Thursday, November 26, 2015

When the GI bug is bugging your child

In the past few months, pediatricians' and family practitioners' offices, and ERs in our area have been inundated with visits related to stomach flu or viruses. Here is what to look for and what to do if you suspect your child has the dreaded GI bug.

When the GI bug is bugging your child

Sudden onset of nausea, vomiting, diarrhea, and stomach cramping are common symptoms of norovirus infection, which has been hitting children in our area. Other less common symptoms include fever, chills, headache, muscle aches, and fatigue. (AP Photo/U.S. Navy, Ryan Clement)
Sudden onset of nausea, vomiting, diarrhea, and stomach cramping are common symptoms of norovirus infection, which has been hitting children in our area. Other less common symptoms include fever, chills, headache, muscle aches, and fatigue. (AP Photo/U.S. Navy, Ryan Clement)

You’ve cleaned up your toddler’s throw up for the third time and changed his diarrhea-soaked diapers twice in the past few hours. You’re waiting for the nurse at your pediatrician’s office to call you back.  Your child is refusing to drink liquids and is looking miserable. You’re wondering: What can I do? Should I take him to the ER? How much longer is this going to last? Will his younger sibling get it, too?

Your child most likely has the GI bug, also referred to as stomach virus, stomach flu or food poisoning. The more precise medical term is acute gastroenteritis. It is one of the most common reasons for hospitalization in children 5 years of age or younger. In the past few months, pediatricians’ and family practitioners’ offices and ERs in our area have been inundated with visits related to this illness. The most common culprit, accounting for half of all reported gastroenteritis outbreaks, is Norovirus. You may have heard about the Norovirus outbreaks in two New Jersey colleges - Rider and Princeton University, and at the Ruby Princess Cruise Ship in Florida, in February. In the U.S.,80 percent of Norovirus outbreaks occur between November and April.  

Most outbreaks are caused by spread from infected people to others, touching things that have the virus in them, and consuming contaminated food or water. Rotavirus, Adenovirus, Sapovirus, and Astrovirus, are other viruses that have been identified as causes of acute gastroenteritis in children in our area.  Here’s what parents should know about the stomach bug that’s going around:

What are the symptoms? Sudden onset of nausea, vomiting, diarrhea, and stomach cramping are common symptoms of Norovirus infection. Other less common symptoms include fever, chills, headache, muscle aches, and fatigue. Gastroenteritis is diagnosed clinically, based on symptoms and signs. 

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Will my child be tested to see which virus she has? Probably not. Testing is done only for surveillance purposes. It is not important to diagnose the specific virus causing gastroenteritis since gastroenteritis, regardless of the viral cause, is treated the same way.  

How long does it last? Grown-ups and older children usually get better in 1-2 days. Young children can have more serious and longer illness. Children and grown-ups can get ill from norovirus multiple times.

What’s the treatment? There is no specific treatment for, and there is no vaccine to prevent, norovirus gastroenteritis. Antibiotics are useless against viruses. Keeping children hydrated in spite of the vomiting and diarrhea is key. This is best done by replacing lost body fluids using a balanced electrolyte oral rehydration solution. These are readily available in most groceries and pharmacies. Some sports drinks have a similar electrolyte content and may be used, as well. When your child is actively vomiting, do not feed him his usual diet, including milk or formula, since he will likely just vomit this up again.  Avoid offering plain water, especially in infants and younger children, since this may lead to electrolyte imbalance. To prevent more vomiting episodes, give oral liquids slowly, which in infants may require administration using a teaspoon or syringe.

What should I watch for? In spite of your best efforts, your child with gastroenteritis may become dehydrated. Signs to look for include listlessness, irritability, deepening of the soft spot in young infants’ heads, absence of tears with crying, sinking of the eyeballs, dryness of the lips and mouth, and dryness of the skin. Although decreased urination is an important sign of dehydration, assessing urination can be challenging when your child also has diarrhea. Today’s highly adsorbent diapers may feel dry when they are not soaked. When in doubt, consult your doctor or take your child to the nearest ER. In the ER, your child may be given an anti-nausea medication by mouth, or may require an intravenous line for fluid replacement. If your child is significantly dehydrated and is continuing to vomit or is unable to drink, he may require hospitalization.

How can I prevent this bug from spreading? Norovirus is very contagious because it is easily spread. It is difficult to control because infected people are contagious from the moment they feel ill, up to at least 3 days, and sometimes up to 2 weeks, after they are better. Norovirus spreads rapidly within a household, day-care center, or school.

There are some things you can do to try to contain norovirus:

  • Thoroughly wash your hands with soap and water, especially after handling an infected child’s vomit or stool. Alcohol based (at least 62 percent ethanol) hand sanitizers may help but should not replace hand-washing.
  • Do not let your ill child share his food, food containers, utensils and linen.
  • Immediately clean contaminated surfaces and toys with bleach-based cleaning products.
  • Immediately and thoroughly wash contaminated clothing and linen.
  • Do not handle or prepare food while infected, and at least 3 days after illness resolves.
  • Carefully wash fruits and vegetables, and thoroughly cook shellfish, such as oysters.

Now you’re more prepared when the GI bug bugs your child.

Hazel Guinto-Ocampo, M.D., is chief of pediatric emergency services at Bryn Mawr Hospital.

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About this blog
Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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