Thursday, October 1, 2015

Vomiting and dehydration in children - my experience

This was not the first stomach bug to hit our family, and not the first time one of our children got worryingly ill. We have some experience. Every time though, there’s always that moment when you are uncertain about what to do, and you turn to consult external sources. Like many other parents do when they are worried about their children, we use the internet, however we are also fortunate enough to be surrounded by a well-educated support network, including some medical doctors.

As most of you are aware, the biggest concern when it comes to a stomach bug is dehydration, and severe dehydration is very dangerous. Our focus, therefore, was on determining how dehydrated our child was, and at which point we would need to seek medical treatment (intravenous fluids).

Please note, as any website will tell you: if you are not sure about how dehydrated your child is, you should contact your doctor.

Yes, I am using a double moral here. Because, 1/ we did speak to at least one medical doctor friend, and 2/ the hospital here will almost ALWAYS use maximum intervention, in my (limited) experience. I knew that if we came into the ER with a sick child, even if his dehydration was only modest, it would be treated with an IV, overnight hospital stay, blood tests, and other invasive methods that would brutally bother our already miserable child. So I wanted to make *really* sure I wasn’t overreacting.

Most articles or websites on dehydration in children will give you a list of things (most of the below are from one of my books by my favorite pediatrician, Dr. Sears) to look for, such as:
  • Dry or sticky mouth, chapped lips.
  • Dry, cool skin.
  • Few or no tears when crying.
  • Eyes that look sunken into the head.
  • Lack of urine for 8-12 hours in an older child (or only a very small amount of dark yellow urine)/ Urinating about half as often as usual, urine concentrated like apple juice.
  • Fatigue or dizziness in an older child, less active and playful, but will make eye contact and respond to you.

I found this other really great article however, that gave us some more concrete ways to determine the extent of our son’s dehydration:
  • Prolonged capillary refill time of more than two seconds.
  • Abnormal skin turgor.
  • Abnormal respiratory pattern.

You can look these up if you don’t know exactly what they are, but it’s pretty straight forward. By going through these lists and checks, we were able to determine that indeed, our child showed signs of dehydration, but at worst only moderate. The article helped us not rush to the ER at this point, since, 

“Oral rehydration therapy is the preferred treatment of mild to moderate dehydration caused by diarrhea in children. Appropriate oral rehydration therapy is as effective as intravenous fluid in managing fluid and electrolyte losses and has many advantages.”

We got some Pedialyte, and we knew that as long as our son was drinking water and not having any diarrhea, even though he seemed to vomit up the water as soon as he drank it, he was getting enough fluids to stay, “mildly to moderately dehydrated.”

Again, please note: We are lucky enough to live in a community surrounded by doctors, and the ER is just a few minutes away, practically free, which is why we felt safe to make a close call like this in this situation. If you are in a different situation, you may want to play it safe!


What would you do in a situation like this? What do you usually do when you are worried about a child’s health?