Getting your family through stomach bug season

As any parent of young kids can attest, a stomach virus can race through a household like wildfire. The most familiar symptoms include diarrhea, vomiting, nausea and belly pain, sometimes accompanied by fever, headache and body aches.

Hazel Guinto, MD, system chair of pediatrics at Main Line Health and medical director of pediatric emergency service at Bryn Mawr Hospital, part of the Main Line Health and Children's Hospital of Philadelphia (CHOP) affiliation, offers tips for protecting your family from the most common types of stomach bug and treating your kids at home.

What's considered a "stomach bug?"

Acute gastroenteritis, or inflammation of the stomach and intestines, is the medical term for what most people refer to as the stomach bug or stomach flu — though it has no relation to influenza ("the flu"), which is primarily a respiratory illness.

Stomach bugs are usually caused by viral infections. The two most common (and contagious) are Norovirus and Rotavirus, though Rotavirus has become less common with widespread use of an oral vaccine in young infants. Gastrointestinal (GI) illness can also be caused by bacterial infections, including Salmonella, E. coli and Campylobacter, though these cases occur less frequently.

How stomach viruses are spread

Norovirus is making headlines as cases surge across the U.S. Many people think of Norovirus as an illness that's spread mainly on cruise ships, where crowds of people share close quarters. But outbreaks regularly happen in other settings as well, including schools, daycare centers and restaurants.

You may be surprised to learn that Norovirus is the leading cause of vomiting, diarrhea and foodborne illnesses in the country.

"Norovirus illness leads to about a million pediatric medical visits annually," says Dr. Guinto.

Both Norovirus and Rotavirus are spread in similar ways:

• Through direct contact with someone who is already infected, such as sharing food or drinks, eating from the same utensils, eating food prepared or handled by them, or taking care of them (for example: changing diapers or helping a child use the toilet)
• Eating food or drinking beverages that are contaminated with the virus
• Touching a contaminated surface without washing your hands afterwards — particularly if you then handle food or put unwashed fingers in your mouth

Despite these viruses being highly contagious, there are steps you can take to protect against getting — or spreading — an infection:

• Wash hands for at least 20 seconds with soap and water before eating or handling food, drinks or medications, and after possible exposure to the germs in public or within your home. Hand sanitizer is not effective against Norovirus
• Disinfect objects (including toys) and surfaces in your home using a chlorine bleach solution labeled for use against Norovirus
• Wash and dry bedding or clothing, especially any with vomit or stool on them, using the highest heat settings
• Rinse fruits and vegetables well and avoid raw or undercooked shellfish
• Vaccinate your child against Rotavirus (there is no vaccine yet for Norovirus)

Treating stomach viruses at home

Norovirus affects people of all ages; however the very young and old (children under 5 and adults over 85) are most at risk for severe dehydration from vomiting and diarrhea.

Rotavirus largely affects infants and young children. Though older children and adults can get sick, too, it's younger kids and unvaccinated babies who are at the highest risk for serious dehydration, hospitalization and even death.

Call your pediatrician if your baby:

• Has a fever
• Is vomiting after feedings (with more force and volume than normal spit-up) or is unable to keep liquids down
• Is passing frequent, very loose or watery stools (more than three times)
• Is eating poorly or misses several feedings in a row

For toddlers and older children who are throwing up or having diarrhea, focus on keeping them comfortable and replenishing lost body fluids in order to prevent dehydration. Offer frequent, small sips of clear liquids containing electrolytes (such as Pedialyte^®). You may also try giving them sports drinks or ginger ale (carbonated or flat). Avoid sugary juices and sodas, which can make diarrhea worse.

Wait 30–60 minutes after your child has finished vomiting, to allow their stomach to settle, then aim for one sip, a teaspoonful or 5-ml syringe of clear liquids every 3–5 minutes.

"Oral rehydration takes patience, but it works," Dr. Guinto says.

Watch for signs of dehydration, which include:

• Lack of energy or activity
• Unusual fussiness or sleepiness
• Crying without tears
• Skin not springing back when pinched
• Dry or sticky mouth and throat
• Dizziness when standing up
• Sunken eye sockets or soft spot on the head (for babies)
• A weak cry (in infants)
• Dark-colored urine
• Infrequent or decreased urination (if in diapers, fewer than three wet diapers in 24 hours)

When vomiting subsides and you can reintroduce solid foods, start gradually with small bites of banana, dry toast or other mild foods.

Rotavirus symptoms can last 3–8 days, while Norovirus symptoms usually end in 1–3. Norovirus can remain detectable in your body for another two weeks. Dr. Guinto advises against giving children younger than 12 years old anti-diarrheal medication without consulting your pediatrician, because it hasn't been proven to be effective and can have concerning side effects.

"Remember, to prevent spreading Norovirus, if you and your little ones are having vomiting or diarrhea, you should stay home for up to 48 hours after symptoms resolve," Dr. Guinto says.

Pediatric emergency expertise

If your child has bloody diarrhea, vomits bile (dark green fluid), has a fever for several days or is exhibiting signs of dehydration, call your doctor right away or seek emergency care.

Main Line Health, in partnership with Children's Hospital of Philadelphia, provides trusted, 24-hour pediatric emergency care at Bryn Mawr Hospital for infants, children and teens.

"Whenever you need that extra support, we're here," said Dr. Guinto.

Next steps:

Meet Hazel Guinto, MD
Learn more about the Main Line Health and CHOP affiliation
Learn more about coping with stomach bugs