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Monday, December 7, 2009

The Stomach Flu - Acute Gastroenteritis

Acute gastroenteritis (AGE), more commonly known as stomach flu or a stomach virus, is a viral illness effecting the stomach and intestines. It is a very common illness in children and can be caused by a number of different viruses. The diagnosis of AGE is based on the symptoms a child presents with, most notably vomiting and diarrhea. Other symptoms include: fever, diffuse stomach pain, loss of appetite and increased tiredness or irritability.

Although concerning to parents, a loss of appetite is normal. The main concern is dehydration. Thus, if your child refuses to eat, he may just not feel up to it, but you need to encourage him to drink plenty of liquids. Children need to replace all the liquid lost from vomiting and diarrhea. Drinking large quantities at one time may induce vomiting, so it is better to give them a few sips at a time. For younger children, fill a sippy cup or straw cup with water, Pedialyte, juice or a sports drink and let them sip on it throughout the day. Pedialyte is a good alternative to water in this situation because it not only replaces the fluid lost but also the electrolytes. Unfortunately, some children do not like the taste. In order to avoid dehydration, this is one instance where it is better to just let them drink what they like. Even frozen juice or ice pops are okay. If your child has no urine output for 8 hours or more, has no tears when he cries, has a dry mouth (no saliva) or his eyes look sunken, you should call your doctor, as these are signs of dehydration.

AGE is usually fairly shot lived, resolving in 3-5 days. Although in young children, the diarrhea may persist for longer. This is in part due to inflammation and damage to the intestinal lining by the virus leading to decrease lactase enzymatic activity. Lactase is the enzyme in the body that breaks down milk products. After a bout of AGE, for a short period of time, it is more difficult to digest milk products. Thus, excess milk or dairy products should be avoided. This does not mean that children need to switch to lactose-free formulas or that infants should stop breastfeeding. Mothers who are breastfeeding should continue to do so and most children can remain on their regular formula. Instead, it should simply reassure parents as to why, although their child may seem better, they are still having some lingering diarrhea.

Parents should also start a bland diet revolving around the BRAT foods. The BRAT diet is an acronym for bananas, rice, apples and toast. Other bland carbohydrates can be substituted for rice and toast such as pasta. These foods can be prepared with a little butter but salsas, beans, and sauces should be avoided.

What you can do at home:
1. Keep your child well hydrated.
2. Start the BRAT diet.
3. Limit excess dairy products (but continue with normal formula or breast milk).
4. Limit spicy foods.
5. Practice good hand hygiene to avoid spreading the virus.

When to call your doctor:
1. Signs of dehydration
2. Bloody stool, black tar-like stool or stool that resembles red jelly
3. Bloody vomit or vomit that resembles coffee grounds
4. Abdominal pain that is localized to one consistent area of the stomach, especially the right lower quadrant of the abdomen
5. Difficulty arousing your child, or if they seem particularly sick to you