The typical course of a viral gastroenteritis begins with exposure to another ill person in the home, school or day care. Generally, younger children are more affected than older ones so that the contact may have not been very ill or only have diarrhea. Often there is fever, sometimes high, that lasts around 24 hours. The young child then begins to have episodes of vomiting which within a day is followed by loose, watery diarrhea sometimes with foul odor, mucous, or undigested food but no blood or pus. The stools may be loose for 7 to 10 days. The treatment of gastroenteritis can be divided into management of gastroenteritis in the first 24-48 hours and treatment of the symptoms in the days to come.

The first step in the treatment of gastroenteritis is to decide whether any treatment is needed at all. Viral gastroenteritis will run its course and our treatment will not shorten the course. Its aim is to prevent potential complications such as dehydration. A child who vomits once or twice or who has 2 or 3 loose stools may not really need any treatment at all. On the other hand, someone who vomits or has diarrhea 10 or 12 times may need a great deal of treatment.

The management of gastroenteritis in the early phases is geared towards the prevention of dehydration and the observation for signs of this. When used properly, there are very effective oral electrolyte solutions available at most pharmacies and groceries. In third world countries, where gastroenteritis is a leading cause of infant mortality, these have proven their efficacy in saving lives and maintaining hydration even in the presence of vomiting. These solutions are PEDIALYTE (used for maintaining hydration), REHYDRALYTE (used under a physician supervision for rehydration), INFALYTE (perhaps able to do both and decrease diarrhea) and KAOLYTE. REVITALICE and PEDIAPOPS are electrolyte solutions that are frozen like popsicles. The flavor may be more readily accepted than PEDIALYTE or INFALYTE. All of these are over the counter, available at many stores and should be attempted while watching for dehydration before calling the doctor.. While it may be prudent to "rest the stomach" for an hour or so in a child who is retching, these electrolyte solutions help maintain hydration even in the presence of vomiting. If necessary, in a vomiting child, the solutions can be given a tablespoon every 10 to 15 minutes. A child who refuses one solution may take it better from a tablespoon as "medicine," through a straw, frozen as in Pedialyte or Revitalice popsicles, or a different electrolyte solution may be tried (PEDIALYTE also comes fruit flavored). In a very hesitant child, the fluid can be mixed with a small amount of Gatorade, nutrasweet kool aid or juice--just enough to give it some flavor. These electrolyte solutions work because they have the correct amount of glucose (sugar) and sodium (salt) for the body to absorb water quickly and efficiently.

Whether the primary symptom needing treatment is vomiting or diarrhea, the initial management is the same--maintain hydration with electrolyte solutions. Most vomiting usually lasts less than 12 hours, and children with persistent significant vomiting at 24 hours or one showing signs of dehydration surely need to be checked in the office. In general though, the vomiting usually passes quickly without any treatment. Similarly, while diarrhea may persist for several days, it is usually at its worst only a day or two.

The signs of dehydration to watch for are greatly decreased urine output (not voiding at least every 8 hours in infant or every 12 hours in older children); sunken eyes, lethargy, unsteady gait or dry eyes and mouth.

Looking at the moistness of the mouth is probably the best indicator. A 6 month old spitting and blowing bubbles is probably all right; another 6 month old with dry lips and mouth is probably not.

Sometimes a physician orders a blood test to look for biochemical evidence of dehydration.

 When should a child with the stomach flu be seen by a physician?

 The main reason to have children seen by a physician is if you think the child is dehydrated or are concerned about another disease.

The management of the secondary phase of gastroenteritis is twofold. Once the initial symptoms of vomiting or profuse diarrhea have decreased, continue to offer additional fluids in the form of electrolyte solutions. But most importantly, feed the infant or child reintroducing solids as tolerated. In the past, parents were instructed to avoid solids until all symptoms had passed which sometimes resulted in starving kids for several days. Thanks again to studies in underdeveloped countries, now it is known that this is unnecessary and perhaps detrimental--early refeeding leads to a quicker recovery. Obviously there are some limits on this, spicy or "heavy" foods are probably not the wisest choices but more easily digested food such as cereals (rice, barley, oats), starches, oatmeal, potatoes, and broth can be offered. In fact anything other than high fat or spicy foods is probably OK. A child on a soy formula can be restarted immediately on this although some physicians would recommend giving it half strength or diluted for 12 to 24 hours. Infants on cows' milk formula or milk may do the same, however, if this worsens diarrhea, the child may have a temporary lactose intolerance and these may need to be avoided and a soy formula (ISOMIL, PROSOBEE, or ISOMIL DF) may need to be substituted for several days. The enzyme that digests the sugar found in cow's milk and cow milk formula reside in little fingertip projections in the intestine and in severe diarrhea these finger tips may be lost and take a while to regenerate. Within the past few years a new formula, ISOMIL - DF, has been developed with the idea that increased fiber in the formula will cause more substance and less diarrhea. The take home message is FEED THE CHILD AS EARLY AS POSSIBLE