My tips for surviving Hand, Foot and Mouth has been a really popular post for me – so I decided to make another due to recent experiences.
Stomach virus/stomach bug.
Last Friday, we were away for Ukranian Christmas celebrations – 3 hours away from home. And James started vomiting. I could not figure out how he could be sick yet no one else (especially Maggie) have any symptoms. We ended up driving 3 hours home the next day early because he continued to vomit for 24 hours. Thankfully – the car ride was uneventful and we made it home for a good sleep. He seemed a lot better Sunday other than being tired and taking some longer naps, so we assumed the cause had to be something he ate. Was it a food allergy? I wasn’t sure.
Monday, James was sick a little bit twice more. I decided it was time to take him to our care providers office just to make sure nothing else was going on. As I drove there, my husband called me – now Maggie had it too. It was a stomach bug!
Disclaimer: this is not medical advice. This blog is for informational purposes only. Please seek medical advice from your trusted healthcare provider.
How did you know it was a stomach bug/virus and not something else?
As you can see from my little narrative above, I didn’t at first. Stomach viruses are very contagious and James has no exposure we don’t have since he is a baby. He sees us at home and he sees daycare which is just Maggie, our provider and 1-3 other kids depending on the day. Maggie is always there with him.
I assumed (wrongly) that if he had been exposed, someone else in our family also would have been so there would be symptoms in the next 24-48 hours. When none came in that time frame, I started to think of other causes.. but for some viruses, I didn’t give it enough of a window.
See my previous post on differentiating between colds, influenza and stomach bugs here.
Like a cold, infectious stomach bugs are caused by multiple possible viruses (stomach bugs can also be caused by other things like bacteria, etc too). Common viruses that we see are norovirus (you’ve probably heard of this one), rotavirus (which babies should be vaccinated for – read more here), adenovirus and astrovirus. Each virus has a different “incubation” period, or time from infection to symptoms showing up.
Adenoviruses and astroviruses tend to have slightly longer ones than rotavirus and norovirus, which come on pretty quickly. They also tend to last longer.
Based on the window of time when Maggie presented with symptoms (about 3 days) and the length of our illnesses (about 1 week give or take a few days), I think we probably had an astrovirus or adenovirus, but this is just a guess. It could have been any number of things, but because it was contagious (we all got sick and some of our extended family) I knew it was a bug and not food allergies.
I vividly remember having norovirus during an outbreak and it was very quick to present and very extreme – quite different than this one.
Truly – there isn’t a way for me to know for sure, but knowing the symptoms & spread it makes the most sense.
What about food poisoning or bacteria/parasites?
This also crossed my mind initially, because James was sick within a certain time of eating his dinner and he did have 1) food we don’t usually have; 2) a new food. Because it was contagious, we eventually ruled out the potential allergy cause but could it have still been food poisoning if we all ate the same thing?
But Maggie actually ate cereal for dinner (typical toddler haha!) so I also knew this wasn’t the cause. Food poisoning symptoms can present within different ranges depending on the cause – so it can be hard to tell, but it wouldn’t cause anyone who didn’t eat the food to get sick. Bacterial causes can spread – but not as easily as with viral. Generally speaking – food poisoning symptoms do tend to come on much faster but that is not always the case.
You can also generally rule out a bacterial (or parasitic) bug by looking at symptoms – but this should be done by a healthcare professional if you have concerns. I’ll talk about when the recommended time frame is to see a healthcare professional below. This post will focus on viral stomach bugs.
Why did James get sick alone first if he has the same exposures as everyone else?
His immune system probably hasn’t seen as much as the rest of ours! Without getting too science-y, the viral load he was exposed to initially may not have bothered the rest of us, but then being exposed to it directly with him vomiting all over and around us was probably enough to get the rest of us sick.
Additionally – adults tend to be better at hand hygiene which is a major barrier to spread. Kids… not so much. James obviously doesn’t wash his hands unless we do it for him, whereas even Maggie is washing her hands often. There are many factors involved, but it is not unusual for him to have presented first due to a variety of reasons. I’ll talk about more preventative methods below.
Symptoms & Management
I don’t know that we really need to review this – I think most of us are familiar with the symptoms of a stomach virus. There is stuff coming out at least one end, but sometimes both (diarrhea and/or vomiting). You may also have abdominal cramps or discomfort and nausea. Sometimes (but not always) there may also be a fever and just a general feeling of fatigue and malaise (feeling unwell).
