NOROVIRUS (AND FRIENDS)

Norovirus

Norovirus, and its nasty “friends," have plagued us this winter! It is not uncommon to have bursts of the “stomach flu” throughout the year. However, this winter, these viral illnesses seem to be hitting harder than usual, as evidenced by an increase in ED visits. Severe outbreaks have even shut down school districts/daycares, creating a legitimate fear amongst parents. Acute gastroenteritis (A.G.E.) is the medical term for diarrheal illnesses usually caused by viruses such as Norovirus, but the reality is that there are many viruses that can cause A.G.E.

Outbreaks of these viruses spread like wildfire because they are so easily spread from person-to-person through direct contact or via fecally-contaminated food or water. All it takes is one infected person, for example, who then prepares food for a large group, and then suddenly, the whole group is sick.

 SYMPTOMS of A.G.E. include:

    ≥3 loose or watery stools in 24 hours

    Vomiting

    Crampy abdominal pain that comes and goes

    +/- Low grade fever

Symptoms typically last anywhere from 2-10 days, usually not exceeding two weeks. Severity will vary even amongst family members exposed to the same virus, depending on previous exposure and built-up immunity to that specific virus. So while mom and dad might have some crampy abdominal pain and mild diarrhea, their little 8 month old might be hit quite hard and suffer significant dehydration.

TREATMENTAcute gastroenteritis is caused by viruses, not bacteria, therefore antibiotics are NOT indicated for this illness. In fact, if treated with antibiotics, symptoms may become even worse. A.G.E. is generally self-limiting, meaning with some good hydration and T.L.C., it will go away on its own.

During the course of illness, most children will have a decreased appetite and they may not want to eat as much as usual. This is distressing for any parent. However, maintaining hydration is the MOST important factor, as level of dehydration directly correlates with the “severity” of illness.

 DIET- Keep their diets simple and age-appropriate.

    Infants: Breastfeeding or bottle-feeding should continue. However, if you find your baby is vomiting after bottle-feeds, it may be useful to reduce the volume of each feed, and increase the frequency instead (for example, if normal feeds are 4 oz. every 3 hours, change this to 2 oz. every 1.5 hours). This ensures that their overall 24 hour consumption is the same, while allowing their sensitive tummies to better tolerate smaller quantities at each feed.

    Babies/children that eat solids: Complex carbohydrates, lean meats, yogurt, fruits, and vegetables are better than foods containing high fats and sugar. Previously the “BRAT diet” (bananas, rice, applesauce, toast) was frequently recommended, however, newer studies suggest this does not provide sufficient nutrients. Foods high in sugars (including fruit juices) can actually increase diarrhea and cause electrolyte disturbances, and should be avoided.

    Probiotics: or other yogurt-containing live culture products, have been shown to replenish good “gut bacteria” and help reduce length of disease.

MEDICATIONS- Avoid the temptation of using anti-diarrheal medications and over-the-counter anti-vomiting medications. These medications can have adverse effects and are currently not recommended for children, unless specifically prescribed by your physician.  

COMPLICATIONS-The complications of A.G.E. are mostly associated with dehydration. At times, your child may need medical evaluation to assess the need for IV fluids and rehydration in a monitored setting.

 RED FLAGS to seek immediate medical attention:

    Decreased urine output (no urine in diaper for over 6-8 hours)

    Lethargy or ill-appearing

    Vomiting that is green (bile), bloody, or doesn’t stop (intractable)

    Refusal to drink any liquids

    No tears when crying

    Rapid, shallow breathing

    Severe abdominal pain

It is important to note that there are other disease processes that can cause vomiting, fever, and diarrhea. Everything from a urinary tract infection to appendicitis and other surgical emergencies can also manifest in this way. If your child looks very ill, has persistently high fevers, severe abdominal pain, prolonged symptoms or other alarming signs not listed above, these are NOT consistent with A.G.E. and you should seek immediate medical attention or consult your physician.

 PREVENTION-

    Wash hands thoroughly after diapering or cleaning up vomit.

    Keep contaminated diaper/trash away from food preparation areas.

    Use diluted bleach-containing products to disinfect contaminated areas (alcohol-based solutions have little effect on Norovirus).

    Frequent hand washing is the MOST important preventative measure for everyone in the family.

    If your kids are sick, keep them home.

As mothers ourselves, we know first-hand the misery and exhaustion of frequent laundry and smelly cleanup that is associated with Norovirus and its friends. Just remember to allow your child to rest, keep them hydrated with lots of fluids, supplement with probiotics, avoid sugars, wash hands frequently, and keep reminding yourself...this too shall pass!

 

Written by 3MD|THREE MOMMY DOCTORS™

DISCLAIMER: The information contained on this website are not intended nor implied to be a substitute for professional medical advice. It is designed to support, not replace, the relationship that exists between a patient/medical treatment facility and his/her physician. For specific medical advice, diagnoses, and treatment, consult your doctor.

 

REFERENCES

1.     Noda M, Fukuda S, Nishio O (2007). "Statistical analysis of attack rate in norovirus foodborne outbreaks". Int J Food Microbiol 122 (1–2): 216–20. PMID 18177970.

2.     Guarino A, Ashkenazi S, Gendrel D, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr 2014; 59:132.

3.     National Institute for Health and Care Excellence. Diarrhoea and vomiting in children: Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years. https://www.nice.org.uk/guidance/cg84 (Accessed on July 15, 2015).