What Causes Vomiting and Diarrhea?
Vomiting and diarrhea can be caused by many different conditions, including acute gastroenteritis (infection in the stomach and intestines), food poisoning, and food allergy or intolerance. Vomiting by itself (i.e. without diarrhea) can be due to the above reasons but can also be caused by a variety of other reasons including urinary tract infection, pneumonia, ear infections in younger children, reflux, and neurological problems such as migraine headaches and head injury.
*This page is meant to address acute gastroenteritis, also known as the "stomach flu", one of the most common causes of vomiting and diarrhea, and to prevent the dehydration that can be associated with gastroenteritis. If you suspect your child has another cause of vomiting and/or diarrhea or any of the warning signs below, or if you have any other questions or concerns, you should call your pediatrician.
Warning Signs
You should always call your pediatrician if your child has any of these warning signs or if you have any other questions or concerns.
* Age younger than 6 months
* Blood or dark green substance in the vomit
* Blood or mucous in the stool
* Abdominal pain lasting longer than 2 hours
* Vomiting without diarrhea lasting more than 24 hours, especially if accompanied by fever
* Stiff neck
* Acting unusually sleepy, listless, or irritable
* Has any of the following signs of dehydration
- No urine in 8 hours
- Sunken eyes or no tears when crying
- Dry mouth
- Fast heartbeat
- Sunken soft spot in babies younger than 1 year
Treatment for Vomiting and Diarrhea
There is no specific treatment for acute gastroenteritis, such as an antibiotic, that will help the infection clear faster. The main treatment for a child with stomach flu is giving fluids to prevent dehydration. If your child has a fever, you can give a fever reducer, but if she has a fever you should make sure she does not have any of the warning signs above. In addition, avoid giving ibuprofen (Motrin or Advil) to children who have not had anything to eat.
In most cases of mild or moderate dehydration, you can give fluids at home according to the guidelines below; however, in some cases of severe dehydration you may need to take your child to the hospital for IV fluids. In general, we do not recommend anti-nausea or anti-diarrheal medications for children with the stomach flu as these drugs have their own side effects and complications, but in rare cases your child may get an anti-nausea medicine in the hospital if she has severe dehydration. If you suspect your child has severe dehydration or any of the warning signs above, call your pediatrician right away.
What Fluids to Give to Children with Vomiting and Diarrhea
For children under 1 year old who are breastfeeding, you should continue to breastfeed but may need to do so more frequently and for shorter periods of time. For a child under 1 year who is on formula, you may need to stop giving formula up to 12 hours if she is actively vomiting; if she is not vomiting, then in most cases you can keep giving formula, but may need to give smaller amounts more frequently. In cases of severe diarrhea, switching to a soy or lactose-free formula for 1-2 weeks is sometimes recommended. You can talk to your pediatrician about these specific recommendations.
For children under 1 year, you can supplement breast milk and formula with an electrolyte solution such as Pedialyte. Children under a year generally prefer unflavored Pedialyte, while those older than a year prefer flavored.
For children over 1 year old, an electrolyte solution is still an excellent choice for rehydration. You can also give other clear fluids such as sports drinks (e.g. Gatorade), flat ginger ale, chicken or vegetable broth, popsicles, or jello. Avoid giving plain water as it does not replace the electrolytes lost in the diarrhea or vomit. In addition, avoid most juices as well as milk, as they can make diarrhea worse; the only exception is white grape juice.
How Much Fluid to give to Children who are Vomiting versus Those who are not Vomiting
If your child is not vomiting, feel free to give as much of the above age-appropriate fluids as she will drink. Keep a cup nearby and encourage her to take frequent sips.
For a child who is vomiting, the goal is to give very frequent but small amounts of liquids. Start with 1 tablespoon of fluid every 10-15 minutes. If your child keeps down the drink, you can slowly increase how much you are giving over time. If she throws up, wait 30-45 minutes and start over with a smaller amount, such as 1 teaspoon every 10-15 minutes. Some younger children are reluctant to drink anything for fear of vomiting, and in this case you may need to give your child fluids with a syringe or medicine dropper. If your child is unable to keep down 1 teaspoon of fluid or refuses to drink, call your pediatrician for advice.
The goal of fluid therapy is for your child to urinate at least once every 8 hours; if she is not meeting this goal or has any of the warning signs above, call your pediatrician right away.
Giving Solids to Children with Vomiting and Diarrhea
If your child does not want to eat, do not force her to do so. Children often lose weight when they have the stomach flu; however, they usually quickly regain the weight when they are feeling better.
For a baby younger than a year who wants to eat, start with bland foods that she has eaten before, such as rice cereal, mashed potatoes, small pieces of dry toast, and cheerios. Bananas and applesauce are also good for slowing down diarrhea.
For older children you should follow similar guidelines adjusted with age-appropriate foods. Older children can eat white rice, mashed potatoes, dry toast, plain pasta with nothing on it, plain crackers (e.g. Saltines), and dry non-sugary cereal (e.g. Cheerios, Rice Krispies). Again, bananas and applesauce are usually well-tolerated and help slow down diarrhea.
As your child's appetite improves and symptoms resolve, you can resume a normal diet over about 48 hours.
Remember, you should always call your pediatrician if your child has any of the warning signs above, you have any questions or concerns, or if your child's condition does not improve with the above treatment recommendations.
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