Tips and tricks for tummy bug troubles

Unfortunately, it’s the time of year where stomach bugs are rife. I was recently in the hospital twice in the space of two days, as my little one had a severe case of gastroenteritis. While I was there, I had many in depth conversations with paediatricians, nurses and the matron, who gave me many materials and ideas about the prevention and management of gastroenteritis, and how to recognise the signs of dehydration.

Gastroenteritis (or more commonly known as the ‘tummy bug’) is an infection of the intestines and stomach which causes vomiting and diarrhoea (D&V). It is often caused by infections like the norovirus, or rotavirus, though it can also be bacterial.
D&V caused by tummy bugs is common in children younger than 5, however lots of diarrhoea and vomiting can cause dehydration, which is a serious complication. This is unusual, and most children can be cared for at home following advice from a qualified healthcare provider.  In most cases, diarrhoea usually lasts 5-7 days and has come to an end by 2 weeks, while vomiting usually only lasts between 1-3 days.
While we were at the hospital, the paediatrician told me that parents should avoid taking their children to the GP if they suspect gastroenteritis, as it is spread so quickly and easily. Instead, parents should call 111 (UK) or their GP if they are concerned. Just to recap, the symptoms of gastroenteritis are:
  • feeling sick
  • sudden, watery diarrhoea,
  • mild fever
  • vomiting, which can be projectile
  • abdominal craps
  • poor appetite

When to seek medical advice for your child

As gastroenteritis is spread so quickly, it is best to care for your child at home to avoid infecting others. However, you should seek medical assistance if your child:
  • has blood in their poo, or green vomit
  • has been vomiting for three days or more
  • has had diarrhoea for more than a week
  • has a serious underlying condition and also has D&V
  • has symptoms of dehydration –
    • sunken eyes
    • cold extremities
    • mouth and lips appear dry
    • seems to be getting worse, will not take fluids or vomits immediately after drinking
    • are floppy, unresponsive or lethargic
    • skin appears to be more baggy than usual
    • much higher pulse rate than usual
    • they have had more than 8 loose nappies per day
    • they do not have more than 2 wet nappies per day
    • no tears when crying
    • sunken fontanelle in babies

Preventing the spread

  1. Children should not attend any kind of childcare or school while they have vomiting or diarrhoea, and should not return until at least 48 hours have passed since the last episode of vomiting or diarrhoea.
  2. Hand washing is the best way to prevent the spread of gastroenteritis. This includes the obvious times, like after using the toilet, changing nappies, or touching food. Do not rely on alcohol hand gels.
  3. Towels and other personal items should not be shared between children or other members of the family while someone is suffering with gastroenteritis.
  4. Children should not use a swimming pool for 14 days after their last episode of diarrhoea.
  5. Disinfect any surfaces and items that could be contaminated.

Treatment

Most cases of gastroenteritis can be treated at home, with supervision from medical professionals in more severe cases.
Children should be encouraged to drink plenty of fluids, even if it is only small sips at a time. Breastfed babies should continue to be breastfed as long as they are tolerating the breast milk.
Oral Rehydration Solutions (ORS) such as dioralyte may be used, which is available without prescription from a pharmacy or supermarket.
A note on liquids – liquids are absorbed by the body very quickly, so if your child vomits ten minutes after drinking, it is highly likely that most of the fluids have already been absorbed by the body, and fluids should continue to be given.

Children who are vomiting

Small sips of liquid should be given to begin with, and if this is not vomited, the amount can be increased. Generally the amount of liquid a child should aim for in this phase is 1.5 to 2.5 oz per lb of body weight in a 24 hour period – for example we were told to aim for 1oz per hour for my little one. Once the vomiting lessens, a more normal diet may be trialed the next day. We found it easiest to start giving 5-10mls every 5 minutes, and did so using a bottle we would have usually used for milk – ORS can be kept in the fridge for 24 hours after mixing it from a sachet, and it is both easier to monitor intake, and less messy on your child’s part!

Children who have diarrhoea but little vomiting

These children should be given more liquid to combat the liquid lost through loose stools. However, this liquid can be given in larger, less frequent amounts, and children can attempt to continue their normal diet. If your child has significant diarrhoea, it is advisable to stop dairy products during this time as these foods can make diarrhoea worse.
 
While it can seem really daunting to care for your child while they’re unwell, rest assured that gastroenteritis is very common. There are around 5 billion cases of it every year worldwide, so you’re not alone.
What have your experiences of the tummy bug been like?
 
