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The Smelly Truth about Stomach Flu

"Viral gastroenteritis most commonly affects children, especially those below 3 years of age. "
By: Lourdes Nena A. Cabison-Carlos, MDThe Smelly Truth about Stomach Flu

Poop and vomit--two of the messiest and smelliest predicaments of parents. Imagine them teaming up together. Loose watery non-bloody diarrhea or gastroenteritis is very common. For Filipino children, acute viral gastroenteritis is one of the top causes of hospitalizations and even death every year. Although usually called “stomach flu”, it is not to be confused with the actual, real flu caused by the influenza virus which affects the respiratory system.

Viral gastroenteritis most commonly affects children, especially those below 3 years of age. The usual culprits are adenovirus, novo virus (known as the winter bug virus in the US) and rotavirus, which is the pathogen linked to majority of cases in babies from 3-24months. Aside from causing stress, sleepless nights and endless trips to the bathroom, diarrhea can cause dehydration and may have a negative impact on growth and intelligence.

Gastroenteritis is usually acquired through infection by various routes. It can be transmitted by person-to-person contact, feco-oral route (yup, seriously, wash hands after using the toilet!), touching infected surfaces, or through contamination of water or food. Hence, poor environmental hygiene and poverty are linked to higher incidence of gastroenteritis. Water can be contaminated by people or animals defecating near (or in) water sources.  Thus, outbreaks can also be linked to times when access to clean drinking water are hard, like during typhoons, floods or other calamities (and sometimes, even during fiestas).

The usual symptoms

Infection can either be asymptomatic or can range from mild diarrhea to severe diarrhea with vomiting and concomitant dehydration. Infection can last from 1-10 days and the severity of infection depends on the causative agent. Children with viral gastroenteritis usually present with the following:

  • Watery, bloodless diarrhea that can occur as often as 10-20 times a day
  • Nausea and/ vomiting
  • Abdominal cramps
  • Low-grade fever

Doctors who deal with a child with diarrhea must differentiate a viral from a bacterial or parasitic cause, because these would usually need other treatment modalities.

What you usually give a child with diarrhea

Because the most usual culprit is a virus, antibiotics is not usually warranted. The number one goal of therapy is to prevent dehydration. We also need to replace the electrolytes (“salts”) lost through vomiting and diarrhea.

To keep children both hydrated and nourished, it is important to introduce food slowly. Wait at least ten minutes before offering food or water to a child who just vomited. Avoid giving fatty and spicy food. Also, stay clear of fried food. Although tempting, do not give your child acidic or tetra packed juices, sports drinks or caffeinated beverages. Below are the standard treatments to avoid dehydration:

  • Reformulated oral rehydration salts (ORS): this is the mainstay in treating and preventing dehydration. These rehydration salts are formulated to replace the minerals like sodium, potassium and chloride lost thru vomiting and diarrhea. Although popular, sports drinks should be avoided because these are meant to replace electrolytes lost through perspiration, and not by pooping.
  • Zinc supplementation: both the WHO and UNICEF recommends giving zinc to children with diarrhea. Evidence suggests that zinc reduces the duration and severity of diarrhea in children.
  • Probiotics: These are non-pathogenic microorganisms like bacteria or yeast. A good example is the popular Lactobacillus.  Studies have shown that when used for episodes of acute gastroenteritis, they can shorten the duration of illness by one day. 
  • Over-the-counter medicines meant to control diarrhea (like loperamide) and vomiting are contraindicated and can do more harm than good. It is best to just wait it out and keep the child hydrated.
  • For young children and infants, regular feeding should not be interrupted. Unless your child has lactose intolerance, there is usually no indication for you to switch to lactose-free milk.

When to bring to a doctor

If your child has other co-existing illnesses, visit your doctor right away.  On the other hand, since gastroenteritis is usually caused by a virus, it (most of the time) goes away on its own with no complications. However, since children are more susceptible to dehydration and are dependent on adults for just about anything, in some instances, a visit to the doctor is needed. Some of the symptoms to watch out for are:

  • Not being able to keep food or liquid down
  • Vomiting or diarrhea for more than 2 days
  • Voluminous diarrhea for more than 10x/ day
  • Blood in poop
  • High-grade fever
  • Signs of dehydration, which include (but are not limited to):
    • Dry mouth
    • No tears when crying
    • Little or no urine ( your child should have at least one urine output every 6 hours)
    • Sunken fontanels (that soft spot at the top of the head) in infants
    • Drowsiness, unresponsiveness or weakness

The doctor will then assess the degree of dehydration, test the stool for other microorganisms, get the electrolyte levels in the blood and give intravenous therapy until dehydration resolves.

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