It’s not surprising if kid and adult presentation is slightly different – a lot of viruses like this hit kids harder than us (or vice versa in some cases). For example, my husband got very mildly ill with no vomiting whereas the rest of us vomited. It really depends.
None of us had fevers, but it wouldn’t be unusual to have that as a symptom with any of the viruses. It would be mild though – a higher fever could indicate another cause. See your physician or call your local nurse line for guidance in this case or if you have concerns about a reading. Review the appropriate thermometer to use based on age here (the best one is always what you’re most comfortable with + what you have!).
As an adult, my worst symptoms were nausea and fatigue. But that’s also because I was parenting simultaneously and I feel if I could have just “rested”, maybe those wouldn’t have been so severe? Who knows.
Usually, symptoms for a stomach virus come on pretty suddenly, or at least within that 24-72 hour window I talked about above.
With stomach viruses, we are most concerned about the risk for dehydration – especially in little ones.
Dehydration
First, let’s talk about the signs of dehydration (particularly in your children but they would be similar in adults).
Mild dehydration may be demonstrated by slight lethargy and decreased urine output – meaning your child is either peeing less or having fewer wet diapers. An older child may complain of thirst. If you’re concerned at this point – it doesn’t hurt to call your provider or nurse line. Depending on baby’s/child’s age and symptoms, oral rehydration may be recommended and your provider can give you the guidance for that (where to go or what to do – if you’re thinking of pedialyte remember it is recommended over the age of 1 and you should follow doctor’s guidance for dosing, and read below for a bit more info on this).
For mild cases and just during a routine case of gastroenteritis, you can offer hydration at home – whether that be breast milk, formula or some diluted unsweetened apple juice or other favourite drink/fluid (whatever they want if they’re in the toddler stage and more picky). Offering this support at home and early can help reduce the need for a doctors or hospital visit.
Should I stop breastfeeding if I am sick too?
I saw a myth the other day that you can’t breastfeed if you have a stomach virus. This is not true – you can still breastfeed your baby (if you are able) and you should if they’re (and you are) able to tolerate it. It is actually beneficial since your antibodies are what will be passed on in the breast milk, not the virus. Just remember to wash your hands well if you are sick and baby is not!
A more moderate case of dehydration may demonstrate a sunken soft spot (fontanel) on the head; no wet diaper for 6-8 hours; crying but few tears and demonstration of dry mouth. An older child may complain again of thirst and also, lightheadedness. You should seek assistance from a healthcare provider, especially if you have a younger baby under 6 months.
Severe dehydration would be an ER visit asap – baby or child may demonstrate difficulty awakening and extreme exhaustion; very dry mouth and no tears at all when crying; and no wet diapers in 12+ hours. An older child may be weak or faint; and they may appear less alert.
Remember: if you see signs of dehydration there is nothing wrong with reaching out to your provider with questions and concerns, or a nurse line if it’s during hours where your primary care provider (or a primary care provider) is not available. If baby is under 6 months especially, you should reach out sooner.
Most cases of gastroenteritis can be managed at home. However, other “red flag” symptoms for an ER visit would be things like vomiting blood; any decreased level of consciousness; inconsolable crying; rapid breathing or difficulty breathing; a high temperature; and a few other signs you can find in this American Family Physician article.
Do I need to feed my baby differently? Dilute their formula?
Continue breastfeeding or formula feeding as usual (no diluting).
Offering hydration options is the main guidance to avoid dehydration.
How much and what type of fluids to give?
The WHO recommendation for mild dehydration is 50-100 ml of fluid after every loose bowel movement for children under 2; 100-200 ml for children up to 10 years of age; and as much as the child desires for older children. But due to possible other considerations in relation to your child’s specific health situation – please consult your healthcare provider or healthcare team if you have questions and need specific guidance.
As I mentioned above, half strength (diluted) unsweetened apple juice for rehydration, or use of child’s preferred drink, has been shown to be effective in reducing the need for hospitalization for mild dehydration when compared to a formal oral rehydration solution.
You should slowly increase the amount of fluids offered. Small, frequent offering first and progress as the child tolerates it.
Pedialyte and its counterparts can also be used with the guidance of your provider. Remember again that this is not recommended by the for children under 1 year of age (follow the guidance from your provider). For older children, again consult your provider for dosing (as well as any product specific guidance) – usually the popsicle option can be a good substitute if you’re having trouble getting them to take it.
