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Published on: 4/11/2001
Last Visited: 9/7/2001
Steven Schwartz , MD ; SUNY-Downstate Medical Center , NY
Vomiting and Diarrhea : How Sick is Your Child.
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Also Dr. Steven Schwartz.He is professor of pediatrics at SUNY Brooklyn.Also , he's the chairman of pediatrics at Long Island College Hospital , and he is a gastroenterologist , which will be very helpful.
So let's start off with you , Dr. Schwartz , and let's talk about diarrhea.What is diarrhea.
STEVEN SCHWARTZ , MD : That's a very good question , Cheryl.
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STEVEN SCHWARTZ , MD : Absolutely.In an older child who develops diarrhea , pretty well certain it could be diet-related , or there could be an intestinal infection , typically viral.In a young child -- particularly an infant under six months of age and certainly an infant under two to three months of age -- diarrhea can just be one of the symptoms of far more serious illness.And if a parent questions what's -- sees diarrhea in a young infant -- their physician should be contacted immediately.
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STEVEN SCHWARTZ , MD : Some breast-fed infants -- particularly when they get to older than a month of age -- may have one stool a week.Others will have ten stools a day.Again , they will generally develop their own pattern.And that pattern -- if it changes -- is something at least to be looked at and considered as if it's a manifestation of a problem.
Formula-fed infants tend to have firmer -- what we call more pasty stools.And this is largely a consequence of the different kinds of bacterial flora that are in the bowel of breast-fed versus bottle-fed infants.
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STEVEN SCHWARTZ , MD : I want to say something.True vomiting is never really normal.Young infants will have some spitting up.It's a topic for another day , but most young infants have an element of what we call gastroesophageal reflux..Listeners have probably heard of GR or GR , well , this is not gastroesophageal reflux disease , it's just a tendency to spit up a little bit.After feeding.That's okay.
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STEVEN SCHWARTZ , MD : We consider it , we consider it different.And I think that the difference may be subtle.But I think it's important to understand that.
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STEVEN SCHWARTZ , MD : Well , the most important -- the most important , potentially life-threatening situation would be if the vomitus turns greenish.That suggests that it's coming from lower down in the intestine , it may represent an obstruction.
A child who forcefully vomits can have a gastric problem , or can have an infection.Can have an ear infection.Can have other kinds of illnesses where vomiting is just a manifestation of that.
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STEVEN SCHWARTZ , MD : If it's important -- most infants and young child become ill , they get a little cranky , they may be a little irritable.When a child gets significantly dehydrated , the opposite tends to happen.They tend to become listless.They tend to become almost lethargic , and they may be lethargic.And that shouldn't be confused with everything's okay.If your child went from irritable to being listless , and continues to have symptoms of vomiting and diarrhea , that's a real danger sign.
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STEVEN SCHWARTZ , MD : Well , again , a lot depends on age as well.I think the child less than three months of age will always be seen by the pediatrician.
Beyond that , it's really -- how well do I know the child.How reliable is the history that I'm getting.Are they sick contacts.Are there other people at who are sick.
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I've heard that many times , Dr. Schwartz.
STEVEN SCHWARTZ , MD : Uh , yeah.Fruit juice , number one , is very high in sugar.And because of that , it's probably not the best liquid to give your child , anyway.
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STEVEN SCHWARTZ , MD : But they love it.Particularly in a child with diarrhea , the high-sugar content plus many of the juices contain certain sugars which the body poorly absorbs and can actually make diarrhea worse.So if you have an infant with gastroenteritis and you want to give them an oral solution , use one of the oral rehydration solutions , don't use fruit juice.That's really the opposite of what you should be doing.
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STEVEN SCHWARTZ , MD : That's very important to emphasize.I have , unfortunately , seen some infants who come into the office being on one of the oral rehydration solutions for three , four days.This is not a good situation.We try to limit it to twenty-four hours , no more than 24 hours , and then reevaluate.
Many children with -- otherwise healthy children with gastroenteritis can also feed through their gastroenteritis.And do not -- do not have to have special solutions.
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STEVEN SCHWARTZ , MD : Medications -- there are certain medications which you can give which will absorb some of the fluid , a little bit like a sponge , that may not affect the amount of fluid that's lost in the bowel.There are certain medications that can actually change the way the bowel passes fluid through it.But all that's happening -- instead of the fluid coming out -- the fluid stays inside , in the bowel , and is not absorbed.And so you don't know where you are.
So , especially in infants , you want to stay away from antidiarrheal medications.In fact , most of these are contraindicated in children.
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STEVEN SCHWARTZ , MD : Well , the oldest one is Lomotil.And Lomotil is really contraindicated in children.Imodium -- which is another one , it's commonly available -- can be used in certain situations , not during infancy.And really , your child should only receive it on a doctor's advice.
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DANIEL NEUSPIEL , MD : Steve , what do you think about using medications to suppress vomiting in children.
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STEVEN SCHWARTZ , MD : Most medications which actually suppress vomiting do so by sedating the child.So the child is sedated and is not taking anything orally.
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STEVEN SCHWARTZ , MD : Again , these are medications which do so through sedative effects.Anti-histamines are used.
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STEVEN SCHWARTZ , MD : Other medications are used.Phenergan is a popular one.Tigan is another popular one.Again , I never use them.I never use anti-vomiting agents , I never use anti-spasmodics --.
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STEVEN SCHWARTZ , MD : You're really not changing the natural course of the disease , and you're only creating potential complications.
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STEVEN SCHWARTZ , MD : The best way to treat it is fluids.A bland diet in an older child , with a doctor's advice.Visits to the physician if you're concerned about the child's state of dehydration.And allowing nature to run its course.
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Dr. Schwartz , thank you very much for joining us.
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Sign On San Diego Faculty : Steven Schwartz , MD
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Steven Schwartz , MD
Read this faculty member's articles
Chronic Abdominal Pain in Children
Breast-Fed Babies May Be Leaner
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