Parent Information for Pediatric Stomach Bug (Gastroenteritis)
First-Line Treatment: Oral Rehydration Solution (ORS)
The cornerstone of treating a stomach bug in children is oral rehydration solution (ORS), given in small, frequent amounts—start with 5 mL (1 teaspoon) every 1-2 minutes and gradually increase as tolerated. 1, 2
How to Give Fluids When Your Child is Vomiting
- Use a teaspoon, syringe, or medicine dropper to give very small amounts (5-10 mL) every 1-2 minutes, rather than letting your child drink from a cup 3, 2
- Critical pitfall to avoid: Do not allow a thirsty, vomiting child to drink large volumes rapidly from a cup or bottle—this perpetuates the vomiting cycle 2
- Gradually increase the volume as your child tolerates it without vomiting 3
- Correcting dehydration often reduces the frequency of vomiting 3
Amount of ORS to Give Based on Dehydration Severity
Mild dehydration (dry mouth, slightly decreased urination):
- Give 50 mL/kg (about 1 ounce per pound) over 2-4 hours 3
- Example: A 20-pound child needs about 20 ounces over 2-4 hours
Moderate dehydration (very dry mouth, minimal urination, decreased activity):
- Give 100 mL/kg (about 2 ounces per pound) over 2-4 hours 3
- Example: A 20-pound child needs about 40 ounces over 2-4 hours
Replace ongoing losses:
- Give 10 mL/kg (about ½ ounce per pound) for each watery stool 3
- Give 2 mL/kg for each vomiting episode 3
Feeding Your Child
Resume normal feeding immediately after rehydration is complete (within 4 hours)—do not withhold food. 2, 4
For Infants:
- Continue breastfeeding on demand throughout the illness 3, 2
- Bottle-fed infants: Resume full-strength formula immediately after rehydration 3
- Lactose-free or lactose-reduced formulas are preferred initially, but regular formula can be used under supervision 3
For Older Children:
- Resume age-appropriate normal diet during or immediately after rehydration 2, 4
- Recommended foods: Starches, cereals, yogurt, fruits, and vegetables 3
- Avoid: Foods high in simple sugars and fats 3
Medications: What NOT to Give
Do not give anti-diarrheal medications (like loperamide/Imodium) to any child under 18 years—these are contraindicated and potentially dangerous. 2, 4
- Antibiotics are not needed for typical stomach bugs, which are viral 1, 5
- Your doctor may prescribe ondansetron (Zofran) if vomiting prevents adequate fluid intake 2, 6
When to Seek Medical Follow-Up
Contact your doctor or return to the clinic if your child develops any of these warning signs: 3, 4
Immediate Medical Attention Needed:
- Severe dehydration signs: No urination for 8+ hours, no tears when crying, sunken eyes, extreme lethargy or irritability 3, 6
- Signs of shock: Cold hands/feet, rapid breathing, confusion, or unresponsiveness 3
- Bloody diarrhea (red or black stools) 1, 3
- High fever (>102.2°F/39°C) with severe illness 1
Call Within 24 Hours If:
- Unable to keep down even small sips of fluid despite proper technique 3, 4
- Decreased urine output (no wet diapers for 6-8 hours in infants, or <3 times daily in older children) 3
- Persistent or worsening vomiting despite small, frequent volumes 3
- Watery diarrhea lasting more than 5 days 3
- Increasing lethargy or irritability 3
- Abdominal pain that is severe or worsening 6
Assessing Dehydration at Home
Check these signs every 2-4 hours to monitor your child's hydration: 3, 2
- Skin turgor: Pinch skin on abdomen—should snap back immediately
- Mucous membranes: Inside of mouth and lips should be moist, not dry
- Mental status: Child should be alert and interactive, not lethargic
- Urine output: Should have wet diapers every 4-6 hours (infants) or urinate 3-4 times daily (older children)
- Activity level: Should gradually return to normal as rehydration progresses
Prevention of Spread
Practice strict handwashing and hygiene to prevent transmission to other family members: 3