Diarrhea and vomiting in a child: how to treat and what to feed?

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You carefully followed preventive measures - washed your hands and fruits, monitored the shelf life of food, but diarrhea and vomiting still overtook the child. How to treat intestinal infection or poisoning? How to compensate for dehydration in a child? What diet should you follow during illness? Blogger Dr. Daria says.

The main treatment for intestinal infections is the correction of dehydration, which can occur due to vomiting or diarrhea.

Signs of dehydration (when the situation is close to critical):

• the child pees less than once every 4–6 hours;
• cries without tears;
• the baby's fontanelle sinks;
• dry tongue and mouth;
• severe drowsiness;
• decrease in skin elasticity when the collected fold does not straighten out for a long time.

Antiviral drugs are ineffective in principle in such situations, interferons have no proven effectiveness, and antibiotics should only be prescribed by a doctor if the infection is confirmed. You need to understand that independent and uncontrolled prescription of antibiotics can increase diarrhea, and in the future, immunity to certain types of antibiotics will develop, and there will be nothing to treat.

Antimicrobial agents stand apart; they are also called intestinal antiseptics. Usually they are not absorbed from the intestines, they are quite safe and can be used independently in acute situations when you are traveling and do not know the cause of the disease: poisoning or a viral infection. Such drugs will work well for food poisoning, but personally I prefer to start and most often limit myself to sorbent therapy. For viral infections, intestinal antiseptics are ineffective.

Causes of vomiting and diarrhea in a child without fever

Often parents are too careless about vomiting and diarrhea in their children, if the body temperature remains normal. This is explained by the fact that adults are accustomed to the temperature against the background of any disease. However, it is worth considering that some pathological conditions can occur without this symptom. It is possible that the child has a reduced immune system or even has diseases of the immune system. As a result, the body's defenses do not respond, and the body temperature does not rise.

It is also worth remembering that in infants the symptoms of many diseases are blurred, and the deterioration of the condition occurs much faster than in older children. Therefore, in just a few hours, the baby can fall into a serious condition that is life-threatening.

A serious condition with vomiting and diarrhea can be caused by intoxication, so in complex treatment enterosorbents are prescribed - agents that rid the body of toxins. Since March 2021, children under 2 years of age, as well as pregnant and lactating women, have ceased to be prescribed Smecta sorbent. This happened after the publication of a warning from the regulator ANSM (National Agency for the Safety of Medicines and Medical Products), which contained information that lead was found in the raw materials for the production of Smecta. The lead contained in Smecta can have a toxic effect on the child’s body, and primarily on the development of the brain. After this message, ROAG (Russian Society of Obstetricians and Gynecologists) issued a recommendation not to use the drug Smecta in these groups of people, but to use drugs that have been successfully used for decades - Enterosgel or similar drugs.

Numerous studies indicate the high efficiency of the Enterosgel gel form, selectivity of adsorption and safety. The water-saturated gel form, unlike finely dispersed sorbents, minimizes the risk of constipation, which is important when choosing a sorbent for the little ones. In addition to the removal of toxic substances, pathogenic bacteria and rotaviruses, Enterosgel promotes the growth of the number of beneficial microbiota, the healing of microtraumas of the gastrointestinal mucosa, which has a positive effect on the body's resistance to viruses and infections.

Vomiting and diarrhea without body temperature in children can occur for the following reasons:

Intestinal infection

The most common intestinal infections in childhood are rotavirus infection, dysentery, salmonellosis, and escherichiasis. They can occur without fever, but it is possible to increase body temperature to subfebrile levels, and in some cases to high values.

Vomiting and diarrhea have the following characteristics:

• Vomiting does not depend on food intake and can be one-time or more frequent.
• Vomit consists of the food that the child has eaten.
• Viral infections are characterized by loose, watery stools.
• Bacterial intestinal infections are characterized by mucous stools with foam and a strong odor.
• Diarrhea with intestinal infection prevails over vomiting.

In addition, the following symptoms are characteristic of an intestinal infection:

• Severe cramping pain in the abdomen.
• Restlessness of the child, which, as diarrhea and vomiting intensify, will be replaced by drowsiness and lethargy.
• Refusal of water and food.
• As the disease progresses, increased body temperature may occur.
• Symptoms of dehydration: sunken eyes, dry eyes, lack of urination, sunken fontanel (in infancy), convulsions. These symptoms should never be ignored.

