What a 6-Year-Old Can Take for Upset Stomach
For a 6-year-old with upset stomach, the primary treatment is oral rehydration solution (ORS) to replace fluid losses, not medications—antimotility drugs are absolutely contraindicated in children, and antiemetics like ondansetron should only be used if vomiting prevents oral rehydration and only after age 4. 1, 2
Immediate Management Approach
First-Line Treatment: Oral Rehydration
- Administer oral rehydration solution (ORS) such as Pedialyte, CeraLyte, or Enfalac Lytren—not apple juice, Gatorade, or soft drinks 1
- Give 10 mL/kg (approximately 2-3 tablespoons for a 20 kg child) for each watery stool 1
- Give 2 mL/kg (approximately 1 tablespoon for a 20 kg child) for each vomiting episode 1
If Vomiting is Present
- Start with very small, frequent volumes: 5 mL (1 teaspoon) every 1-2 minutes using a spoon or syringe 1, 2
- Gradually increase the amount as tolerated—a common mistake is allowing the child to drink large volumes at once, which worsens vomiting 2
- Ondansetron (0.2 mg/kg oral, maximum 4 mg) may be considered only if the child is over 4 years old and vomiting prevents successful oral rehydration 1, 2, 3, 4
Dietary Management
Continue Normal Eating
- Resume age-appropriate diet immediately or during rehydration—do not withhold food 1, 2
- Recommended foods: starches (rice, potatoes, noodles, crackers), cereals, yogurt, fruits, vegetables, bananas 1, 2
- Avoid: foods high in simple sugars (soft drinks, undiluted apple juice, Jell-O, presweetened cereals) and high-fat foods 1
What NOT to Give
Absolutely Contraindicated Medications
- Never give antimotility drugs (loperamide/Imodium) to any child under 18 years—these are associated with serious adverse events including death 1, 2
- Antibiotics are not indicated unless there is bloody diarrhea (dysentery), high fever, or diarrhea lasting more than 5 days 1
When to Seek Immediate Medical Attention
Red Flag Signs
- Bloody diarrhea (may require antibiotics) 2
- Severe dehydration signs: decreased urine output, lethargy, irritability, sunken eyes, dry mucous membranes 2
- Bilious (green) vomiting (suggests intestinal obstruction) 4, 5
- Intractable vomiting that prevents any oral intake 2
- Altered mental status or signs of shock 1
Practical Algorithm
Step 1: Assess hydration status by checking skin turgor, mucous membranes, mental status, and urine output 2
Step 2: If no dehydration present, give ORS for ongoing losses and continue normal diet 1
Step 3: If vomiting is the main problem, start small frequent volumes of ORS (1 teaspoon every 1-2 minutes) 1, 2
Step 4: If vomiting persists despite small volumes and the child cannot keep anything down, consider ondansetron 0.2 mg/kg (maximum 4 mg) once 1, 4
Step 5: If any red flag signs appear or the child is not improving after 2-4 hours, seek medical evaluation 1, 2
Important Caveats
The 2017 IDSA guidelines emphasize that ondansetron may increase stool volume as a side effect, though it effectively reduces vomiting 1. The medication should only be used to facilitate oral rehydration, not as routine treatment 1, 2.
Probiotics may be offered to reduce symptom severity and duration, though specific organism selection should be guided by product literature 1, 2.