Island Kids | The dreaded stomach bug

||| ISLAND KIDS by EVAN BUXBAUM, MD, MPH, FAAP |||

Hello, and welcome to my new column “Island Kids,” where we will be talking a few times a month about issues that affect the health and wellbeing of the wonderful children we’re growing on these islands. I’ve been a pediatrician for the past two decades, and I love sharing what I know with parents and families. I’d love to hear from you, so if there are questions you have about your kids or children in general, please send them to obstructionpress@gmail.com.

As many Orcasonians already know, we have recently had an unwanted winter visitor to our peaceful shores: Norovirus. This unpleasant bug starts with the sudden onset of vomiting and diarrhea, usually accompanied by intense belly pain. Sometimes there can be fever and body aches as well. It’s tough on everyone, but watching our kids go through it is especially difficult. Below we’ll talk about what this illness entails, how to help a child who is sick with a stomach infection, and when to seek help.

Norovirus takes 1-3 days to kick in after exposure, but when it starts it comes on quickly. Often people blame the last meal they had for ‘food poisoning,’ when in fact the virus had been incubating in their unsuspecting bellies for days. It spreads by the unpleasantly euphemistic ‘fecal-oral’ route, meaning someone who is infected doesn’t adequately wash their hands (hand sanitizer doesn’t kill the Norovirus) and touches a surface or food that the next victim comes into contact with. The virus can survive outside the body on surfaces for a long time, and it is highly infectious, so when it goes through a community it spreads rapidly.

Symptoms usually only last 1-3 days, but those are memorable days. Vomiting can be repetitive and violent, and may coincide with the diarrhea. Nausea is very common. Kids really suffer with this virus and as parents it’s difficult to watch, especially as there’s little we can do to cure it. There are measures however that can lessen their misery.

The most concerning consequence of Norovirus or any belly infection is severe dehydration. This is especially dangerous in young children and the elderly or immune-compromised. Every year there are about 20 million Norovirus cases in the U.S., leading to 100,000 hospitalizations and 900 deaths.

In children with any vomiting/diarrhea disease, the number one priority is hydratio — getting fluids into their bodies faster than they are going out. Small frequent sips work best — drinking a lot all at once during the acute phase of vomiting may bring on nausea and the fluids could come right back up. Once the vomiting has stopped, it’s important to push fluids and replenish their hydration.

Offer breastmilk or formula to a sick infant, but if they are throwing that up it’s best to switch to rehydration fluids. In infants and toddlers, rehydration drinks such as Pedialyte are recommended over water because they are absorbed faster and stay in the body longer. Pedialyte also comes in popsicles, which is another option for younger kids. Rehydration fluids are also great for older kids, but watered down juice or sports drinks work too for kids 4 and up. Avoid sugary drinks like undiluted juice or soda as these may make diarrhea worse.

Watch for signs of dehydration including dry lips, sunken eyes, crying without making tears, and lethargy. In older children and teens, going more than 8-10 hours without peeing is a sign of dehydration, while longer than 4 or 5 hours in babies is cause for concern.

There is no vaccine or anti-viral medicine for Norovirus, but for symptomatic relief Tylenol or ibuprofen helps with body aches and can relieve some of the discomfort. Baths and cool compresses may give some comfort. There is some good evidence for starting a probiotic early in the course of the illness.

In children experiencing extreme or prolonged vomiting your doctor may prescribe a dissolvable medication that stops the nausea and vomiting for several hours, which gives the child a chance to rehydrate. We never encourage any medications like Imodium or Pepto Bismol that stop the diarrhea — we don’t want to get in the way of the body ridding itself of the virus, at least in that direction.

Finally, the kindest thing you can do for others when you have a stomach virus is to not spread it. Wash your hands well with soap and water for at least 20 seconds (not hand sanitizer) frequently, don’t prepare food for others while you’re sick and for three days afterwards, and keep in mind that you can still shed the virus up to four weeks after you’ve recovered, so keep up the good hygiene. Come to think of it, good hygiene is always a great idea.

Hope this advice helps you the next time you or your young ones get this or one of the other belly bugs that periodically go around.

Take good care, and hug your kids often.