The Ins and Outs of the Stomach Bug

We all know the feeling: you are woken from a deep sleep by the sound of your three-year-old’s vomit hitting the floor. Your stomach drops as you quickly process what is happening and what it means for the rest of the family. You hope and pray that it’s a one-off or something they ate, but all signs point to the stomach bug—or, as we so lovingly refer to it in my house, “bubble guts.”

Well, here are the facts – “Bubble guts” are caused by a virus, most commonly rotavirus, norovirus, or adenovirus. These viruses attack the stomach and intestines. Once they infect the lining of the gastrointestinal tract, they cause irritation and inflammation, ultimately resulting in the classic symptoms of fever, abdominal pain, nausea, vomiting, and diarrhea.

These viruses spread by sharing food, water, and utensils with someone who has the virus, not washing your hands after touching items that may have the virus on the surface, or not washing hands after diaper changes or toileting. Symptoms start 1-2 days after exposure and usually last between 2-10 days. It is highly contagious, so once one person goes down, you’re all going down. No one in the house is safe, except maybe the dog.

Vomiting 

Vomiting is one of the first signs of the stomach bug. It can be very distressing to children and parents mostly because it happens without warning, anytime, anywhere (except maybe in a convenient, easy-to-clean location, such as the trashcan or the toilet). But the good news is that this stage typically lasts only 24-48 hours.

Diarrhea

Now you’ve made it through that first 48 hours, the vomiting has slowed, and you think we are out of the woods. Then comes diarrhea, which refers to frequent, large-volume, loose, or watery stools. Children can have between 6-8 stools per day. The worst of this stage typically lasts 3-5 days. However, children can have loose stool for another week or more.

Dehydration

Due to the vomiting and diarrhea, the body loses more fluid than it takes in. Therefore, one of the most important things you can do during this time is to keep your child hydrated.

But not just any fluid will do. Water is good. However, something to replace the essential electrolytes in the body, like sugar and salt, is better. Pedialyte is one of our tried and true recommendations. Avoid juices or sugary drinks, as this often worsens the diarrhea.

Remember that too much of even the proper fluids can cause vomiting if given too quickly, so take it slow. Small sips throughout the day will keep your child hydrated. If your child refuses to take small sips, you may have to use a syringe. Usually, 1-2 tsp at a time, about every 10 minutes, will do the trick.

Fortunately, most healthy children do not get dehydrated from a mild episode of the stomach bug. Below are the signs of dehydration to be aware of:

• Only 1-2 wet diapers in a 12-24 hour period
• Dry mouth and tongue
• Lack of tears
• Lethargy

Return to Regular Diet

Your child is now tolerating liquids! They are starting to perk back up. They may even be asking for a snack/meal. Don’t be fooled. They need more time for those chicken nuggets and fries. Go slow with reintroducing foods, and keep it bland. Usually, things like bananas, rice, applesauce, toast, and crackers are best. You want to make sure what goes down stays down. Your child will likely not return to their regular diet for another few days.

But aren’t there any medicines? 

Prevention is the best medicine! Wash your hands, and then rewash them. Use warm soap and water. Scrub for at least 20 seconds at a time. Most of these stomach viruses can survive your trusty hand sanitizer. Get your child vaccinated! We vaccinate infants against rotavirus, one of the most common causes of stomach bugs.

Once you have the stomach bug, it’s just a matter of time. Supportive care, including fluids and rest, is best! Think of it this way: vomiting and diarrhea are the body’s way to fight infection. We want that virus out. So, we are not necessarily trying to stop the process, no matter how distressing.

That being said, if your child cannot keep anything down, we may prescribe an anti-nausea medication to keep them hydrated. However, medicines that slow down the stool, such as Imodium or Pepto-Bismol, are not recommended for children. They may prolong or worsen symptoms. Additionally, vomiting and diarrhea can upset the balance of the good and bad bacteria in the intestines. We often recommend replacing good bacteria with probiotics like yogurt or over-the-counter probiotic packets. Probiotics will help improve and strengthen the immune response of the intestines. They are hopefully reducing and shortening the duration of symptoms.

Red Flags

But wait, there are some red-flag symptoms that may point to something different. Be on the lookout for:

• Signs of dehydration, as detailed above
• Blood in the vomit or stool
• Focal abdominal pain
• Prolonged fevers

There you have it! The ins and outs of the stomach virus! If you have any additional questions or concerns about bubble guts, please ask us at your next visit!

Alanna Nutz, MD