Q&A with Dr. Jay

Question: My 5 year old had to go the ER for IV fluids because he got dehydrated from a stomach/intestinal flu. What can I do to avoid this the next time?

Dr. Jay: The most common mistake that people make is that they give their children too much liquid too soon after vomiting. I suggest that you should not give any fluids to your child until 1 hour has passed since a vomiting episode. Once that hour has passed where there has been no vomiting, you can start by giving your child an ounce of Gatorade or Pedialyte. You may have to wait several hours for the initial vomiting episodes to pass, so be patient. Your child will not dehydrate that quickly. Make sure that your child sips this ounce and doesn’t drink it quickly. They may cry for more but do not give them more. If they keep this ounce down for 1 hour, then you can offer another ounce. Do this for a total of three times and if they keep it down each time, then you can offer 2 ounces the next time. Remember to wait at least an hour in between. Usually, the parents are giving their children 4- 8 ounces and not waiting for the stomach to settle and this just causes the child to vomit even more. Keep your child on just clear fluids (not milk) for 8 hours. If they have not vomited, they can be offered crackers or toast. If they cannot tolerate food, keep them on the Gatorade or Pedialyte for a whole day then try again. Don’t push the food. Make sure they remain hydrated before they start eating solids. If after a couple attempts, your child cannot keep even an ounce down after waiting an hour, call your doctor or seek medical attention because they may need an IV.

Question: We just received a note from our preschool that hand, foot, and mouth disease is going through the school. What should we look for in our child?

Dr. Jay: Hand, foot, and mouth (HFM) disease is caused by a virus called Coxsackie A. The name is derived because this virus causes distinct lesions on the palms of the hands, the bottoms of the feet and ulcers to appear on the inside of the mouth. The lesions on the hand and feet at first look like small insect bites because they are slightly red and raised. They then soon get a clear or slightly white head on the bump. They do not pop and they do not appear to hurt the child. The main problem with HFM is the lesions inside the mouth. These lesions look like canker sores or ulcers and can cause pain. The child will often drool because it hurts to swallow. The child can also get dehydrated because they will not drink. This virus may bring a low grade fever. Because this is a virus, this is self limiting and an antibiotic is not needed. The fever is usually gone in 2-3 days. The oral lesions will resolve in 5-7 days and the lesions on the hands and feet will last a little longer, about 7-10 days. Make your child comfortable by keeping the fever down with fever reducers and offer cold foods and drinks like ice cream and popsicles for their mouth pain. Because this virus is so contagious, by the time it is diagnosed, it is too late for the other children in the daycare. The infected children do not officially have to be quarantined and they can return to school or daycare when they no longer have a fever.

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