Doctor’s Rx: Caring for your sick child

Vomiting
True vomiting in a newborn, not just a little spit-up, needs to be evaluated, especially if it is projectile, forceful or happens after two or more feedings in a row.

For infants and toddlers, call your pediatrician if your child is unable to keep down even small amounts of fluids, the vomiting persists for more than a few hours, there is any bright red blood or dark brown material in the vomit, or if your child really looks sick or has any signs of dehydration such as decreased wet diapers.

This time of year I receive so many phone calls from nervous moms with vomiting toddlers and children, and I know firsthand that it’s no fun to clean up throw-up. When a stomach virus hits, the most important thing is to keep your child hydrated, which can be challenging when everything seems to come right back up. Start small with 1 teaspoon of a clear electrolyte solution every 10 or 15 minutes and if the fluid stays down, you can slowly increase the amount over several hours. Go slowly; a common mistake is to let your thirsty child drink several ounces at once, which may be too much for their upset tummy to handle. If your child can’t keep down even small amounts, call your pediatrician. If the vomiting appears to be caused by a stomach virus, which is common this time of year, after examining your child, your pediatrician may prescribe a dose of an anti-nausea medication to help your little one keep down fluids.

Diarrhea
Although there are several viruses that cause diarrhea every winter, the most common in young children is rotavirus. Many parents often refer to this as the “stomach flu.” Thanks to the rotavirus vaccine, fewer infants are now hospitalized for dehydration from this very contagious virus every winter. The typical course is fever and vomiting for a few days followed by watery diarrhea for a week, or sometimes more.

The most important thing to remember is to keep your child hydrated by giving plenty of fluids. Call your pediatrician if your child refuses to drink or can’t keep down fluids, there is blood or excessive mucus in the stool, your child has fewer wet diapers than usual, the diarrhea lasts for more than one week or there are more than eight stools per day. A tip that I like to give parents to help prevent diaper rash is to use a diaper ointment with zinc oxide at every diaper change.

Why does it seem like my toddler is sick all winter long?
Healthy children can catch around 10 infections a year, specially if they are in child care or preschool. During the winter it's common for them to bring home something new every two or three weeks. Most of the usual infections are coughs and colds, which are caused by viruses and will clear up on their own. So they may be sick for a few days to a week or so, they finally get well and then a few days later their nose starts running again. Kids pick up the colds from their friends and classmates since these germs can survive on surfaces for hours and spread easily from person to person.

When can he return to day care, school or attend a birthday party?
I can't tell you how often I get asked this question. Generally speaking, he can be around other kids once his fever has been gone for 24 hours and he's feeling better. If your child has been placed on an antibiotic or antibiotic eyedrops, he should take the medication for at least 24 hours before being around others. Often it's the mild symptoms, such as the slight runny nose and cough, that leave parents wondering what to do — especially since many kids have a cough and runny nose most of the winter. Only you can make that game-day decision, but be considerate of others and ask yourself, would you want another child with the same symptoms around your son? And check with your child care or school as they may have specific guidelines for when sick children can return.

How can I help keep my children healthy the rest of the winter?
Hopefully you've already vaccinated everyone in your family against the flu, as flu vaccines are now recommended for everyone over 6 months of age. The best way to prevent coughs and colds is to teach your children to wash their hands, especially before they eat or rub their eyes or nose, which are the three most common entry points for germs. Eat healthy, exercise, get plenty of sleep and take your entire family in for regular checkups with their doctor.

Dr. Tanya Remer Altmann is a nationally recognized parenting and medical expert who has answered parents’ questions in her own private practice as well as in countless articles and television interviews, including regular contributions to TODAY. Still a practicing pediatrician, Dr. Altmann is also the mother of two young children — so when it comes to those haggard questions at 3 a.m., she shares the pain!

Dr. Altmann is the author of “Mommy Calls: Dr. Tanya Answers Parents’ Top 101 Questions About Babies and Toddlers” (American Academy of Pediatrics, October 2008).

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