Treatment of intestinal infections in children under one year of age is carried out only in a hospital setting. If the child is older than one year, then the issue of hospitalization is decided depending on the severity of the patient’s condition.

Therapy consists of the following main activities:

• Prescription of antitoxic drugs - enterosorbents.
• Prescription of nitrofurans, furazolidone.
• Eliminating the cause of vomiting and diarrhea: antibacterial or antiviral therapy.
• Parenteral rehydration therapy.
• Elimination of symptoms of the disease: lowering body temperature, relieving pain.

The final stage of treatment is rehabilitation therapy with the administration of probiotic drugs.

Food poisoning

Food poisoning in childhood most often occurs from either dairy products or breast milk. Juices, fruit and meat purees, both home-made and factory-produced, are also dangerous.

Features of vomiting and diarrhea due to food poisoning:

• Repeated, exhausting vomiting that occurs soon after eating.
• Frequent stools with an unpleasant odor and blood.
• Diarrhea and vomiting may stop quickly, but the patient's condition will worsen.

Other symptoms of food poisoning:

• Abdominal pain is severe and occurs as spasms.
• The child's moodiness, which, as the disease progresses, gives way to lethargy and drowsiness.
• The patient refuses food and water.

All children with suspected food poisoning are subject to hospitalization (under 3 years of age). As for older children, the issue of inpatient treatment is decided depending on the severity of the patient’s condition.

Treatment of food poisoning comes down to the following points:

• Gastric lavage.
• Prescription of nitrofurans, furazolidone.
• Purpose of enterosorbents.
• Carrying out parenteral rehydration therapy.
• Prescription of anti-inflammatory drugs, antispasmodics.

The course of treatment for food poisoning always ends with restorative therapy with the administration of probiotics.

Dysbacteriosis

Vomiting with dysbacteriosis occurs infrequently, no more than 1-2 times a day. The stool is unstable, constipation is replaced by foamy diarrhea. Other symptoms of dysbiosis are: loss of appetite, rumbling and pain in the abdomen after eating, white coating on the tongue. Skin reactions are possible, but do not always occur. These include rash, itching and dry skin.

Treatment of dysbacteriosis is outpatient. To begin with, the child is offered nitrofurans for intestinal sanitation, then, against the background of nutritional correction, the intestinal microflora is restored with the help of eubiotics and probiotics.

Allergic reaction

Vomiting and diarrhea without fever may occur due to an allergy to a food product or drug. In younger children, such a reaction often occurs to the first complementary foods.

Vomiting begins soon after feeding and contains undigested food debris. In addition, the child develops itching, hives and other skin reactions. Severe allergies are accompanied by swelling of the mucous membranes of the nose and throat, and breathing problems.

Treatment depends on the severity of the allergic reaction. In mild cases, therapy is carried out at home. Antihistamines, enterosorbents and hormonal drugs are prescribed (in severe cases).

How and when can you become infected?

Sources of rotavirus infection can be a sick child or an asymptomatic carrier. The virus is excreted from the body in the stool and gets onto household items, clothing and food with dirty hands.

Doctors often call rotavirus infection a “dirty hands” disease.

A healthy child can introduce the virus into the body first by touching things, and then by touching the face, and also by eating unwashed vegetables and fruits.

Rotavirus outbreaks typically occur in winter, early spring, or late fall because viruses persist in the environment longer at low temperatures. In summer, food poisoning occurs more often - the cause is usually bacterial contamination of food, and bacteria multiply better in the hot season.

Causes of vomiting in a child without fever

The causes of vomiting in a child without fever can be very diverse, most of them are presented in the table:

Another pathology in which vomiting without fever is observed is appendicitis. But with appendicitis, vomiting will be only the first sign of the onset of inflammation, and after a few hours the body temperature will still increase.

What are the dangers of rotavirus without treatment?

Diarrhea and vomiting cause the body to lose a lot of water along with sodium, potassium, magnesium and other electrolytes. This leads to disruption of the lungs - the child begins to breathe frequently and shallowly; the heart and blood vessels - the heart rate increases, blood pressure decreases; and the brain - dizziness, headache, and weakness appear.

