Parent’s guide to vomiting and diarrhoea (Gastro-enteritis)
Vomiting and diarrhoea (frequent loose or watery stools) can be caused by either bacteria, viruses or parasites that infect the intestines. Diarrhoea can also be caused by intolerance to substances found in some food or some medications.
Regardless of the cause it is important to ensure that your child maintains adequate fluid intake. Initially, this can be achieved by offering oral rehydration solutions (ORS). One should wait at least 15 minutes after your child has last vomited before giving the ORS. Medications should generally be used only after consulting a doctor.
Keep in mind that a child that is nauseous is not likely to want to eat. At the initial stages, we are most concerned with fluid intake to ensure that your child doesn’t suffer from dehydration.
For infants under 6 months:
Offer your infant small, frequent volumes of ORS. 15mls every 15 to 20 minutes. Small, frequent amounts are more likely to stay down than larger volumes. This volume can be increased as the infant tolerates the fluid. A guide would be to increase the volume slowly after 4 hours without a vomit. Breast feeding should be continued in addition to the ORS.
For infants 6 months to 1 year:
Offer your infant small, frequent volumes of ORS. 25ml- 50mls every 15 to 20 minutes. Small, frequent amounts are more likely to stay down than larger volumes. This volume can be increased as the infant tolerates the fluid. A guide would be to increase the volume slowly after 4 hours without a vomit. If your child is still being breast fed, then breast feeding should be continued in addition to the ORS.
For children 1 year or older:
Offer your child small, frequent volumes of ORS. 25ml- 50mls every 15 to 20 minutes. Small, frequent amounts are more likely to stay down than larger volumes. This volume can be increased as the infant tolerates the fluid. A guide would be to increase the volume slowly after 4 hours without a vomit.
Types of oral rehydrating solutions (ORS)
- Electrolyte solutions are best for infants and children. Sachets of powder are reconstituted with the recommended volume of cooled, boiled water.
- If you do not have access to a commercial rehydration solution, then you can make your own until you are able to buy one. To do this you should add 8 level teaspoons of sugar and ½ a teaspoon of salt to 1 litre of boiling water. Mix well and allow to cool before giving it to your baby. It is important not to use more than ½ a teaspoon of salt.
- The following mixtures can also be attempted in babies from 4 months of age:
- A mixture of one part clear apple juice to one part rehydration solution.
- A mixture of one part clear apple juice to one part cooled boiled water.
- Clear apple juice.
- Sports drinks are not ideal fluids BUT if all else fails you can try them in children older than 1 year.
Once your child is tolerating ORS, special milk feeds can be attempted if the child is not breast fed. Gastro-enteritis (vomiting and diarrhoea) can result in the inability of the intestine to digest lactose in cow’s milk or formulas based on cow’s milk. For this reason, it is advised that lactose containing products be avoided.
Lactose free (LF) formulas are available and are preferable to the other formulas at this time if possible.
(Once your child’s illness has passed you will once again be able to go back to the original formula that was being offered)
Once your child is tolerating fluids adequately, solids can gradually be introduced. These would include the following:
- Apples
- Bananas
- Cereals (milk free)
- Carrots
- Rice cereal mixed with a lactose free formula or water
- Starches such as bread, rice or potato
Further tolerated foods:
NOTE some of these may not be appropriate to your child’s age group.
- Creamy meal
- Marmite/Bovril
- Toasted white bread
- White pasta
- Chicken soup
- White chicken meat or lean meats
- Yellow vegetables.
The following foods should be avoided as they can aggravate gastro-enteritis:
- Bran
- Raw fruits (other than apples and bananas)
- Green vegetables
- Butter
Signs of dehydration
- Increased thirst
- Decreased urine (wet nappies)/ No wet nappies for 3 hours or more
- Dry mouth or tongue
- Few or no tears when crying
- Sunken eyes, cheeks, abdomen or fontanel
- Irritability or listlessness (low energy)
- Decreased skin turgor
