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Vomiting and Diarrhoea in children

Causes

As any parent knows all too well, sickness, with or without diarrhoea is extremely common in all small children. We have all spent many happy hours mopping up baby sick !! Babies tend not to have much of a stopper in their stomachs and are sick very easily ( Hold them upside down and the last meal will usually run out ! ) This is usually of no significance whatever and all that one needs to do is start again and give another feed. Obviously if they are unwell then they will be sick evven more than usual, however on its own the fact that baby has been sick is of no great importance.

There are numerous causes of sickness and diarrhoea in children. Many children will be sick with other illnesses, if they have a high temperature, or are coughing a lot they will be sick too. However parents soon learn what is to be expected, or when their child is being sick when not expected and possibly causing concern.

Most episodes of stomach upset are caused by viruses. There are particular bugs well known for this. RotaViruses cause outbreaks of the well named "WinterVomiting Disease" ( no prizes for guessing what happens here.) Norwalk Viruses do much the same but in summer. These bugs are very infectious and pass from child to child very easily. It is not unusual to see schools or nurseries where nearly every child is affected. The pattern with this sort of thing is always the same. The child becomes generally unwell and off colour then starts being sick. There may be some cramping stomach pain, though this is not usually severe and ther may or may not be a raised temperature. If there is going to be diarrhoea it will start a bit later than the vomiting. The sickness will usually settle after 2-3 days at the most. The diarrhoea takes a bit longer to settle, and will often persist until the child is back to his normal diet.

Fluid Loss

As you probably know the human body is over 80% water, so it follows that if anything disrupts the intake of water, it does not take long for problems to start. When a person vomits they bring up whatever was in the stomach at the time, they do not lose significant amounts of extra fluid. Diarrhoea however is quite the reverse. Large amounts of fluid can be rapidly lost, this is nearly all fluid from within the body, not just what has worked its way along from the stomach. Severe diarrhoea can lead to the loss of critical amount of water and dehydration in a short period of time, if the patient is able to drink then they can keep up with the fluid loss. However if they are vomiting as well they may not absorb much of a drink before it is sicked back up. Fluid is also lost through sweating, an ill person with a fever can sweat a significant volume of water. If this is all happening in a hot climate, then the amount of fluid lost via sweat will greatly exacerbate the problems. If the patient is a baby or small child

then with vomiting and diarrhoea in a hot climate can lead to severe dehydration and death within a matter of hours.

There are a few general points about D&V. These points are sweeping generalisations and should not be regarded as more than a guide. There will always be exceptions. If in doubt seek advice.

As a general rule, vomiting on its own, in our climate is unlikely to result in significant dehydration to cause serious problems, unless the vomiting is particularly prolonged. Usually despite vomiting, enough water can be absorbed between pukes to keep pace with normal fluid loss.
Diarrhoea on its own, in our climate is unlikely to lead to dehydration provided that the patient keeps drinking.
D&V combined do not frequently lead to serious dehydration in our climate provided that the patient keeps drinking despite being sick. Some will be absorbed between pukes even if not much. Also provided that the D&V is not too prolonged. However it is vital that a close watch is kept for signs of dehydration.

Treatment

The mainstay of treatment in adults and children is with oral re-hydration. If there is a small amount of salt and sugar in the fluid being drunk, then this will help promote rapid absorption of water from the stomach. The amount of sugar and salt is critical for it to be effective. To ensure that the make up is correct sachets of the correct amounts of sugar and salt are disolved in a set amount of water. The patient sholud then drink as much of this as possible. Every effort should be made to get the patient to drink, despite being sick. The amount that is absorbed between the solution being drunk, and the non absorbrd solution being sicked up, is usually adequate to prevent dehydration. If the sugar and salt mix is correct then the stomach can absorb fluid rapidly, especially if the body is getting a bit dry.