Tag Archives: virus

Vomiting without Diarrhea

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Definition:

* Vomiting is the forceful emptying (throwing up) of a large portion of the stomach’s contents through the mouth

* Nausea and abdominal discomfort usually precede each bout of vomiting

Causes:

* Main Cause: Stomach infection (gastritis) from a stomach virus (eg, rotavirus). The illness starts with vomiting but diarrhea usually follows within 12 to 24 hours.

* Food poisoning from toxins produced by bacteria growing in poorly refrigerated foods (eg, Staphylococcus toxin in egg salad, Bacillus cereus toxin in rice dishes)

* Serious Causes: If vomiting persists as an isolated symptom (without diarrhea) for more than 24 hours, more serious causes must be considered. Examples are appendicitis, kidney infection, meningitis, and head injury.

* Vomiting can also be triggered by hard coughing. This is common, especially in children with reflux.

Severity of Vomiting:

Te following is an arbitrary attempt to classify vomiting by risk for dehydration:

* Mild: 1 to 2 times a day

* Moderate: 3 to 7 times a day

* Severe: Vomits everything or nearly everything, or 8 or more times a day

* Severity relates even more to the length of time that the particular severity level has persisted. At the beginning of a vomiting illness (especially following food poisoning), it’s common for a child to vomit everything for 3 or 4 hours and then become stable with mild or moderate vomiting.

* The younger the child, the greater the risk for dehydration

Return to School: Your child can return to child care or school after vomiting and fever are gone

Call 911 Now (Your Child May Need an Ambulance) If:

* Unresponsive or difficult to awaken

* Not moving or too weak to stand

Call Your Doctor Now (or in Alberta, canada call 780-408-LINK) If:

* Your child looks or acts very sick

* Confused (delirious)

* Stiff neck or bulging soft spot

* Headache

* Signs of dehydration (very dry mouth, no tears, and no urine in more than 8 hours)

* Blood in the vomit that’s not from a nosebleed

* Bile (bright yellow or green) in the vomit

* Abdominal pain is also present (EXCEPTION: Abdominal pain or crying just before and improved by vomiting is quite common)

* Appendicitis suspected (eg, pain low on right side, won’t jump, prefers to lie still)

* Diabetes suspected (excessive drinking, frequent urination, weight loss)

* Poisoning with a plant, medicine, or other chemical suspected

* Child is younger than 12 weeks with vomiting 2 or more times (EXCEPTION: spitting up)

* Receiving Pedialyte (or clear fluids if older than 1 year) and vomits everything longer than 8 hours

* High-risk child (eg, diabetes mellitus, abdominal injury, head injury)

* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)

* Vomiting an essential medicine

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Has vomited longer than 24 hours

* Fever present for more than 3 days

* Fever returns after gone for longer than 24 hours

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Vomiting is a recurrent chronic problem

Parent Care at Home If:

* Mild to moderate vomiting (probably viral gastritis) and you don’t think your child needs to be seen

Home Care Advice for Vomiting:

1. Reassurance:

* Most vomiting is caused by a viral infection of the stomach or mild food poisoning

* Vomiting is the body’s way of protecting the lower intestinal tract

* Fortunately, vomiting illnesses are usually brief

2. For Bottle-fed Infants, Offer Oral Rehydration Solution (ORS) for 8 Hours:

* ORS (eg, Pedialyte, store brand) is a special electrolyte solution that can prevent dehydration. It’s readily available in supermarkets and drugstores.

* For vomiting once, continue regular formula

* For vomiting more than once, offer ORS for 8 hours. If ORS is not available, use formula.

* Spoon or syringe feed small amounts of ORS —1 to 2 teaspoons (5 to 10 mL) every 5 minutes.

* After 4 hours without vomiting, double the amount

* After 8 hours without vomiting, return to regular formula

* For infants older than 4 months, also return to cereal and strained bananas

* Return to normal diet in 24 to 48 hours

3. For Breastfed Infants, Reduce the Amount Per Feeding:

* If infant vomits once, nurse 1 side every 1 to 2 hours

* If infant vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without vomiting, return to regular breastfeeding.

* If infant continues to vomit, switch to ORS (eg, Pedialyte) for 4 hours

* Spoon or syringe feed small amounts of ORS —1 to 2 teaspoons (5 to 10 mL) every 5 minutes

* After 4 hours without vomiting, return to regular breastfeeding. Start with small feedings of 5 minutes every 30 minutes and increase as tolerated.

