The stomach virus (acute gastroenteritis) is extremely common throughout the year however, the peak season is from November to April. The stomach bug is commonly spread by direct contact with the infected person, such as caring for them or sharing food and drinks. It is incredibly important to wash your hands with soap and water to help prevent the spread of the stomach virus.
DEFINITION:
Upset stomach with rapid onset with or without accompanying symptoms
SYMPTOMS:
- Nausea
- Vomiting
- Diarrhea
- Fever
- Diaphoresis (sweating)
- Abdominal pain
Gastroenteritis can easily cause dehydration in children. Signs of dehydration include:
- Dry mucous membranes (lips and mouth)
- Absence of tears
- Decreased urinary output
- Excessive thirst
- Lethargy
- Cool extremities
- Sunken fontanel or soft spot in babies
- Fast heart rate
TRANSMISSION:
Acute gastroenteritis is transmitted by fecal/oral transmission meaning that it is transmitted the by transfer of the organism from the hands or a surface that another person can then touch and transfer the organism into their mouth. The illness can also be transmitted in contaminated food or water. If a person with the illness doesn’t wash their hands after stooling or vomiting, the virus is likely to be passed on to someone else.
CAUSES:
The cause is usually a virus such as rotavirus or enterovirus; sometimes bacteria such as salmonella, shigella, campylobacter, or E. coli; also parasites such as giardia and cryptosporidium.
TREATMENT:
Rehydration with fluids
Some physicians will use anti-nausea medicines either orally or rectally.
OUTCOME:
Excellent, with good hydration.
DISCUSSION:
Although gastroenteritis is usually a self-limited illness that will go away after some pain and discomfort, it can be serious. It is estimated that there are over 1 billion cases and 3 to 5 million gastroenteritis-related deaths each year in the world. The deaths are caused by dehydration leading to shock. Fortunately, this is very rare in the United States since we have such good oral rehydration fluids and easy access to intravenous therapy. Usually, these illnesses are viral and are transmitted by someone who failed to wash his or her hands after having a bowel movement or vomiting; that person then either prepared food or touched a surface leaving the organism behind. Someone else then touches it, doesn’t wash their hands and gets the organism in their mouth. Now you see why good hand washing is so important.
The best treatment is to avoid getting gastroenteritis in the first place, because once you get it, treatment is limited. The way to treat gastroenteritis is to prevent dehydration. Your goal is to replace the fluid that is lost through the diarrhea — not to stop the diarrhea itself. Medicines that prevent diarrhea should not be used. They don’t cure the illness and in fact can be dangerous, causing things like respiratory depression, lethargy, coma, ileus or shutting down of the intestines, and even death. The best thing to do is to give the child plenty of fluids, preferably an oral rehydration therapy such as Pedialyte, Ricelyte, Rehydralyte, Pediapops, or Palsicles. In addition, early re-feeding is advised. Physicians used to restrict the diets of those with gastroenteritis by cutting out milk and food, then slowly reintroducing foods using a “BRAT” diet: bananas, rice, applesauce and toast. Now, however, it has been found that feeding right through the illness is the best thing to do. It stimulates the intestines to improve faster and actually shortens the course of the illness. If this fails and a dehydrated child does not get rehydrated, then IV fluids may be needed. Once an IV is placed, fluids are given intravenously and you wait until a child can tolerate orals. Again, no anti-diarrheals should be used.
Very rarely an infection needs to be treated with something other than fluids. These cases would include some of the bacterial or parasitic causes, such as shigella, E. coli, vibrio cholera or giardia. Generally speaking, however, even most bacterial causes are treated with the use of rehydration as the only therapy. It is not the bacteria that causes diarrhea, but a toxin that is produced by the bacteria, and going on an antibiotic can kill the bacteria, thereby releasing much more toxin all at once. Thus, the best treatment for stomach virus is the replacement of fluids lost.
ONE DOCTOR’S OPINION:
Vomiting and diarrhea are always difficult illnesses; a child is suffering and everyone just wants it to stop. But forcing the diarrhea to stop can be detrimental. Hydration is the best treatment we can give for those suffering from this illness. Most people want a medicine to stop the pain, if nothing else. I use Emetrol for this. Phenergan, Compazine, and Tigan also can be used and can be given rectally for the child who is vomiting, but you have to be very careful with these antihistamines. They do help with the pain, but they have been known to cause seizures in very rare cases. I do use these medicines at times. I prefer not to, but I, too, want to decrease a child’s suffering. I explain to all parents, though, that we could be masking something more serious, and it would be best if we could try not to use these medicines unless absolutely necessary. What if the illness that looks like a stomach virus is actually an early appendicitis? What if these antihistamines relieve the pain, giving a false sense of relief, and the appendix then ruptures, causing an even more serious illness? What if it is an intussusception (telescoping of the intestines), volvulus (twisting of the intestines), malrotation (abnormal rotation of the intestines), or some other rare illness where surgery is needed? This is very rare compared to 1 billion cases of gastroenteritis a year, but it is something to keep in mind when using these medicines.
My best advice: Wash your hands before putting anything into your mouth.
Written by Dr. Michael Bornstein, who has 30 years of experience as a pediatrician.
Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.
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