Sources:
Cochran, W. (2018). Gastroenteritis in Children – Children’s Health Issues – MSD Manual Consumer Version. [online] MSD Manual Consumer Version. Available at: https://www.msdmanuals.com/en-gb/home/children-s-health-issues/digestive-disorders-in-children/gastroenteritis-in-children [Accessed 14 Oct. 2018].
 
Nhsinform.scot. (2018). Gastroenteritis. [online] Available at: https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/gastroenteritis [Accessed 14 Oct. 2018].
 
Nice.org.uk. (2009). Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management | Guidance and guidelines | NICE. [online] Available at: https://www.nice.org.uk/guidance/cg84 [Accessed 14 Oct. 2018].
Technology, H. (2018). Home. [online] East Sussex Healthcare NHS Trust. Available at: http://www.esht.nhs.uk/ [Accessed 14 Oct. 2018].
 
With thanks to helpful conversations for the staff on Kippling ward, ESHT.

Diastasis Recti 101

Aah, the mum tum. The pooch. The overhang. While the post-baby jelly belly is something most mums expect to encounter to some extent, fixing it isn’t always as straightforward as you might first imagine. It took nine months for your tummy to get that big, so it’ll take at least nine months to fix it, right?

But what if it doesn’t shrink? What if you still look 4 months pregnant months (or even years) after delivery, and nothing you do seems to be shifting the baby weight?

You might be amongst the 60% of mums who have a Diastasis Recti

From a medical perspective, (according to the Mayo Clinic):
“During pregnancy, the growing uterus stretches the muscles in the abdomen. This can cause the two large parallel bands of muscles that meet in the middle of the abdomen to separate — a condition called diastasis recti or diastasis recti abdominis.”

These muscles form part of a wall of muscle that holds the uterus, intestines and other organs in place and lends support to the pelvic floor. Typically, the gap will go back to normal around 8 weeks postpartum.  However, the gap sometimes does not close on it’s own, which can cause a number of health issues (not to mention leaving you perpetually frustrated at your stubborn tum).

Signs you may have a Diastasis Recti include: 

  • lower back pain
  • constipation
  • bloating
  • poor posture
  • incontinence that lasts for more than eight weeks postpartum (separated abs can cause issues with your pelvic floor)
  • a pooch or bulge in the middle of the stomach
  • dome like bulge in the stomach when coughing or getting up from lying down

Before you start to panic, it’s not all doom and gloom. Below is a list to help you check yourself for a diastasis, and what to do if you think you have one.

Checking for a diastasis

  1. Lie on your back with your feet flat on the floor, knees together and bent.
  2. Raise your head and shoulders off the floor so that you can see your tummy.
  3. Place your hand flat on your stomach, fingers pointing towards your toes.
  4. Try and feel for the gap between the muscles above and below your belly button. You might feel them squeezing your fingers tightly. You might not. That’s ok too.
  5. Note how many finger widths you can fit in the gap, and how high up your torso that measurement is. You may find your diastasis is larger at the bottom than the top, or vice versa.

Typically a diastasis recti is measured as 1 finger width = 1cm. Therefore, if your diastasis is 3 finger widths, it is 3cm wide. If you feel a gap wider than 2cm, you have a diastasis. A gap wider than 4-5cm wide is considered severe.

What to do if you think you have a diastasis recti

If you’ve found that you have a diastasis, it is more than possible to improve it. The best way to do this is to get guidance from a physiotherapist, who can advise you on the best exercises to do to close the gap. In the meantime, here’s a list of things to avoid:

  • traditional crunches, sit ups and planks, as these can increase intra-abdominal pressure and actually make the gap worse by putting too much strain on the muscles, effectively pulling the gap wider rather than closing it.
  • holding baby on one hip, if it is painful
  • coughing without supporting the ab muscles
  • lifting or carrying heavy loads

Alternatively, there are many diastasis recti repair exercises on youtube, which you may like to follow along to. Just be careful you don’t put too much pressure on your stomach, as this can delay your healing and even make the condition worse.

Last but not least, if exercises from your physical therapist fail to improve your condition, surgery is always an option, however this should be a last resort, and always discussed fully with your medical team.

Needless to say, if you’re experiencing any physical difficulties postpartum (be it months or years) you should always speak to a medical professional about your concerns. While having a Diastasis Recti can be a pain (both literally and figuratively), it can be improved over time.

You’ve got this, mama.

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