In infants, rotavirus infection is most dangerous because convulsions or loss of consciousness can occur as a result of the loss of large amounts of fluid and electrolytes. It is very important to immediately call an ambulance at the first signs of an intestinal infection in infants.

Causes of diarrhea in a child without fever

The causes of diarrhea without fever in a child may be the following:

• Intestinal infection, minor poisoning. With an intestinal infection, diarrhea is frequent, on average it happens up to 5 times per knock. If a child has poisoning, then there will be no foreign impurities in the stool, but if there is an intestinal infection, then the stool may have a non-standard color and mucous consistency. Since intestinal function is disrupted, particles of undigested food will be present in the stool. In addition to diarrhea, the child will experience abdominal pain, and the tongue will be covered with a white coating. Probably a rash. As for treatment, it depends on the severity of the intestinal infection or poisoning. In mild cases, the child remains at home.
• Allergy to a drug. Diarrhea manifests itself a couple of hours after taking the medicine. In addition, there may be skin reactions. Treatment boils down to stopping taking the drug.
• Enteritis. Inflammation of the small intestine is characterized by severe diarrhea up to 6 times per knock. The stool is greasy with food particles. The pain is localized in the navel area, appetite disappears. Treatment is carried out at home.
• Parasitic infection of the intestines. The stool is unstable, diarrhea gives way to constipation. The child loses body weight, abdominal pain similar to colic is possible, and sleep is disturbed. Increased drooling and lethargy may occur. Treatment boils down to prescribing anthelmintics.
• Dysbacteriosis. The stool is foamy, has an unpleasant odor and occurs up to several times a day. In this case, there is bloating, loss of appetite, and abdominal pain occurs a couple of hours after eating. Sometimes skin reactions appear, the tongue becomes covered with a dense white coating. Treatment at home.

It should be remembered that diarrhea without fever can also develop with other, more serious diseases. Therefore, if diarrhea does not go away after a day, then consultation with a specialist is required.

What to do to avoid getting sick

Frequent and thorough hand washing with soap is the prevention of any viral and bacterial infections.

• You need to teach your child to do this from an early age: after going outside and going to the toilet, before meals, and just several times a day.
• Parents should wash their hands themselves before touching or feeding the baby.
• It is important to wash vegetables and fruits before eating, observe temperature conditions when preparing food, and drink boiled or bottled water.

The largest amount of virus is excreted in the stool in the first 5 days of illness, so during this period you need to wash your hands more often and wet clean your home.

Causes of vomiting and diarrhea without fever that are safe for a child’s life

Vomiting and diarrhea without an increase in body temperature do not always indicate serious problems with the child’s health. Often these two symptoms simply accompany the natural physiological states of children.

Only vomiting (without fever and diarrhea) can occur in a child for the following reasons:

Physiological regurgitation

An infant may vomit milk or formula. However, his health does not deteriorate, his body weight remains within normal limits. Children burp up to 20 ml at a time. The discarded contents consist of curdled milk without foreign impurities.

The causes of physiological regurgitation may be the following:

• Large amounts of food.
• Incorrect posture of the baby during feeding.
• Imperfection of the digestive tract of infants.
• Incorrect nipple latching.

To reduce the frequency of regurgitation, the baby should be held with his head slightly elevated during feeding. After eating, you need to put the baby in an upright position for 15 minutes. This will allow excess air to escape. It is equally important to monitor the amount of food that an infant consumes.

Teething

Vomiting when the first teeth appear is not associated with food intake, its volumes are insignificant, and no cyclical behavior is observed. It happens due to the baby crying during feeding, which is explained by sore gums. At the same time, when screaming, children swallow too much excess air. Also, you should not force your child to eat while he is teething.

You can help your child in the following ways:

• Massage the gums with your finger or using a teether.
• Apply a gel with an anesthetic component to the gums.
• Avoid force-feeding if the child does not want to eat. Incorrect introduction of complementary foods

Vomiting due to improper introduction of complementary foods occurs once and does not harm the child’s health. It is explained by the fact that the body either does not accept the new product, or that the enzymatic system is not yet able to cope with the introduced components.

If vomiting occurs, the new product should be excluded from the child’s menu for several weeks or more. After this time, you can offer it again, but in small quantities.

Psychogenic vomiting

Neurotic vomiting is typical for children over the age of three. It occurs as a reaction to a certain stress factor.

