Rotavirus season again
Posted on Mar 8, 2009
We unofficially think of March in Massachusetts as the diarrhea month since that is when we typically see most cases of rotavirus. And we have started to see some cases of this. Rotavirus is the single most common cause of diarrhea in children—in fact almost every child will be infected with this at least once by the time they are 5 years of age. This is true for all parts of the world. In young children, rotavirus infection gives a typical course of initial fever and vomiting, followed by diarrhea that can easily last up to 10 days. The diarrhea is yellow, watery, foul-smelling and explosive and often is described as shooting out of the diaper. The combination of vomiting and diarrhea can lead to severe dehydration. Here in the United States, it leads to many children needing Emergency Room visits and hospitalization for IV fluids, but fortunately is not a frequent cause of death. However, worldwide, it is estimated that rotavirus causes at least 500,000 deaths each year in children due to the dehydration it causes. This is truly a staggering number to reflect upon.
Treatment for this virus is supportive—maintaining fluid intake and replacing fluids as necessary until the illness passes. There are no antibiotics or specific medicines to give for this.
We use salt-based solutions as our main rehydration solutions. Commercial brands available include Pedialyte, Ceralyte, Rehydralyte and Infalyte. These have the correct balance of salts and sugars necessary. Juices and sports drinks have too much sugar in them to use exclusively. A home recipe to make your own oral rehydration solution is to take 1 liter of water (4&1/4 cups) and mix in 1 tsp of table salt and 8 tsp of sugar. A ½ cup of orange juice or a mashed banana can be added to improve the flavor and add in some potassium.
The basic idea behind treatment is to feed small, frequent amounts of this oral solution during the vomiting phase of the illness—for example, small sips or teaspoons every 5-10 minutes. If your child vomits, just continue with this plan. Some fluid is still being absorbed and the vomiting should stop relatively soon. If you have a nursing infant, do this along with continuing to nurse regularly, as most infants will tolerate breast milk quite well.
Once the vomiting has subsided and/or the diarrhea phase has begun, our goal is to go back quickly to a regular diet as soon as the child will take it and then supplement it with the oral rehydration solution—ideally giving some to drink after each loose stool. Excessively limiting the diet to prevent diarrhea or taking lactose out of the diet has not been shown to be helpful. It seems that the better nutrition the kids are able to get in, the sooner they recover from the illness.
We have also been recommending the idea of a probiotic—the “good bacteria” to replace what has been lost in the bowel due to illness. There are a number of studies that show quicker recovery if this is included in the diet. Culturel capsules and Florastor are two common brands. Food should be supplemented with this twice a day until the diarrhea resolves. Live culture yogurt is another excellent source of these bacteria.
Here are a few links to other sites which review these topics:
http://pediatrics.about.com/od/weeklyquestion/a/05_vomiting.htm
http://www.keepkidshealthy.com/welcome/treatmentguides/gastroenteritis.html
