Vomiting & Diarrhea
Vomiting & Diarrhea
Definition
Diarrhea is frequent loose or watery stools.  Vomiting is a very common symptom in childhood, and is usually of little concern.  Often it is of a minor and temporary nature, but when vomiting is persistent and prolonged, the consequences can be rapid and serious.  Vomiting is the forcible ejection of stomach contents and is usually accompanied by nausea.  Projectile vomiting is forcefully ejected as far as 2-4 feet from the child and is not associated with nausea.  Both are symptoms and may be indicative of a variety of acute and chronic illnesses.
Causes
Diarrhea and vomiting are symptoms, not specific diseases.  Causes are often unknown, but they may include:
Bacterial infections
Contaminated foods
Viral infections
Induced by antibiotic therapy
Motion sickness
Food allergies
Respiratory viruses
Emotional upset
Infections with parasites
Defense mechanism
Symptoms
With loose stools or mild diarrhea, there may be 2-4 watery stools in 24 hours.  Occasionally there is slight fever, and the child may be irritable.  There may be an increased desire to eat.

With vomiting, there is the vigorous expulsion of a large portion of the stomach's contents with at least 1-2 episodes in 24 hours.
Complications of severe or prolonged condition
Dehydration is a possible complication to prolonged or severe vomiting or diarrhea.  The speed with which dehydration develops depends on the amount of fluid lost.  If any of the following symptoms are noticed, the child needs immediate medical evaluation.
Decreased elasticity of the skin
Progressive decrease in urine output
Dry mucous membranes in the mouth
Decreased tearing
Sunken eyes and/or soft spots
Rapid thready pulse and/or rapid breathing
Restless, irritable, at times lethargic or unconscious
With some dehydration, the infant or child may lose 3-9% of his or       her body weight and may be thirsty and drink eagerly.
With severe dehydration, the infant or child may lose 10% or more      of his or her body weight and may drink poorly or may not be        able to drink at all.
Coma may develop.
Death may result.
Treatment
All infants under 1 year of age with mild diarrhea, loose stools, or vomiting should be seen by a health care provider.

All children with severe or prolonged vomiting or diarrhea, and those with the symptoms of dehydration listed above should be seen immediately by the health care provider.

Do not give antidiarrheal medications such as Pepto Bismol, Immodium, Lomotil, or Kaopectate.  These products have the potential to prolong or worsen the illness by keeping the bacteria or virus in the body longer.

If the child is in diapers, take measures to prevent diaper rash.  (See Diaper Rash).

Parent and child should practice good handwashing technique to prevent the spread of illness among others in the household.

Avoid exposing the child to other children.  Keep him at home, not day care center or school, unless positively diagnosed as being not contagious.

Dietary measures for infants with loose stools or mild diarrhea:
If breastfeeding, continue to nurse the infant.
If bottle feeding, continue full-strength formula.
If the baby is eating solid foods, a normal diet should                        continue during diarrhea.
Vegetable juices such as carrot juice may be offered.            Plain water may also be effective if given with starchy                     foods such as mashed potatoes.  Avoid fruit juices such       as apple and grape juice until diarrhea stops.  Other         inappropriate fluids include colas, gingerale, Gatorade,             artificially sweetened soft drinks, juice-like drinks, and               chicken broth or beef broth.
Children over 1 year of age with loose stools or mild diarrhea:
Children who eat solid foods can continue their usual diet in small frequent meals.  Foods that may be tolerated well include lentils, fish, meat such as chicken and turkey, pasta, rice, bread, soda crackers, eggs, dairy products, mashed cooked vegetables such as potatoes, cooked cereals, and bananas.  Unsweetened orange juice diluted in half with water can be used in children with diarrhea who are not dehydrated.  Plain water may also be effective if given with starchy foods such as soda crackers or mashed potatoes.  Foods which are not normally well tolerated are spicy or fried foods.  Avoid fruit juices such as apple and grape juice until diarrhea subsides. 
Other inappropriate drinks include colas, ginger ale, Gatorade, artificially sweetened soft drinks, juice-like drinks, and chicken broth or beef broth.
Children over 1 year of age with vomiting:
The child who vomits may tolerate 1-2 teaspoons of clear               liquids every five minutes until vomiting stops, then 1-2               ounces every 10-15 minutes may be given.
Use the same diet as for diarrhea.
If vomiting continues longer than 24 hours, the child should be         seen by a doctor.
Signs that child is improving
Loose stools may continue for a day or two after treatment is started, but should decrease in number.  Mild diarrhea does not last over a week.  No blood, mucus, or pus is present in the stools.

The child's urine output remains normal.

The child does not vomit following more than two meals in a row.

The child has tears and a moist tongue and mouth, but no puffy eyelids or other signs of swelling.

The child's temperature, breathing, appetite, activity, and behavior return to normal.
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