Acute gastroenteritis, also known as AGE to pediatricians and stomach flu to many parents, is the bane of all.  It can cause belly ache, vomiting, fever, and diarrhea in varying quantities and combinations. It can last anywhere from 12 hours (if you’re lucky) and a week (if you’re not).

What causes AGE?

For the most part it is caused by viruses.  Rotavirus used to be the most common, causing tens of thousands of infants and young children to get dehydrated and end up in the hospital each year.  However, in the US, vaccines in the against Rotavirus have saved us 40,000-50,000 hospital admissions yearly. Unfortunately in the rest of the world it is still a main cause of diarrhea in children.

Viruses such as norovirus, astrovirus, adenovirus, and still sometimes rotavirus are the most common causes of typical AGE.  There are some bacteria that cause AGE, such as salmonella and shigella, but they can also cause a worse infection with bloody stool and high fever.

Isn’t there an antibiotic or something that will fix it?

No.  Since most of the time AGE is caused by viruses we don’t have medicines to treat it with.  In fact, even if it’s one of the ones caused by a bacteria, most of the time we don’t treat it with antibiotics because most of the time if doesn’t help, and can even make things worse.

So what can I do to help my child get through it?

Supportive therapy.  Too much dehydration is what we worry about, so supportive therapy in this case mostly means keeping them hydrated.  Giving small amounts of fluids frequently helps the stomach to not rebel as much. Sometimes this means as little as 5 ml given in a syringe, then waiting 15 minutes, then another 5 ml, then another 15 minutes, etc.  If they’ve kept fluids down for at least 15 minutes, then they have absorbed quite a bit even if they throw up.

Deciding which fluids to give can be troublesome.  Obviously we prefer electrolyte solutions like Pedialyte, but sometimes kids won’t drink these.  One option is to mix in half a popsickle for flavor. Really, though, we are generally happy if the child is drinking something and staying hydrated.  Even if it’s milk.

Food isn’t nearly as important as fluids, and we’re okay with the child not eating for a day or two.  However, there’s no reason to restrict foods if the child asks for them. You might want to stay on the bland side, but recent thought is that the old BRAT diet is not helpful as we thought.

The most recent studies have shown that probiotics don’t help with AGE.  Also medicines like immodium are not recommended as we want whatever is in the gut causing problems to be able to get out.

There are a few different prescription medicines for vomiting and nausea.  They don’t always work, but can be helpful if they do. However there are some side effects, and they don’t always work.

Other treatments such as pediatric pepto (don’t use adults pepto as it has aspirin in it), heating pad on low may help on a limited basis.  

How long will it last?

Anywhere from a few hours to a few weeks.  I usually tell people to expect 5-7 days with the 3rd day being the worst.  However, I’ve had some last as long as a few weeks.

When do I need to worry?

Dehydration is usually what’s going to get the child put in the hospital.  To check for hydration you look on the inside of the mouth, not the lips – it should be moist.  Then you press one of the fingernails until it turns white, and it should turn back pink right away.  Next, you can press down on the skin of the chest until it turns white, and it should turn back pink within a few seconds.    Number of wet diapers, if there are tears if the child cries, and any weight loss can be taken into account.

If the child develops blood in the diarrhea, a high fever, or other signs of being more ill, especially if they’re very young, you should at least call your doctor to see if they should be seen.

Also, if diarrhea lasts more than about 5-6 days and isn’t at least getting more solid, I generally want to check out the diarrhea to see if we can find which virus or bacteria is causing the trouble.  Most of the time it doesn’t help with treatment – as antibiotics aren’t appropriate to use usually – but it can be helpful to know the cause and how that virus or bacteria usually acts.

Finally, if you just aren’t sure, or want the child to be checked, then call.  That’s what your pediatrician is there for.