Re: throwing up, fever.
Asked by amb

Question:
 

 My son's caught this stomach flu that seems to be going around.  He has a fever and has puked a couple of times, and has chills. 

What do I do if

he throws up abotu 20 minutes after he got tylenol?  Will it have been absorbed already?  Can I give him more?  

I'm not sure what to do for him, beyond giving him tylenol and soda crackers and fluids.

Tips?

My Advice:

 

‘Tis the season…..for gastro

For the southern hemisphere, or at least where I come from, gastro viruses and food poisoning bacteria seem to be more prevalent in the summer season.  I don’t know the exact reason why, but I have a feeling that gastro bugs just prefer the warmer weather, same as the flu prefers the cold.  It is also the time of year with lots of family gatherings, which can encourage the spread.  With the introduction of the rotavirus vaccination, rota gastro is under control.  But I have noticed an increase in the other gastro bugs….so there is no escaping!  As the weather gets warmer, our hospital emergency departed is inundated with the dreaded vomiting and diarrhoea. 

Here are some tips to deal with gastroenteritis in children:

Fever

Always use medications as directed.  Keeping medication down in a vomiting child can be difficult, and sometimes giving the medication can cause a vomit.  Good antipyrexials (drugs that settle fever) are paracetamol and ibuprofen/nurofen.  If a medication is vomited within 5 minutes of the dose being given then the dose may be repeated.  Any longer than this, part of the drug will be absorbed and repeating the dose will risk overdose.  Paracetamol may be given 4-6 hourly, but no more than 4 doses in 24 hours.  Nurofen may be given every 6 hours, and ideally should not be taken on an empty stomach, which is nearly impossible during a gastro illness.  The occasional dose on an empty stomach will not cause any adverse effects.  Choose paracetamol first, then if the fever continues, or part of the dose is vomited, then nurofen may be offered.  You do not need to wait 4 hours after a dose of paracetamol before offering nurofen, as they are 2 completely different drugs.  Only treat fever that is associated with  irritability and misery, or if its above 38.5 degrees, as the fever itself has a role to play in killing the bacteria or virus causing the infection.  Leaving high fevers untreated may result in febrile convulsions.

try the non drug methods, like cool facewasher to the head, or tepid baths.

go with the flow when it comes to chills.  your child may be cold and shivery and want to wrap himself up in a blanket.  let him have a light blanket.  when the meds kick in, he will become sweaty and start to feel warm again.

Vomiting and diarrhoea

Vomiting and diarrhea are to be expected.  The body needs to expel the virus or bacteria, and vomiting and diarrhea is unfortunately for your child, the best way the body can do this.  What counts is how much V+D, and how your child is coping.  Doctors will avoid treating the actual vomiting and diarrhea, as it all needs to come out in its own time.  The best we can do is offer supportive therapies to avoid dehydration.  Also keep a close eye on the back end, as little bottoms with diarrhea can become red, sore and excoriated very quickly.  A good barrier cream (have a look at the chemist) or nappy cream should help.

Preventing dehydration

 Offer small amounts of fluid frequently.  Large amounts will cause vomiting.  If your child is having trouble keeping fluids down, try a ‘trial of fluids’.  This method is used in our paediatric emergency dept- give 2ml of fluid per kg of child every 20 minutes, for around an hour.  If this volume is tolerated (no vomits) then the volume can be increased gradually.  If this is not tolerated, you will need to seek medical advice.

Good fluids to offer include weak cordial, hydralyte or gastrolyte (available from the chemist, comes in sachets and ice blocks) or watered down flat lemonade.  Avoid giving sugary drinks as the sugar will only draw out fluid from the body and worsen the dehydration (anyone who has learnt about osmosis will understand).

At first, food is not important, once fluids are tolerated then food can be re-introduced.

Symptoms to be wary of 

If you are concerned, or if your child has the following, he should be assessed by a Dr:

Bloody diarrhea

Not keeping any fluids down within 6 hours

Moderate to severe dehydration involves: high pulse rate, pale grayish or mottled skin, lethargy and decreased responsiveness, dry lips, sticky or thick and stretchy saliva, no tears when crying, sunken eyes, or for babies-sunken fontanelles, less wet nappies and poor skin elasticity (if you pinch up some skin on the back of the hand, it should spring back down instantly.  If it takes a second or 2 to return to normal, then the child is dehydrated).  These symptoms need to be treated.

The hospital may choose to treat with a nasogastric tube (a tube that is inserted through the nose into the stomach, through which fluid is administered) or intravenous therapy via a drip.

Avoid contact with others to prevent the spread.