Gastro in Children: Case Scenario
[WARNING: When gastro strikes, please don’t give your children sports drinks or undiluted juices and lemonade]
Jamie a father of three comes into the pharmacy to ask for advice to help his wife and his 3-year-old daughter who have both have been up vomiting throughout the night. To help his daughter he gave her some fizzy lemonade and his wife took a Stemetil (anti-nausea tablet) which she had in the medicine cupboard but he also gave her one of his sports drink to help settle her stomach because he thought the electrolytes would help her. He came in to ask if there is anything else he could do? He also was worried if his youngest child being only 8 months catches the gastro bug?
Before helping Jamie with some tips and advice to help treat the gastro, It was important to check whether his three-year-old daughter had any of the following:
- Not passing urine ie dry nappies, dry mouth,lack of tears, is pale, has sunken eyes, cold hands and feet, drowsiness and very irritable
- Is refusing to drink
- Has a rash that doesn’t fade when the skin is pressed
- Blood in her stools or vomit
- Vomit a green colour
- Severe abdominal pain
If Jamie answered yes to any of the above, it would be straight to the hospital because young children if they become severely dehydrated is a medical emergency and needs to be admitted to have fluids given to them usually by a drip.
Since Jamie answered ‘no’ to the above, we could answer Jamie’s question with what to do and what not to do when suffering gastro.
Hydration- the biggest problem whilst suffering with gastro is becoming dehydrated because of loss of fluid via vomiting or diarrhoea, so drinking fluid is very important. It’s important to be aware that not every drink your child requests will be good for them whilst suffering gastro and sports drinks, undiluted juices and soft drinks ie lemonade can exacerbate dehydration. Oral rehydration solution is the best way to stay hydrated and are available over the counter from any pharmacy. They are scientifically formulated to contain the correct balance of glucose and electrolytes for rapid rehydration. Water or sugary drinks are not as effective as Hydralyte, as they do not restore lost electrolytes (which retain the fluid). Examples of these are Hydralyte, Gastrolyte, Pedialyte. These come in a number of different forms ie powder sachets and effervescent tablets that you combine with water, ready pre-made solutions, icy poles and jelly solutions. The only way I can get them into my children is either an icy pole or a jelly and even that is a struggle because the flavour is a combination of sweet and salty. I explained to Jamie to try and get his 3-year-old daughter and wife, to keep sipping water too and if the oral rehydration solutions are refused by his daughter and juice or lemonade is requested, it must be diluted. 1 part lemonade or fruit juice, to 4 parts water is the ratio recommended. So if you give 100ml of juice, add 400ml water to make up to a total of 500ml. Alternatively, you can use 10ml of concentrated cordial and add 250ml water (equivalent to 1 cup of water).
I also explained to Jamie that if his 8-month-old baby developed gastro if he/she is:
Continue breastfeeding more frequently (on demand or, at least, every 2 hours) in order to increase the fluid intake. Also in between feeds, offer oral rehydration solution in a bottle. You can start to reintroduce the solids if your baby is already on solids even if their stools are still loose. Offer foods your baby/child regularly eat, there is no need to restrict their diet.
Formula Fed babies/toddlers:
If Jamie’s baby is formula fed, formula can be stopped for a maximum of 12 hours, whilst frequently offering oral rehydration solution and clear fluids, and then return to their regular formula. Continue to offer the formula more frequently and oral rehydration solution in between feeds. Your baby may only take small amounts at a time but as long as they are drinking and producing wet nappies, that is what is important to look out for.
Children can develop lactose intolerance after suffering from a bout of gastro and the loose stools may continue. Speak to your doctor if this is the case, as your child may need to go to a lactose-free formula for a short period of time (approximately 1 month) until the lactose intolerance settles. This would need to be done under appropriate advice from your child’s health care professional. If your child is older than one and is no longer on formula and drinks full cream milk, with appropriate advice he/she may need to switch to lactose-free milk for one month and then be assessed thereafter.
It can be very difficult to get your child to drink when they are feeling nauseous and really don’t want to put anything near their mouths. Be patient and keep encouraging your child. Children love icy poles, so what I do with my fussy eating daughters, is always offer the oral rehydration solution in icy pole form first, and if that doesn’t work, I make my own diluted (1 to 4 parts) lemonade icy poles or diluted fruit juice icy poles and that’s usually a winner (ie. Add 100ml of lemonade to 400ml of water and then pour into icy pole moulds and freeze) . Another tip is using exciting looking twirly straws in water or oral rehydration solutions and children have fun watching the fluid go through the straw.
If your child is off their food, that is not a problem. You can start to reintroduce the solids if your baby is already on solids even if their stools are still loose. Offer foods your child regularly eat, there is no need to restrict their diet.
Jamie also asked exactly how much fluid should my child be drinking?
Aim for at least 5mls of fluid per kg body weight each hour. ie if your baby is 10kg, you should aim for 50mls fluid each hour to replenish the fluid that is lost. The best advice is keep offering your child water and oral rehydration solution and reminding them to drink as young children can become dehydrated easily and need small amounts of fluid often.
Below are a few more tips I gave Jamie:
There is strong evidence to shows that Probiotics co-administered with standard rehydration therapy decrease the duration of infectious diarrhoea by approximately 30 hours with 2 particular strains of probiotics having the most evidence. ( Lactobacillus rhamnosus GG and Saccharomyces boulardii ) Ethical nutrients Gastro Relief contain these 2 probiotics and can be given to children from 3 months. They come in capsules and in babies and children, the capsules can be opened and mixed in breastmilk, formula or water.
2) It’s very important NOT to give any medication that will stop nausea/vomiting and diarrhoea. Let your baby/child’s body do what it needs to do, and that is, get the virus/bacteria out of their system. If you give medication to stop nausea it will only keep the bug in their system for longer and delay the recovery.
Do not give sports drinks, Lucozade, or undiluted lemonade, cordials, or fruit juices as they can dehydrate your child even more by drawing fluid into their bowels.
NB. The above tips apply to managing gastro symptoms in adults and it’s a very common misconception that adults think the sports drink will help with gastro and rehydrate them but they, unfortunately, do the opposite as they contain too much sugar, sodium and potassium and draw fluid away from the cells, worsening dehydration.
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also, if you tried a remedy that worked well for your children that was, or wasn’t mentioned above, let me know. I hope this information does help.
Disclaimer – The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein. The names of people mentioned in this blog have been changed to protect the real patient’s confidentiality.