Gatorade and sports drinks should be avoided as they are not properly balanced in terms of electrolytes for vomiting/diarrhea. Similarly, sweetened juice is not an alternative to unsweetened and diluted options.
Food and Diet
No appetite is a common symptom of gastroenteritis and you don’t need to force your child to eat. Maintaining fluids is most important, and food should be offered when they are ready (showing signs of hunger or vomiting is slowing down at 24+ hours depending on the virus).
At this point, you should offer a combination of complex carbohydrates, lean meats, veggies and/or fruit. You generally should avoid simple carbs or high sugar foods as these may prolong diarrhea. UptoDate also recommends avoiding high fat foods since they are generally harder to digest. In many cases, once they feel better you can offer their regular diet too – because lets be real, we can only get toddlers to eat what they want to eat.
If your child only has mild diarrhea, they probably do not need to change their diet at all.
What about the BRAT diet?
BRAT diet is not recommended because the foods in it (bananas, rice, applesauce and toast) in combination are of low nutrient value. They might help slow diarrhea but they will not impact the duration of vomiting.
Should we avoid milk products?
A common misunderstand I hear a lot, but generally – no. Unless your child has specific dietary requirements or conditions that normally prevent them from consuming dairy you do not need to avoid it. Or, you can avoid it if you notice it is causing gas or discomfort during their illness.
Medication
There is not many options here for management – you can treat a fever of course, but beyond that antidiarrheals are not recommended for children and most of the time, antiemetics (antinausea or vomiting) are not prescribed or recommended either. In some cases, they may be prescribed but that would be at the discretion of you and your provider (and the completion of an informed decision conversation!).
Probiotics
To be clear, probiotics appear to have an important impact on gastro bugs (specifically on diarrhea) but they do not prevent it or “cure” it. What has been shown in studies, such as in a large systematic review from 2020, is that the duration of diarrhea seems to be lessened with probiotics added to patients regimen. Notably – we don’t know which type of probiotics are best for this (which strains) or the optimal dose needed. More research is needed in this area but it seems to be promising and a “doesn’t hurt” option.
What about zinc supplements?
If you live in a developed country, there is no evidence to support a need for zinc supplementation because most children in developed countries do not have existing zinc deficiencies.
Rehydration with fluids and prevention of dehydration are the key to management for this one. And as always – rest!
Prevention
Prevention is key here and surprisingly, not impossible. Here are some tips for preventing the spread and preventing getting gastro bugs:
- A key preventative method if you are worried about spreading the illness or getting it from your children is hand hygiene, and other hygiene methods too. Frequent handwashing can help to prevent the spread of infection – use of antimicrobial soap is preferable over hand sanitizer, but if that is all you have it can be used too. You should wash hands after diaper changes and dispose of diapers properly. If you are sick you should avoid preparing food for others. Disinfect contaminated areas and surfaces – dilute bleach is recommended by the AAP.
- Stay home – yep, this is echoing COVID guidance but it’s true. When you are sick (or your children are) it is best for them to stay home. Most daycares wouldn’t allow a child with severe diarrhea or vomiting to attend anyways or they would be sent home. To prevent spread to others, keep your child home. I know this is sometimes easier said than done due to the lack of paid leave, support, etc. They can return when they have not been sick for 24 hours (or as per your daycare/child care/schools guidance). This is prevention because you should do onto others as others are hopefully doing onto us – which is what we hope for, but know this is not always the case based on how the pandemic has gone.
- If you breastfeed, continue to breastfeed – this can help prevent your child getting sick if they haven’t got it already. And like I mentioned, it’s ok to do this when you are sick (as long as you feel up to it). You can also pump or catch milk and feed it other ways. Those antibodies are great for babe.
- Rotavirus vaccination – an important cornerstone in rotavirus prevention. I’ve written about this vaccine at length before here.
Gastro is truly unpleasant but it is thankfully short lived and generally mild. Rest as much as you can (especially if you are sick too – I was!) and don’t feel bad about screen time. You’re in survival mode and surviving is the most important, however that gets done. Always consult your provider with questions (or nurses line)!
Additional Resoures
Bacterial Gastroenteritis – StatPearls
Viral Gastroenteritis – StatPearls
How to say “no” to norovirus in your home – Wellington-Dufferin-Guelph Public Health (great post!)
elephantinthewomb.ca 
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