Common causes of psychogenic vomiting are:

• Parents insisting that their child eat
• The child has experienced strong positive or negative emotions, including resentment or anxiety.
• The child is very worried before any important event for him.

If a child experiences episodes of psychogenic vomiting, it is necessary to protect him as much as possible from a stressful situation and consult with a child psychotherapist.

Vaccination against rotavirus

There are two vaccines - the Belgian Rotarix and the Russian RotaTek. Only RotaTek is registered in the Russian Federation. It contains the 5 most common strains. Vaccination against rotavirus infection is not included in the national vaccination schedule, but it can be done at the request of parents. RotaTek has strict age restrictions and intervals between revaccinations - be sure to consult your pediatrician.

“The effectiveness and safety of vaccines against rotavirus infection, subject to age limits, has been confirmed in many studies,” says Elena Kolganova, a pediatrician at the Fantasy children’s clinic. — After receiving the third dose of the vaccine, the number of hospitalizations decreased by 100%, and visits to the clinic decreased by 96%. Rotavirus, unlike influenza, rarely mutates, and therefore vaccination does not need to be carried out every year - immunity lasts up to three years.”

What can you give your child for vomiting and diarrhea?

Since vomiting is not an independent disease, but a symptom of poisoning of the body, or a sign of some kind of infection, antiemetic drugs should not be offered to a child. Stopping vomiting with the help of antiemetics will only worsen the patient’s condition, since all harmful substances will remain inside and be absorbed into the blood. If the cause of vomiting is not food poisoning, you cannot self-medicate. It is necessary to seek help from specialists as soon as possible in order to prevent serious problems with the child’s health.

To stop diarrhea, you should also not give your child antibacterial drugs (Enterofuril, Levomycetin, Loperamide (Imodium), Furazolidone), since most often they will not have a therapeutic effect. Statistics indicate that in the vast majority of cases, diarrhea in childhood is caused by a viral intestinal infection, food poisoning, or overeating. In each of the three cases, antibiotics will not help. In addition, stopping diarrhea, like vomiting, will cause harmful substances to stay longer in the body and continue to poison it from the inside.

Most likely, parents who independently gave their child an antibiotic for vomiting and diarrhea will claim that both of these symptoms stopped 1-3 days after starting to take the medicine. However, it is known that a viral intestinal infection goes away on its own during this period, which means taking antibiotics was unjustified and unnecessary. In case of poisoning, diarrhea stops after all harmful substances are eliminated from the body. Therefore, antibacterial therapy does not have a positive effect on the course of the disease.

However, you can help your child’s body cope with infection and poisoning by offering him probiotics and enterosorbents. The action of the first drugs is aimed at destroying viruses, and the second at binding harmful substances and preventing them from entering the blood. Therefore, in case of food poisoning, the child is given enterosorbents, and in case of intestinal infection, probiotics.

If the child is very small and is breastfed, then he is allowed to be given Enterosgel, probiotics Linex and Bifidumbacterin. When the child is over two years old, he is prescribed the following sorbents: White Coal, Enterosgel, Filtrum and Smecta. After two years, diarrhea can be eliminated with a drug called Enterol.

Also, for diarrhea, regardless of the child’s age, he can be given Zincit (10 to 20 mg per 24 hours), or another zinc preparation. As for Zincite, the course of treatment is from 10 to 14 days.

So, the first priority facing parents is to restore electrolytes and lost fluids. The child is not given antiemetic drugs, but for diarrhea they are offered either enterosorbents or probiotics, depending on the cause of the disease.

Lost fluid is restored using special saline solutions, which can be purchased at a pharmacy. The most famous of them are Regidron and Regidron Bio, but you can also buy the drugs Disol and Trisol. If you can’t visit a pharmacy, you can make your own saline solution. To prepare it you will need a liter of boiled water, a teaspoon of salt, five teaspoons of sugar. It is necessary to ensure that the sick child constantly drinks this liquid, but in small sips.

