Management of Gastroenteritis
by Warren P. Silberstein, M.D.
02/14/97
Gastroenteritis is the medical term for the illness characterized by vomiting, diarrhea, abdominal pain, and fever. Some people refer to it as intestinal flu, but it is not related to the influenza virus. Most gastroenteritis is caused by viruses such as Rotavirus, Norwalk, and others, but food poisonings by bacteria like Salmonella also cause gastroenteritis.
The treatment of gastroenteritis is a perfect example of the fact that infants are not just small children, and that children are not just little adults. For all age groups the major risk of gastroenteritis is dehydration, but for infants and small children dehydration is a much more serious risk than for older children and adults. Dehydration can occur in adults if they are vomiting and unable to retain fluids, but adults rarely become dehydrated from diarrhea except with extreme cases such as with cholera. Young children and infants can dehydrate much more quickly because they are smaller and therefore a smaller amount of body fluid loss will result in dehydration.
In adults, the focus of treatment is on symptom relief. Adults have responsibilities and plans where frequent bathroom breaks would be embarrassing and a major inconvenience. Babies in diapers don't really care how frequently they go. The main medications for adults are Kaopectate, Lomotil, and Imodium. Medicines like Kaopectate work by binding water in the stool and making the stool firmer. The mechanism of action is very similar to making cement. Medications like Lomotil and Imodium work by slowing down the movement of the intestines. This results in less frequent bowel movements and decreased cramping. The important thing to understand about these medications is that they don't prevent water loss, so they don't prevent dehydration. And even though they provide symptomatic relief, they don't make you get over the illness any faster. Also, since the narcotic type medications like Lomotil and Imodium slow down intestinal movement, if the intestine is severely inflamed this can result in huge amounts of fluid being retained in the intestines instead of the body circulation. This retention of fluids in the intestines can be dangerous in an infant. It is generally not advisable to use the narcotic type medications in a child under 2 years of age.
In infants, the focus of treatment for gastroenteritis must be prevention of dehydration. This makes control of vomiting the first priority. A child who is unable to retain fluids by mouth will dehydrate very quickly. The first step in management of vomiting is to put the stomach to complete rest. When children first become ill they may vomit multiple times in a row until the stomach is empty. After the initial phase calms down the stomach should be rested by not taking anything by mouth for at least 1 hour. Many parents who become anxious about getting a child to retain some food or drink and worry about a child going without a meal for too long keep pushing food and fluids on the sick child, but this is a mistake because it only ends up coming back up. After the resting phase the child should be started slowly on clear fluids, starting as small as 1 teaspoon every 15 minutes and gradually increasing to 4 ounces every few hours. If a child cannot tolerate even small amounts of clear fluids he needs medical attention. The ideal clear fluid is an electrolyte solution like Pedialyte, Kaolectrolyte, or other oral electrolyte rehydration fluid. which will replace the salts lost from vomiting and diarrhea. For older children the frozen electrolyte ice pops like Revitalice or the new Pedialyte brand might be helpful. Herb tea, water, and clear juices may serve as clear fluids as well, but they won't replenish the lost electrolytes which is essential for preventing dehydration. A fluid is only considered clear if you can see through it when you hold it up to light. Too much sugar, as might occur with excessive juice intake, can aggravate diarrhea. Soda, unless it is completely flat, may aggravate the vomiting and the pains by filling the stomach with gas. Food and milk must be avoided until the vomiting is completely resolved since anything that sits in the stomach can provoke vomiting.
Management of diarrhea in infants requires making sure that the infant drinks enough fluids, preferably an electrolyte solution like Pedialyte, to make up for the fluid losses. There isn't any medication or treatment that makes the intestines heal faster, but as long as you prevent dehydration that allows time for the body to recover from the illness. If a child is not severely ill, is not vomiting, and has an appetite, it is okay for him to eat bland foods and drink his milk.
If a child is active and in good spirits you can be reasonably sure that he is not dehydrated. If he has dry diapers, fever, lethargy, cries without tears, or has dry mouth, these are signs of dehydration that require medical attention.
