold, carbonated beverages may help ease a queasy stomach and feel better going down than plain water or warm tea.
Sipping is the operative phrase here; no matter how thirsty you feel, you're more likely to tolerate small sips spaced apart by a few minutes than larger gulps of liquid. Aim for 1 to 2 ounces every 30 minutes or so. Ginger ale and tart lemon sodas (e.g., San Pellegrino Limonata or club soda with lemon juice) are my personal go-tos. Diet versions should do the trick as well, though if you're not eating for a day or two, you may find that a little bit of sugar provides necessary energy to make it through the day. (Yes—this is one of the only times you'll see me recommending sugary soda consumption!)
In cases of severe vomiting, it's important to replenish salt as well. For this, a bowl of salty chicken broth, sipped by the spoonful, is my home remedy of choice—though in my New York City-based practice, we also direct patients to one of the papaya-themed food shacks to order a banana-papaya beverage, and instruct them to add a pinch of salt.
Once vomiting has subsided, you'll want to lay off the sugary drinks immediately, as they can worsen impending diarrhea.
If your infant is vomiting, try feeding her expressed breastmilk or her regular formula with a small syringe or teaspoon to minimize the volume of fluids she takes in at a time; this may help her hold down some of the fluids long enough for them to be absorbed. One teaspoon, or a 5-milliliter syringe, can be given every 1 to 2 minutes. (Feeding too much liquid at once can actually make vomiting worse.) Ask your pediatrician whether adding Oral Rehydration Therapy (ORT), such as Pedialyte, is indicated as well, and if so, how much per day.
If your older infant or young toddler refuses liquid ORT, you can try freezing it into popsicle form; this may be more acceptable to them. Note that drinks like Gatorade, soda, juice, and broth are not equivalent substitutes for ORT in young children; they are not formulated with the same ratio of sodium, potassium, and glucose that is required to rehydrate a child.
In all cases, you'll want to monitor baby's wet diapers or your young child's urine output. If her urine output is minimal or absent, advise your pediatrician immediately; this may indicate significant dehydration and require further treatment—such as IV fluids.
Other signs to monitor include: how much weight the baby or child has lost; listlessness or lethargy; whether her mouth, tongue, and lips are moist or dry; whether she has tears; and whether her eyes or fontanel (the soft spot on an infant's head) appear sunken. If you are concerned or unsure, it's always better to err on the side of caution and have baby evaluated by the pediatrician (or if necessary, the emergency room), as dehydration can happen quickly in little people.
• Eating: As is often the case with viral gastroenteritis, once the vomiting portion of the infection subsides, symptoms start manifesting further down into the GI tract, causing diarrhea that can persist for up to several days.
If you're not vomiting anymore and you've replenished lost fluids, you can start back on solid foods. Many people gravitate toward starchy, "binding" foods first—bananas, rice, pasta, saltine crackers, plain bagels, and pretzels, though in reality there is no good evidence to support that the "BRAT diet" (bananas, rice, applesauce, toast) is any better tolerated than a normal diet.
[See Smart Snacking for Kids]
I'd steer clear of sugary juices, soda, and sports drinks at this stage of the illness; they can draw even more water into the gut through osmosis and make diarrhea worse. If diarrhea has been severe or prolonged, you may also find switching to lactose-free dairy for a few days, and up to two weeks, may be more comfortable until the intestines repair themselves and resume their full digestive capacity.
For infants and young children with mild to moderate diarrhea, the American Academy of Pediatrics (AAP) recommends resuming an unrestricted, age-appropriate diet once vomiting has subsided, and the child has been appropriately rehydrated. The organization cites research that shows children with diarrhea who were fed their normal diets did not experience worse or prolonged diarrhea compared to children fed restricted diets like "BRAT" diets. Temporary lactose intolerance, they also found, affected only about 20 percent of young children with mild diarrhea.
Good choices of food to reintroduce include a variety of low-sugar carbs (e.g., plain cereals like Cheerios, breads, rice, and potatoes), low-sugar yogurts, peeled fruits, lean proteins (e.g., eggs, chicken, and fish prepared with minimal added fat) and even some simple, well-cooked veggies like green beans and carrots.
• Medications: Unfortunately, viral infections need to run their course; no medications can hasten the process. Viruses don't respond to antibiotics, so don't bother begging your doctor for them.
If vomiting is severe and prolonged, however, your doctor may prescribe you an anti-nausea medication to help give you some relief. This may help lessen the severity of symptoms, but it won't cure the underlying infection itself.
Resist the temptation to take Immodium (Loperamide) or another over-the-counter, anti-diarrheal medication without first consulting your doctor. In many cases, your doctor may advise waiting at least a day or so to ensure the infection has had a chance to work itself out of the gut before medically slowing down the elimination process. Depending on your symptoms, your doctor may advise against its use altogether.
The AAP advises against use of Loperamide or other medications to treat acute diarrhea in all children, period.
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Tamara Duker Freuman, MS, RD, CDN, is a NYC-based registered dietitian whose clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.