12 Things You Should Know About Stomach Flu in Children

Classic stomach flu, or gastroenteritis, can cause vomiting, diarrhea and fever.(Getty Images)

It’s the middle of the night. You’re sound asleep – or you were. You slightly arouse to a bit of rustling, and nearly fall back asleep, when you hear a small voice. You snap awake, heart racing. Then your child clearly repeats one of the most horrifying phrases a parent can hear in the middle of the night: “I just threw up.”

As Halloween nears, stomach flu – characterized by vomiting and diarrhea – begins to creep into our cities. So it’s always best to be prepared when this menace enters your home. Here are my answers to the most common questions about stomach flu:

1. Why is this happening? Classic stomach flu is called gastroenteritis. It is caused by a family of viruses that attack the lining of the gastrointestinal (or GI) tract and can cause vomiting, diarrhea and fever. Although many people believe that the seasonal flu shot will protect against tummy germs, that’s not the case. The flu shot protects you from influenza, which is a respiratory illness, not a GI illness.

2. How long will this last? Most tummy illnesses last about 24 to 48 hours, with the worst part being the first 12 hours. Most start with vomiting first, followed by diarrhea. Sometimes both happen at once. Ew. The good news is the vast majority of school-age kids can recover from mild dehydration quite easily. The risk of severe dehydration increases in babies and toddlers who have less body mass.

3. Is my whole family going to get this? Stomach viruses are super contagious, so the possibility of this is high. When trying to prevent the illness from spreading, containment is critical. If you are able, find a comfy place for your child to rest that might be away from the rest of the family. It’s best to have a bathroom close with appropriate cleaning supplies. The more you are able to contain the person and the fluids they expel, the better your chances are that other family members might remain well.

4. What should I offer him to drink? Rehydration solution like Pedialyte is best for replacing fluid losses as the illness continues. I would avoid plain water, milk, formula, juice or soda during the worst part of the illness. It is OK to continue to breastfeed in short, frequent sessions.

5. What should she eat? The BRAT (bananas, rice, applesauce, toast) diet is not really a thing. Traditionally, these foods were considered “best” during stomach illness due to their bland nature. Although those foods are typically well-tolerated, the BRAT diet is unnecessarily restrictive without real benefit. There is no reason that kids can’t have any food that might sound good to them. The key is to offer small amounts of the desired food and never force them to eat.

6. How should he eat and drink? Small and frequent is the name of the game with any intake. Older kids are typically able to self-regulate food and liquid volumes to their comfort level. Babies and toddlers, however, have a tendency to overeat during that short window of time they are feeling well after getting sick. If a child slams 5 ounces of fluid right after vomiting, for example, there is a high likelihood you will be seeing that again. Help them help themselves by offering small volumes of fluid at a time every 20-ish minutes, increasing volume and frequency if they are able to keep it down. As they’re able to tolerate more fluid – closer to what they normally take in – it’s OK to decrease the frequency.

7. Do I just let her eat and drink what she wants? Not exactly. Live by the “20-minute rule.” After a child has vomited, their system needs a bit of time to rest before rehydration. If you immediately start rehydrating after a vomiting episode, you will likely see that coming up again. To avoid this, wait about 20 minutes before offering a small amount of drink or food. Then after 20 more minutes increase the volume a bit, wait 20 minutes, increase again, and so on. For kids under 3 years, start with 1 to 2 ounces of fluid, increasing by 1 ounce every 20 minutes as tolerated. For kids over 3 years, start with 2 ounces.

8. What if she gets a fever? GI bugs can come with fevers. If your child develops a fever, it’s best to choose acetaminophen (Tylenol), which is a bit easier on the stomach, as the fever reducer.

9. How do I clean this up? If your child doesn’t make it to the bathroom on time, baking soda is your friend. Pour a large amount of baking soda on the accident, throw a towel over it, and leave it for a few hours. That should allow time for the vomit to be absorbed into vacuum-able bits for easier removal. Follow up with a routine carpet cleaner treatment for best results. Makes sure that all the laundry items are kept separate for cleaning. Launder in hot water with a bit of bleach for best sanitation. Effective cleaning on non-porous surfaces can be done with bleach cleaning solutions. Be sure to clean everything in the area of the accident, including light switches, doorknobs and remote controls. Remember to wear rubber gloves when cleaning and open up the window for some fresh air.

10. What does a dehydrated kid look like? Most big kids can vomit a few times without getting in too much trouble with dehydration. Younger children, however, can get dehydrated more quickly. A dehydrated child is exhausted, refuses to drink, repeatedly vomits every 10 to 20 minutes, is unable to keep anything down for a few hours, cries without tears, and has dry lips and mouth. Those are clues your child may need more help. It’s critical to know that not all puking is stomach flu. Vomiting can be a significant finding in a variety of childhood illnesses. If your child is not responding to rehydration or has additional symptoms that you are worried about, you need to call your doctor.

11. When can she go back to school? Don’t send your child to school until there has been no vomiting or fever for at least 24 hours and stools are back to normal. Know your day care and school policy on returning after illness.

12. How can I prevent this from happening? Alcohol-based hand sanitizers do not kill all tummy bugs. Prevention involves proper hand-washing with soap and water before eating and after using the bathroom, prioritizing rest, eating good food, staying away from ill people when you can and staying up on your vaccines. Despite best efforts, however, GI illnesses can come quickly and often out of nowhere, so it’s best to be prepared. I keep acetaminophen, a rehydration solution, saltine crackers, chicken noodle soup, Lysol, carpet cleaner and rubber gloves on hand at all times in the fall and winter months.

Bottom line: GI illnesses can be scary, but with a bit of preparation and sanitation, most kids recover quickly.

Pediatrician Advice Parents Ignore

Dr. Natasha Burgert, Contributor

Natasha Burgert, M.D., FAAP has been contributing to the U.S. News For Parents blog since 2018.…  Read moreNatasha Burgert, M.D., FAAP has been contributing to the U.S. News For Parents blog since 2018. After receiving her medical degree from the University of Nebraska Medical Center, she completed her pediatric residency at Cincinnati Children’s Hospital Medical Center. She now calls Kansas City, Missouri, home, working as an innovative general pediatrician, while serving as a national spokesperson for the American Academy of Pediatrics and a member of the AAP’s Counsel of Communications and Media. Her work with patients has been featured in outlets such as The New York Times, The Wall Street Journal and Parents magazine. She has also been on NBC Nightly News, CBS This Morning and other local news programs. She is a regular contributor to NBC News’ Parent Toolkit and her local NPR affiliate and has been quoted in numerous print and digital articles. She’s also been the keynote speak at various health marketing, vaccine advocacy, and physician-led organizations. If she is not in clinic, you will find her regularly sharing evidence-based child health on KCKidsDoc.com, Instagram, Twitter and Facebook.

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