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.

Pyloric Stenosis: when vomiting isn’t just reflux

If you’re reading this, chances are you have (or have had) a very ‘sicky’ baby. Chances are, your friends and family told you ‘it’s just reflux’. And fair enough, it might be. But it might not be. If you’re not convinced, read on to find out more.

My little monkey was always a very ‘sicky’ child. Ever since she was born, she’d be sick after every feed. While that sounds normal, the amount of sick wasn’t. She’d always vomit up at least half of her bottle, and then cry because she was hungry. We endured it for 3 weeks before we insisted on her having a medical assessment. She was diagnosed with a dairy allergy, and we were told that a hypoallergenic milk prescription would fix the issue. It didn’t. We took her back to our doctor countless times, and were berated for wasting GP time as she just ‘had reflux’. We tried countless reflux medications, but everything just seemed to make the issue worse.

Once my little one had reached 7 weeks, I’d had enough. After an evening of being covered in around 18oz of projectile vomit, I took her to A&E and insisted they run blood tests on my daughter. Sure enough, they diagnosed her with Pyloric Stenosis.

Pyloric Stenosis is a condition in which the valve allowing food to pass from the stomach to the intestine becomes too thick, and the hole closes. This means that nothing can get through, which leads to malnutrition, dehydration, and even death. Symptoms include extreme vomiting, lethargy, constipation, and less wet nappies.

Once admitted to hospital, we had to watch an NG tube be placed into our little one, to drain her stomach. She had an IV inserted to keep her fluid intake up, along with some vitamins, but she wasn’t allowed to eat. We were in hospital for 3 days in total before she had her operation, and we weren’t allowed to feed her anything, which was torture when she cried.

Eventually, we were transferred by blue light ambulance to a specialist children’s hospital for her to have laparoscopic surgery. The surgery took around an hour, and my little soldier had 3 doses of infant paracetamol in total during recovery. (What a brave little thing, adults have doses of morphine after similar surgeries).

Luckily, after having her surgery, the Pyloric Stenosis was cured and we never had to return to hospital for the same issue, however, others aren’t so lucky. PS can recur in 1% of cases, and for some people, it becomes a chronic issue which requires constant returning to hospital.

All in all, we were very lucky. Honestly, I think my stubborn nature went a long way in getting her diagnosed, as before I put my foot down, doctors were dismissing me as the ‘hypochondriac mum’.

What can we take away from this? Well,

1) Trust your instincts.
Mother’s intuition is REAL, and it can save you so much bother if you listen to it. If you think something is wrong with your little one, get them checked. The worst that can happen is that a qualified professional can explain to you (at length, if needed) that your baby is healthy, and reassure you.

2) Know your stuff.
While doctors often chastise patients for having a look at good old Doctor Google, sometimes it is your ally, and a tool to be used. Before Mini Me was diagnosed, a doctor incredulously asked me “what do you think is wrong with her then?” When I replied ‘Pyloric Stenosis’, a lightbulb obviously went off for him. He ordered several blood tests and an ultrasound, and sure enough, she was diagnosed. While I’m not saying that you should use Google for everything, but when you’ve been having the same issue for weeks, nothing seems to be helping and things aren’t adding up, maybe you should consider it.

3) Be kind to yourself.
While we were in hospital, I went through a phase of blaming myself for my monkey’s illness. As a mum, its only natural to want to fix things, but some things can’t be fixed by guilt. No, most things can’t be fixed by guilt. I felt awful for the fact I hadn’t put my foot down sooner, but eventually, I was just glad that I had done it at all. I often think about what would have happened if I hadn’t said anything to our doctors, and I’m so glad I did, because the outcome could have been so much worse.

Unfortunately, Pyloric Stenosis can’t be prevented, but it can be cured, and more new mums should know that it exists. If your little one is struggling with vomiting, especially in the first few weeks, please get them checked out, and if you’re unsure, get a second opinion. While Pyloric Stenosis is rare, it isn’t worth excluding as an option.

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