As soon as the attack of diarrhea or vomiting ends, you need to give the child water or saline solution. You should not wait for the medicine to work. If vomiting recurs, then water is offered again. Infants are placed to the breast as often as possible and given additional water during feeding. Older children are fed boiled vegetables, rice, lean meat, and are offered kefir or other fermented milk product. Food is given in small portions. Until the end of the illness, children can be on the BRNS diet (lamb, rice, apples and crackers). Liquid must be supplied to the body during breaks in food (at least 60 ml for infants, at least 100 ml for children after 2 years). If a child drinks the required volumes of liquid, but asks for more, then you should not refuse him this.

During vomiting and diarrhea, carbonated drinks and juices, chicken broth and milk, as well as rice water are strictly prohibited. All these fluids will aggravate the course of the disease by dehydrating the body.

If vomiting and diarrhea are persistent and do not stop for 4 hours, then you should call a doctor so that he can adequately assess the child’s condition. Hospitalization may be required, as persistent vomiting often indicates meningitis, a concussion, or other serious pathology.

Situations in which calling a local doctor or ambulance is mandatory:

• Three or more episodes of vomiting, one after the other, in less than three hours.
• The child’s refusal not only to eat, but also to drink liquids.
• Everything that the child eats and drinks comes out in vomit.
• Lack of tears while crying.
• The child is drowsy and lethargic, he has dry lips and eyes.
• The vomit contains blood.
• Complaints of headaches, as well as neck muscle tension and loss of consciousness.
• Suspicion of poisoning.

Other episodes of vomiting and diarrhea, as a rule, can be successfully stopped by taking the above medications and adequately replenishing lost fluid and electrolytes.

On the topic: what to do if a child has severe vomiting?

What to feed a child after poisoning

The general power supply scheme is something like this:

Days 1–3 - fasting with watering or rice and cereals (ideal) or fast-carbohydrate options - drying, starchy jelly. Day 4-5 – cereals, you can try some boiled vegetables. Day 6–7 – cereals and thermally processed vegetables. Day 8-9 - you can add a baked apple, egg white. Day 10–11 – fish, some seasonal fruits. Days 12–14 – optional legumes, meat, seeds, nuts.

I don’t consciously include milk, but if you really like dairy products, then include them after the 14th day.

And now I’ll give you a couple of recipes so you don’t get bored on sick days.

Blueberry jelly

Pour 30 g of blueberries with water, boil for 10–15 minutes, leave on low heat, strain, add sugar, boil. 10 g of potato starch, diluted with cold water, without letting it boil, remove from heat and add a couple of drops of lemon.

You can pour jelly over semolina pudding frozen in a mold.

Cooked rice meatballs

Option with egg white (if quick recovery) for days 4–6.

Rinse the rice, boil as much as possible, mix with beaten egg white, put in a mold and steam or cook in the oven. Can be mixed with high-quality cocoa without added sugar or flavorings.

What not to do if you have intestinal disorders:

• Antispasmodics and painkillers should not be used without consulting a doctor;
• Do not use medications to block diarrhea without consulting a doctor. Otherwise, toxins will be absorbed into the blood and poison you, and this will also stimulate the growth of pathogenic bacteria, which in children can lead to paralytic intestinal obstruction;
• Do not apply heating compresses to the abdominal area;
• You can't do enemas.

Important: if it is impossible to replenish the water-salt balance, signs of severe dehydration, blood in the stool, or diarrhea that you cannot stop, be sure to call a doctor.

How to help the body recover

“Previously, there was an opinion that if you have a rotavirus infection, you should not consume dairy products,” says Elena Kolganova. — Now scientists have revised their opinion on this matter: if a child is breastfed or formula-fed, then nothing needs to be changed. For adult children, it is advisable to remove fresh fruits and vegetables, as they enhance peristalsis and fermentation processes in the intestines.”

If a child has a temperature above 38.5 ºС, you can give him antipyretics, and in case of severe pain - antispasmodics. You should not give painkillers - this will mask the symptoms and it will be difficult for the doctor to make a diagnosis. You should not rinse your child’s stomach - this will increase vomiting and lead to extreme dehydration - loss of consciousness, convulsions.

“Treatment of uncomplicated rotavirus infection is symptomatic: the main thing is to drink plenty of fluids. Vomiting and loose stools usually go away on their own. However, taking probiotics can speed up the recovery process; their administration is safe and quite effective,” says Daria Zakharova.

It is always easier to prevent a disease than to treat it - observe the rules of personal hygiene and teach your children to do the same, wash fruits and vegetables and do not drink tap water.