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Content provided by Thomas W. Tryon, MD, MBA, FAAP; UCA Pediatric Section Chair
As parents, grandparents and caregivers for children, one of the most stressful illnesses in children is what is commonly called the “stomach flu” or viral gastroenteritis. The “stomach flu” is actually not an influenza illness at all but is caused by a multitude of different viruses and can occur at all times during the year. Those of you who follow news stories of Norwalk Virus (or norovirus) illness that is causing cruise ships to be quarantined, would recognize this as one of the viruses we know can cause gastroenteritis. Gastroenteritis typically involves vomiting, diarrhea and can cause fever and stomach pain. It is very contagious. The treatment is generally supportive care.
However, it seems every practitioner has a canned list of recommendations to give to patients and parents about how best to treat the vomiting, what works for diarrhea, and what is the best diet to recommend for a patient with an upset stomach and vomiting. For example, for many years the BRAT diet (bananas, rice, applesauce and toast) was what we recommended to patients. However, is that evidence-based? Is that truly a diet that is helpful and improves outcomes of patients suffering from a gastrointestinal illness?
Fortunately, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) released an updated comprehensive review of acute gastroenteritis in 2014. Their evidence-based review has been endorsed not only by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) but also by the American Academy of Pediatrics. The worldwide experts define acute gastroenteritis as a diarrhea illness with more than three loose or liquid stools in a 24-hour period which may be accompanied with fever or vomiting. This acute diarrhea can typically last up to 14 days.
Here are some of the other recommendations from the 2014 guideline:
Last, the experts also have recommendations on when a child with uncomplicated gastroenteritis would need to be evaluated by a healthcare provider:
I would add, especially for infants and toddlers, that the child should be evaluated if there is severe cramping abdominal pain especially with the child turning pale or white with the pain episodes. This could indicate a concerning condition called intussusception. Also, should any of the diarrhea turn black or bloody, have mucous in it along with the child running a fever, or if the diarrhea lasts more than two weeks, it would be prudent to have the infant or child evaluated by a healthcare professional.
Finally, vomiting and diarrhea can often be one of the most stressful conditions in an infant or child to manage as a parent. Often parents feel that they cannot help a child with vomiting or diarrhea feel better. When in doubt or when concerned, reaching out to the infant or child’s primary healthcare provider or seeking evaluation in your friendly urgent care is a good idea. Most of all, make sure everyone around the child, including Dr. Mom and Dr. Dad, is practicing good hand hygiene to keep from getting sick and spreading germs to others.
Best wishes for a happy and healthy Winter, 2020 and good luck avoiding all the respiratory illnesses and acute gastroenteritis illnesses. Spring will be here before we know it.
Urgent Care Association
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