4. For Children Older Than 1 Year, Offer Small Amounts of Clear Fluids for 8 Hours:

* Water or ice chips are best for vomiting in older children (Reason: water is directly absorbed across the stomach wall)

* ORS: If child vomits water, offer ORS (eg, Pedialyte). If child refuses ORS, use half-strength Gatorade

* Give small amounts —2 to 3 teaspoons (10 to 15 mL) every 5 minutes

* Other Options: Half-strength flat lemon-lime soda, popsicles, or ORS frozen pops

* After 4 hours without vomiting, increase the amount

* After 8 hours without vomiting, return to regular fluids

* CAUTION: If vomiting continues for more than 12 hours, switch to ORS or half-strength Gatorade

* Solids: After 8 hours without vomiting, add solids

– Limit solids to bland foods. Starchy foods are easiest to digest

– Start with saltine crackers, white bread, cereals, rice, and mashed potatoes

– Return to normal diet in 24 to 48 hours

5. Avoid Medicines:

* Discontinue all nonessential medicines for 8 hours (Reason: usually make vomiting worse)

* Fever: Fevers usually don’t need any medicine. For higher fevers, consider acetaminophen (eg, Tylenol) suppositories. Never give oral ibuprofen (eg, Advil); it is a stomach irritant

* Call your doctor if your child is vomiting an essential medicine

6. Sleep: Help your child go to sleep for a few hours (Reason: sleep often empties the stomach and relieves the need to vomit). Your child doesn’t have to drink anything if she feels very nauseated.

7. Contagiousness: Your child can return to child care or school after vomiting and fever are gone.

8. Expected Course: Vomiting from viral gastritis usually stops in 12 to 24 hours. Mild vomiting with nausea may last up to 3 days

9. Call Your Doctor If:

* Vomiting becomes severe (vomits everything) longer than 8 hours

* Vomiting persists longer than 24 hours

* Signs of dehydration

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Cough

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Definition:

* A cough is the sound made when the cough reflex suddenly forces air and secretions from the lungs.

* A coughing spasm is more than 5 minutes of continuous coughing

Causes:

* Most acute coughs are part of a cold, a viral infection of the large airway (viral bronchitis).

* Other Common Causes: Croup, bronchiolitis, asthma, allergic cough, whooping cough.

Sputum or Phlegm:

* Yellow or green phlegm is a normal part of the healing process of viral bronchitis.

* This means the lining of the trachea was damaged by the viral infection and is being coughed up as new mucosa replaces it.

* Bacteria do not cause bronchitis in healthy children. Antibiotics are not indicated for the yellow or green phlegm seen with colds.

* The main treatment of a productive cough is to encourage it with good fluid intake, a humidifier (if the air is dry), and warm chicken broth or apple juice for coughing spasms (if child is older than 1 year).

Return to School: Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented.

Call 911 Now (Your Child May Need an Ambulance) If:

* Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath)

* Child has passed out or stopped breathing

* Lips are bluish when not coughing

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK)) If:

* Your child looks or acts very sick

* Choked on a small object that could be caught in the throat

* Difficulty breathing for child younger than 1 year and not relieved by cleaning the nose

* Difficulty breathing present when not coughing

* Lips have turned bluish during coughing

* Ribs are pulling in with each breath (retractions)

* Can’t take a deep breath because of chest pain

* Severe chest pain, coughed up blood, or wheezing

* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Continuous (nonstop) coughing

* Child is younger than 3 months

* Earache or sinus pain (not just congestion) is also present

* Fever present for more than 3 days

* Fever returns after gone for longer than 24 hours

* Chest pain present even when not coughing

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Coughing has kept child home from school for 3 or more days

* Symptoms of nasal allergy are also present

* Cough has been present more than 3 weeks

Parent Care at Home If: Cough with no complications and you don’t think your child needs to be seen

Home Care Advice for Cough:

1. Reassurance:

* Coughs are a normal part of a cold

* Coughing up mucus is very important for protecting the lungs from pneumonia

* We want to encourage a productive cough, not turn it off

2. Homemade Cough Medicine:

• Goal: Reduce the irritation or tickle in the throat that triggers a dry cough

* Child Aged 3 Months to 1 Year: Give warm, clear fluids (eg, warm water, apple juice) to treat the cough. Amount: 1 to 3 teaspoons (5 to 15 mL) 4 times per day when coughing. Avoid honey until 1 year of age.

* Child Aged 1 Year and Older: Use HONEY, ½ to 1 teaspoon (2 to 5 mL), as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. (If not available, you can use corn syrup)

* Child Aged 6 Years and Older: Use COUGH DROPS to coat the irritated throat. (If not available, you can use hard candy)

3. Nonprescription Cough Medicine (Dextromethorphan):

* Nonprescription cough medicines are NOT recommended (Reason: no proven benefit for children and not approved for children younger than 4 years) (Food and Drug Administration, 2008).

