Often called the “stomach flu”, stomach viruses are not typically influenza (“the flu”). Most of the time, the stomach bug is caused by viruses such as rotavirus, adenovirus and most commonly norovirus and can make for a miserable experience for children and their caregivers. You may hear your child’s pediatrician refer to it as gastroenteritis.
The main symptoms of stomach viruses are diarrhea, vomiting, or both. Other symptoms can include fever, headache, muscle aches, belly pain, and poor appetite.
With the right approach, lots of love and a few days to recover, it is usually not a serious illness and does not require an office visit or trip to the emergency room. Most stomach viruses tend to last between three and seven days and will typically go away without treatment or medication. Since it is a virus, antibiotics will not help and may cause more diarrhea. Keeping your child hydrated and comfortable are the most important parts of care. Your pediatrician can provide guidance and further treatment plans if you are concerned.
Hydration 101
Provide clear fluids that your child will take. Clear fluids can include brand name oral rehydration solutions (ORS), flavored water, popsicles, flavored gelatin cubes, or clear fruit juices (apple or white grape). Avoid caffeinated beverages because they increase urination and worsen symptoms. Also do not give fruit drinks or liquids that are high in sugar as these can make diarrhea worse.
If your child is an infant (under 1 year of age), continue to give breast milk or formula. They may still tolerate small amounts at a time. If your infant continues to vomit the breastmilk or formula, offer ORS to keep them hydrated. Your child’s doctor can help you decide which fluid is best. Do not give plain water to infants. Infants need both water and salt to replace what is lost by vomiting and diarrhea.
Slow and Small
Providing small amounts of food and drink will help minimize vomiting. Start with a teaspoon (5 mL) amount. This can be given as a sip, a spoonful, a bite of a popsicle, or a few sucks from a bottle or sippy cup. Try to keep hydrating fun. Your child may be hungry and want more but keeping it slow is still best. Wait 15 minutes between “teaspoonfuls.” Track how much your child is keeping down. If your child vomits, wait 15-30 minutes and then start back at a teaspoon. When your child can tolerate the small sips, increase by giving them a few teaspoons per hour. As your child starts feeling better, trying to give them more to drink.
As your child starts to feel hungry and is tolerating clear fluids, you can begin to offer bland foods such as rice cereal, toast or crackers, bananas, noodle soup or applesauce. If your child just has diarrhea, adding yogurt with active cultures may help shorten the symptoms. Avoid foods and drinks that make diarrhea worse like foods high in sugar and greasy, fried foods.
Keep Them Comfortable
Aches and fevers can be treated with acetaminophen and/or ibuprofen products. If these products are not tolerated orally, rectal acetaminophen is a great alternative. As always, avoid aspirin in children. Do not give children medicines that stop diarrhea, such as loperamide. The diarrhea will stop on its own when the body clears out the infection.
Signs of Success
You have successfully maintained hydration if your child urinates at a minimum of one wet diaper or one bathroom trip every eight hours. If it has been more than eight hours, it is time to consult the doctor. If your child has diarrhea, this does count as going potty. Often, the fluids accounted for in urination will not be present due to the diarrhea.
Your child is well-hydrated if their mouth and inside the cheek and gum area look moist and their eyes have tears if crying and not have a sunken-looking appearance. If you notice that this is not the case, please call your child’s doctor.
Any severe stomach pain, bloody diarrhea or vomit, fever lasting several days or symptoms lasting longer than one week should be evaluated by a doctor.
Preventing the Spread
Wash your hands with soap and water often! Hand sanitizer does not work against viruses like norovirus. It is also important to wash or sanitize eating and drinking utensils. If able, keeping things like toys that your child uses frequently away from others.
Make sure that your baby gets the rotavirus vaccine. The rotavirus vaccine can prevent serious or deadly infections caused by rotavirus. This vaccine does not protect against other stomach viruses like norovirus. However, rotavirus is a common cause of stomach bugs in children.
Lauren Gramlich, MS, RN, CPNP, is a pediatric nurse practitioner with the School Based Asthma Therapy Program at Nationwide Children’s Hospital. She received her undergraduate and Master of Science in Nursing from The Ohio State University. Prior to joining the asthma team, Lauren worked in primary care for 12 years.
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