All children get the dreaded stomach bug or stomach flu at some time during childhood, and it is not uncommon to get one or more such bugs every year. While the stomach flu is horrible for all children, it can be even more awful for children with complex medical needs. There are, however, a number of strategies that can help your child get through a gastrointestinal illness and prevent hospitalizations.
Hydration is Key!
For many of our children, we are counting every calorie, weighing every diaper, and measuring every ounce that goes into them. That’s critical to keep them healthy and growing. But when a stomach bug strikes, we have to change our game plan. During a stomach bug, getting every last calorie into your child is not important. What IS important is hydration.
Think about what you do as a parent when you get a stomach bug. You drink lots of fluids, and you don’t eat much, if at all. You need to apply that same approach to your child. Push fluids as much as possible, and let the calories go for a few days. If you try to continue with a regular diet, most of those calories will come shooting out one end or the other of your child anyway.
If your child shows signs of dehydration or malnutrition at any time, is vomiting blood, or has bloody diarrhea, make sure to take him or her to see a physician immediately. Otherwise, you can probably treat the illness at home.
Kids with Feeding Tubes
For children with feeding tubes, stop giving formula or a blenderized diet, and switch to an electrolyte or rehydration solution like Pedialyte. If you can’t access an electrolyte solution, you can use a sports beverage instead, but know that these are not designed for children’s electrolyte needs. It is also possible to make your own electrolyte solution. Ask your doctor for a recommended recipe.
If your child has continuous vomiting, slow down the feeding as much as possible, giving 100% electrolyte solution. Those with feeding pumps should consider moving to continuous feeds. Those who bolus feed should administer the feed over twice the length of time. If your child has a GJ-tube, feed into the J portion of the tube during the illness.
A stomach bug is not the time to push oral feeding if your child is a partial or emerging oral eater. Use that feeding tube when you need it!
Once your child has proven he or she can keep down an electrolyte solution, you can try moving back to a diluted formula or diet. Start with 25% formula/food mixed with 75% electrolyte solution. Continue slowly administering the feeds. Over time, you should be able to move to a 50/50 solution of formula/food and electrolyte solution. Slowly transition back to the child’s regular diet, and begin increasing the rate or speed of administration.
If your child uses a blenderized diet, you can tailor the diet to your child’s illness. Often, a version of the BRAT diet, which stands for bananas, rice, applesauce, and toast, is helpful for a day or two. If nothing else, stick to bland, easily digestible foods.
While a typically developing child might beat a stomach bug in just a day or two, often kids with feeding tubes take much longer to get back to baseline. Don’t worry if your child needs to be on an electrolyte solution for a day or two, or if your child still needs slow or dilute feeds for as long as a week.
Kids on IV Nutrition
Kids on IV Nutrition, often called TPN or parenteral nutrition, can remain on their regular IV nutrition regimen during an illness. Stomach bugs are the one time when that central line comes in really handy! Note that it is possible for children on TPN to become dehydrated during a stomach bug, even if they are receiving normal amounts of IV fluid. Vomiting and diarrhea may increase the need for fluids. If you have flexibility with giving extra fluids, such as D5 or even Normal Saline, you may want to create a plan with your doctor for adding these in when your child becomes ill.
Kids who receive partial oral or enteral feeds along with their IV nutrition may need special attention during stomach bugs. The IV nutrition may not contain enough fluid to meet their needs. Fluids should be increased in whatever way is possible and convenient, including orally, by feeding tube, or intravenously.
Kids Who Eat By Mouth
Kids who eat by mouth should follow normal instructions for maintaining hydration during an illness. They should drink electrolyte solutions as much as possible. Other clear liquids, including plain popsicles, broth, jello, or clear juices or sodas, may also be given. Once a child can keep down clear liquids, a bland diet should be reintroduced slowly, such as toast, crackers, or rice, before resuming a normal diet in a day or two.
Many children with complex medical conditions have significant GI involvement, and a stomach bug may make that worse. Children who are already prone to reflux or vomiting may vomit even more; kids with pre-existing diarrhea or ostomies may see a greater increase in output. Kids who aren’t good oral eaters may become even more difficult to feed, and kids who normally have difficulty getting in enough fluid during the day may struggle even more.
In addition, many of these kids will have lingering effects from a stomach bug for at least week, and sometimes for months. These bugs can be really, really hard on kids! In some cases, adding a probiotic to their regimen may help their gut microbiome to recover after an illness. Probiotics can be given in medication form orally or through feeding tubes, or obtained through fermented foods, such as yogurt.
Of course, the best option is prevention. Washing hands is critically important. Since most stomach bugs are passed on through fecal matter, being careful with hygiene and diapering practices can stop the spread of these insidious bugs.