Vomiting and Diarrhoea

Vomiting

Vomiting can be part of many illnesses in children and babies. It is not usually a major concern as long as your child seems well in other ways.

Vomiting is common for babies and young children. Vomiting occurs when food is brought back up from the stomach. The amount of vomit can often seem larger than it actually is.

Types of vomiting

There are different types of vomiting, including:

• Possetting – this is when a baby vomits up small amounts after a feed.
• Reflux – this vomiting is common in babies. It is caused when the valve at the top of the stomach accidentally opens. The contents of the stomach come back up the food pipe (oesophagus) slowly. Reflux does not harm babies. They usually grow out of it by the time they are walking.
• Projectile vomiting – this is when a baby brings up the stomach contents in a forceful way. The amount of milk or food can seem large on the floor, but is usually only the amount of the last feed. Babies may projectile vomit occasionally, but if it happens after every feed, see your doctor right away as it may be due to a blockage caused by thickening of the muscle at the outlet of the stomach.

Causes of vomiting

Vomiting is usually caused by:

• minor infections like ‘gastro’ or the common cold
• gastro-oesophageal reflux
• motion sickness from travelling in a moving vehicle.

Sometimes, vomiting may be part of a more serious illness. Children may vomit if they have an infection, such as a urinary tract infection or meningitis, a bowel obstruction or appendicitis. If vomiting progresses to fever and diarrhoea, it will usually be caused by a virus infection. If this persists for 12 hours or more, dehydration is likely. so see your doctor or local hospital emergency department without delay.

Treatment for vomiting

The gold star treatment, particularly for a child who’s vomiting excessively, is administering fluids.

While you may only be able to get water into them, many doctors and chemists recommend an oral rehydration solution (ORS) for those children who have vomited a lot. These have the right mix of sugars and electrolytes to replace what the bout of gastro has stripped from their bodies.

The Children’s Hospital at Westmead (CHW) advises parents that if no ORS are available than clear fluids such as diluted juice, cordial or soft drink may be used. The recommended dilution is one part flat soft drinks or juice to four parts water. It says that parents/carers should aim to give their sick child at least 5ml of fluid per kilogram of body weight each hour. The CHW has this helpful calculation:

• 6-23 months: 40-60ml/hour
• 2-5 years: 60-100ml/hour
• 6-10 years: 100-120ml/hour
• 11-16 years: 120-160ml/hour

Vomiting babies aged under six months should be taken immediately to the doctor. For breastfed babies, keep feeding on demand and at least every two hours, providing water or ORS in between.

As for solid food, it’s important that you offer easily digested foods like bananas, potatoes, pumpkin, dry toast or rice within 24 hours.

Medications which stop vomiting are not recommended for children as they can have serious side effects.

Most babies and children vomit easily and recover quickly. After vomiting, a child may be hungry and thirsty. If a child keeps on vomiting and looks unwell, see your doctor.

When to see a doctor

Take a baby to the doctor if any of these symptoms occur:

• poor weight gain because of the loss of feeds in vomiting
• coughing or choking spells
• blood or yellow-green bile in the vomit
• heartburn
• vomiting increases or becomes forceful after every feed
• baby seems unwell.

RELATED: How to tell if it’s a gastro bug or food poisoning

The gold star treatment for vomiting is administering fluids (but maybe not milk!)

Diarrhoea

Food nutrients are absorbed in the small intestine. The waste is pushed into the large intestine (bowel) where water is removed. The resulting faeces is stored temporarily within the rectum then passed out of the body through the anus. Faeces are usually firm, moist and easy to pass. Diarrhoea is the frequent passing of loose, watery and unformed faeces.

Acute diarrhoea is the sudden onset of three or more loose stools per day, lasting less than 14 days. The most common cause of acute diarrhoea is an infection of the intestines, such as gastroenteritis or food poisoning. Viruses are responsible for most cases. The intestinal lining becomes irritated and inflamed, which hinders the absorption of water from food waste. In severe cases, the intestinal lining may even leak water.

Generally, acute diarrhoea resolves after a day or two. Chronic diarrhoea, which lasts four weeks or more, can be caused by a range of conditions that affect the intestines, including inflammatory bowel disease (IBD).

Symptoms of diarrhoea

The symptoms associated with diarrhoea include:

• abdominal cramps
• abdominal pains
• urgency to go to the toilet
• frequent passing of loose, watery faeces
• nausea
• vomiting.

Serious symptoms of diarrhoea

In most cases, acute diarrhoea is self-limiting and will resolve by itself within a day or two.

However, contact your doctor immediately if you experience serious symptoms including:

• blood in the faeces
• pus in the faeces
• painful passage of faeces
• repeated vomiting
• inability to increase fluid intake
• reduced or absent urination
• fever (temperature greater than 38 ºc).

Diarrhoea can be dangerous for babies and young children

Acute diarrhoea can be life threatening to babies and young children. This is because their smaller bodies are more vulnerable to dehydration. If a baby or young child develops diarrhoea, seek medical attention straight away.

Causes of acute diarrhoea

A bout of diarrhoea can be caused by a wide range of disorders, infections and events including:

• food poisoning
• gastroenteritis
• tropical diseases, such as typhoid and cholera
• anxiety or emotional stress
• medications, particularly antibiotics.

Common infectious agents

Contaminated food and water are common causes of acute diarrhoea. Some of the infectious agents known to cause diarrhoea include:

• viruses
• bacteria
• parasites

Treatment for diarrhoea

Babies and young children with diarrhoea need prompt medical attention. Treatment for diarrhoea depends on the cause, but may include:

• plenty of fluids to prevent dehydration
• oral rehydration drinks to replace lost salts and minerals. These drinks are available from pharmacies. An alternative is one part unsweetened pure fruit juice diluted with four parts of water
• intravenous replacement of fluids in severe cases
• medications such as antibiotics and anti-nausea drugs
• anti-diarrhoeal medications, but only on the advice of your doctor. If your diarrhoea is caused by infection, anti-diarrhoeal drugs may keep the infection inside your body for longer
• treatment for any underlying condition, such as inflammatory bowel disease.

Risk of spreading infection

Most cases of acute diarrhoea are potentially infectious to others. Viruses are easily spread, mainly through direct contact with vomit or faeces from an infected person, or through contact with a contaminated object or surface. Occasionally, the virus may be transmitted by airborne particles generated from vomiting and diarrhoea.

People can reduce their chances of getting infected by carefully washing their hands after going to the toilet and before handling food. People looking after a person with the virus must also wash their hands thoroughly. Alcohol-based handwash solutions, available from pharmacies, have been shown to be better at reducing the spread of infection than soap and water, and are less drying to the skin.

Anyone with acute diarrhoea should stay at home if possible to reduce the spread of infection. It is strongly recommended not to visit hospitals and nursing homes, and not to swim in public pools.