* Honey has been shown to work better for coughs

* If you decide to use cough medicine from your drugstore anyway, and your child is older than 4 years, choose one with dextro-methorphan (DM). It’s present in most nonprescription cough syrups.

* Indication: Give only for severe coughs that interfere with sleep, school, or work (every 8 hours)

4. Coughing Spasms:

* Expose to warm mist (eg, foggy bathroom)

* Give warm fluids to drink (eg, warm water, apple juice) if child is older than 3 months

* Amount: If child is 3 months to 1 year of age, give warm fluids in a dosage of 1 to 3 teaspoons (5 to 15 mL) 4 times per day when coughing. If child is older than 1 year, use unlimited amounts as needed.

* Reason: relax the airway and loosen up the phlegm

5. Vomiting: For vomiting that occurs with hard coughing, reduce the amount given per feeding (eg, in infants, give 2 oz less formula) (Reason: cough-induced vomiting is more common with a full stomach).

6. Fluids: Encourage your child to drink adequate fluids to prevent dehydration. This will also thin out nasal secretions and loosen phlegm in the airway.

7. Humidifier: If the air is dry, use a humidifier (Reason: dry air makes coughs worse)

8. Fever Medicine: For fever above 102°F (39°C), give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil)

9. Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse

10. Contagiousness: Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented.

11. Extra Advice: Antihistamines for Allergic Cough

* Antihistamines can bring an allergic cough and nasal allergy symptoms under control within 1 hour

* Benadryl is very effective and no prescription is needed

• They need to be given every 6 to 8 hours

12. Expected Course:

* Viral bronchitis causes a cough for 2 to 3 weeks

* Sometimes your child will cough up lots of phlegm (mucus). The mucus can normally be gray, yellow, or green.

* Antibiotics are not helpful

13. Call Your Doctor If:

* Difficulty breathing occurs

* Wheezing occurs

* Cough lasts more than 3 weeks

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Rash, widespread, and cause unknown

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Definition:

* Rash over large areas or most of the body (widespread or generalized)

* Occasionally just on hands, feet, and buttocks—but both sides of body

* Red or pink rash

* Small spots, large spots, or solid red skin

Causes:

Main Cause: A 2- or 3-day rash occurring with a viral illness. Viral rashes usually have symmetrical pink spots on the trunk.

Return to School:

* Most viral rashes are no longer contagious once the fever is gone.

* For minor rashes, your child can return to child care or school after the FEVER is gone.

* For major rashes, your child can return to child care or school after the RASH is gone or your doctor says it’s safe to return with the rash.

Call 911 Now (Your Child May Need an Ambulance) If:

* Purple or blood-colored rash with fever

* Sudden onset of rash (within 2 hours) AND also has difficulty with breathing or swallowing

* Not moving or too weak to stand

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK) If:

* Your child looks or acts very sick

* Purple or blood-colored rash WITHOUT fever

* Bright red skin that peels off in sheets

* Large blisters on skin

* Bloody crusts on lips

* Taken a prescription medication within the last 3 days

* Fever

* Menstruating and using tampons

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* Widespread rash but none of the symptoms described herein (Reason: needs a diagnosis)

Home care advice for widespread rashes:

1. For Non-Itchy Rashes: No treatment is necessary except for heat rashes, which respond to cool baths.

2. For Itchy Rashes

* Wash the skin once with soap to remove irritants.

* Then give your child cool baths without any soap 4 times per day for 10 minutes whenever the itch is uncomfortable (CAUTION: Avoid any chill).

* Follow with calamine lotion or a baking soda solution (1 teaspoon in 4 oz of water or 5 mL in 120 mL of water).

3. Fever Medicine: For fever above 102°F (39°C), give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil)

4. Contagiousness:

• If your child has a fever, avoid contact with other children and especially pregnant women until a diagnosis is made.

* Most viral rashes are contagious (especially if a fever is present).

* Your child can return to child care or school after the rash is gone or your doctor says it’s safe to return with the rash.

5. Expected Course: Most viral rashes disappear within 48 hours.

6. Call Your Doctor if your child becomes worse.

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Most bugs don’t need drugs

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I am borrowing this slogan from an advertising campaign in which we are trying to educate the public that most infections are caused by viruses and not bacteria. The distinction is important, since antibiotics only work against bacterial infections. Most infections however, are caused by bugs known as “viruses” and these are the diseases that we need to fight off ourselves. We can use medicines for support, but not to “cure” infections caused by viruses.

Examples of diseases caused by viruses are chicken pox, the flu, and most common colds. I am not advocating an anti-antibiotics position, but we have found over the years that bacteria can build-up resistance to certain antibiotics, so it helps us to reduce this risk if we try to only prescribe it when indicated (for a great read on this, please visit Caring for Kids).

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