Stomach Flu: A Primer

Stomach Flu:
What it is
When to worry
What to do

Stomach flu comes in seasons, and Cleveland has just entered its winter season
of stomach flu.  So here is some guidance to help you if your family catches it.

What it is

  • Stomach flu is an infection.
  • The germ is a virus.
  • The infected part of the body is the gut- typically the stomach,
  • small intestine, and large intestine.

The virus this time of year is a species called rotavirus.
Rotavirus has the very curious property of traveling in waves
across the US every year.
Every year waves of rotavirus sweep across the United States,
starting in the Southwest, ending up in the Northeast.
Our part of the country sees it arrive usually sometime in January, 
and leave sometime by May.
This year it hit Cleveland sometime around January 4-5.

You can only get rotavirus infection, or really any stomach flu,
by having the virus land in your gut, and that has to happen 
by swallowing the virus.  The virus can only come from another person.
So like all viruses, the only cause is catching the virus.
You cannot get stomach flu by getting chilled, or wet, or any other
way but catching the virus.

Once the virus is in your gut, here is how it makes you sick.

The virus is quite good at getting inside your cells, taking them
over, forcing them to make billions of new viruses, and thereby
popping or killing the cell.  The infection only ends when your 
immune system kills every cell of yours that has a virus in it.

When the virus kills the cells of the gut, it kills mainly the cells on the
lining of the gut.  This leaves the lining greatly damaged, very similar
to being burned, and is main event explaining nearly all the symptoms of stomach flu. 

When the virus is in the stomach, the burn of the lining
mainly causes vomiting.

When the virus is in the intestines, the burn of the lining
mainly causes diarrhea.

Wherever the lining is damaged or burned, the inflammation
that results makes you feel awful and also causes fever.

As with every illness, when you feel lousy you:

  • Don't eat well
  • Don't sleep well
  • Don't act well

When to worry

With stomach flu, the main things to watch out for are:
  1. Dehydration
  2. Severe abdominal pain
  3. Bloody diarrhea

Dehydration is the state of lacking enough water to function well.
Our bodies are about 66-70% water, so each of us is a bag 
made up mostly of water.  That is why getting water all the time 
is so important.

Dehydration is not the same problem as vomiting alot or having loads 
of diarrhea.  You can be terribly dehydrated with very little vomiting or diarrhea, 
and you have quiet severe vomiting and/or diarrhea and not be dehydrated.

So how do you know if you are dehydrated?
You should worry about dehydration if you see these signs appear:

  • Very decreased or no urination
  • Sunken eyes 
  • Dry cracked lips and mouth
  • A wilted appearance, like a plant that has not been watered for weeks
Dehydrated kids are often very irritable, but so are kids who are ill but not dehydrated.
But if your child  is acting well, not irritable, it is unlikely they are dehydrated.

Severe abdominal pain
Everyone gets stomach aches with stomach flu, but you need to worry when the 
pain gets severe.

How do you know?  Severe abdominal pain has some important features:

  • It really hurts alot, more than the usual tummy ache
  • It keeps going and does not stop
  • It gets worse every hour
  • It seems to happen at one specific spot that you can touch with your finger
If you see these features, call for guidance and help.

If your pain is not that severe, comes and goes completely, does not get worse 
over time, and feels lousy all over the tummy area, it is less severe.

Bloody diarrhea
That's easy to know if present or not:
No blood, no bloody diarrhea,
Blood in the stool means bloody diarrhea.

What to do

In General

As with any viral illness, there is no medication that will cure the illness
or heal the burn-like impact on the lining of the gut.

In the absence of a cure, all efforts to help fall into the category of comforts.

Cures have to be taken no matter how they taste or feel.

Comforts are only helpful if they comfort, so your child has total

say over whether they work.

The key comforts for stomach flu are:

  • Fever control and pain relief- with ibuprofen or acetaminophen
  • Fluid- water, flat soda, pedialyte, they all work well.
  • Being held or massaged
Notice that eating food itself is less important than taking fluids.  See below for more
on this important point.

During heavy vomiting
If your child is vomiting enough that he or she cannot drink fluids, try 
giving 1 teaspoon of fluid every 5 minutes

If you do this for 8 hours, you will get 16 ounces of fluid in, plenty to avoid 

Why a teaspoon- it's enough to get 16 ounces in a day, and small enough to be 
absorbed before it hits the stomach and get expelled.

Heavy vomiting lasts about 2-3 days on average and since the stomach is at the 
start of the gut, usually comes before the diarrhea or with it.

During diarrhea, after vomiting
Once vomiting stops, you can feed your child any fluid, including water, flat soda,
soup, pedialyte,  but also food.

Bland foods like potatoes, bananas, rice, applesauce, and toast are well-tolerated.

Avoid hot spicy foods, but most kids do anyway.

Diarrhea is just like the runny nose of a cold.  In both situations, a lining 
is damaged/burned, and fluid leaks out.

Just as with a runny nose, sometimes the lining heals in a day, sometimes
in a week, sometimes in a month.

Typically diarrhea goes on for 1-2 weeks, but if your child looks well in a week
or two, eating well, good energy, no fever, no blood in the stool, but still has loose
stools for a month, that is not too worrisome.

Do call if they continue to act ill after 2 weeks, or anytime you see bloody diarrhea, 
anytime you think there is dehydration (see above), or if the diarrhea goes on 
beyond one month.

Bottom Line

  • Stomach flu is viral disease.  In January-April around here it is caused by the rotavirus
  • By far, nearly all kids with stomach flu come to no harm, just like with colds, the other viral illness
  • The key items to watch out for are dehydration, severe abdominal pain, and bloody diarrhea
  • Call if you think these are developing
  • If not, look at our approach to giving fluids and comfort measures.
Dr. Arthur Lavin

The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

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