When a child experiences vomiting and diarrhea, these symptoms often signal an underlying illness. This guide provides information to help parents understand how to respond, manage symptoms, and prevent complications.
Understanding Dehydration
Dehydration occurs when the body loses more fluid and electrolytes than it takes in, and is a significant concern during episodes of vomiting and diarrhea. Children, especially infants and toddlers, are particularly susceptible to dehydration as they have less fluid reserve and can lose fluids rapidly. Recognizing the signs of dehydration early is important for timely intervention.
Mild dehydration may manifest as dry lips and mouth, increased thirst, and slightly reduced urination. The child might also appear less energetic or irritable. At this stage, the body begins to feel the strain of fluid loss.
As fluid loss continues, moderate dehydration can develop, presenting with more noticeable signs. These include noticeably dry lips and tongue, crying with few or no tears, and eyes that appear sunken. Reduced urination becomes more pronounced, with infants having fewer than six wet diapers per day and older children urinating less frequently. The child may also exhibit increased irritability, drowsiness, or dizziness.
Severe dehydration is a medical emergency where the body has lost substantial fluid, impacting vital organs. Signs include extreme lethargy or unresponsiveness, a sunken soft spot (fontanelle) on an infant’s head, and very dry, wrinkled skin. The child might have a very rapid heart rate, deep and rapid breathing, and cool, blotchy hands and feet. This level of dehydration requires immediate medical attention.
Caring for Your Child at Home
Managing vomiting and diarrhea at home focuses on preventing and treating dehydration by replacing lost fluids and electrolytes. Oral rehydration solutions (ORS) are formulated with the correct balance of water, salts, and sugar, allowing the body to absorb fluids effectively. These solutions are available over-the-counter in liquid, powder, or popsicle forms; store brands are as effective as name brands.
For infants, continue breastfeeding or formula feeding as tolerated. If a formula-fed infant vomits more than once, offer ORS in small, frequent amounts. For breastfed infants, nurse more often; if vomiting persists, offer pumped breast milk or ORS in small quantities (1-2 teaspoons every 5 minutes).
For older children, offer small amounts of ORS (1-2 tablespoons, 15-30 mL) every few minutes, gradually increasing as tolerated. If your child refuses ORS, try serving it cold, different flavors, or ORS popsicles. Avoid plain water for infants under 12 months. For all children, avoid sugary drinks like fruit juice, soda, or sports drinks, as these can worsen diarrhea.
Once vomiting has subsided for several hours, gradually reintroduce bland, easy-to-digest foods. The BRAT diet (bananas, rice, applesauce, toast) is recommended, along with crackers, potatoes, lean meats, and cooked vegetables. Avoid fatty, greasy, spicy foods, or excessive dairy for a few days, as these can be harder to digest.
When to Call the Doctor
While many cases of vomiting and diarrhea resolve without serious complications, certain signs indicate the need for medical evaluation. Contact a healthcare provider if your child is under 6 months of age and experiencing diarrhea, or if they are refusing to drink any fluids. A persistent fever, especially above 100.4°F (38°C) for infants under 3 months or above 102.2°F (39°C) for older children, warrants a doctor’s call.
Signs of moderate to severe dehydration also necessitate medical attention, including significantly decreased urination (no wet diapers for 8 hours or more in toddlers), dry mouth and lips, sunken eyes, or a sunken soft spot on an infant’s head. If your child cries without tears, appears excessively sleepy, or is less responsive than usual, contact your doctor promptly.
Seek immediate emergency care if your child’s vomit contains blood, bile (dark green or yellow-green), or resembles coffee grounds. Emergency evaluation is necessary if there is blood or pus in the stool, or if the stool is black and tarry. Severe abdominal pain that persists even when not vomiting, repetitive vomiting that lasts more than 8 hours, or any significant change in behavior such as confusion, extreme irritability, or unresponsiveness are also reasons for an emergency room visit.
Common Causes and Prevention
Vomiting and diarrhea in children are often caused by viral infections, commonly known as “stomach flu” or gastroenteritis. Rotavirus and norovirus are common culprits, leading to inflammation of the stomach and intestines. Food poisoning, caused by bacteria or toxins in contaminated food, can also result in rapid onset of vomiting and diarrhea.
Preventing the spread of these illnesses relies on good hygiene practices. Frequent handwashing with soap and water is the most effective measure, particularly after using the toilet, changing diapers, and before preparing or eating food. The rotavirus vaccine for infants significantly reduces the risk of severe rotavirus infections. Proper food preparation and storage, along with avoiding contaminated water, also contribute to prevention.