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Dr. Navitsky
Dr. Navitsky, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1037
Experience:  US Pediatrician licensed in California living abroad.
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My 2 year old (28 mos) daughter has been vomiting sporadically

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My 2 year old (28 mos) daughter has been vomiting sporadically for 6 days, very little food intake, fair to good fluid intake. She is sleeping quite a lot more than normal, but when she is awake, she is not lethargic. She seems happy and often playful, even surprisingly exuberant at times, though she has a marked decrease in overall energy (The first two days, she mostly just sat or slept on the chaise). If I have to wake her from sleep, though, she is extremely weepy and inconsolable for at least half an hour.

On day 1, it started with spontaneous vomiting (after suddenly gagging out of nowhere on nothing) one afternoon, approx. 5 hrs after lunch. I did note foods from lunch in the vomitus, along with what seemed to be large amounts of saliva--if it contained true mucus, it was clear. Vomited 4 or 5 times in the first hour, after that it was only after consuming anything (even fluids--and often even just swallowing saliva) for the next few hours. Within 4 or 5 hrs she was taking fluids again, mostly water or enhanced water with electrolytes.

It has pretty much maintained this course ever since. Decrease in hunger, but when she is hungry or asks for something, she can't keep it down, still throwing up what seems to be a large amount of saliva. I'm giving her watered down white grape juice now, and she tolerated some orange juice today. Over the course of 6 days, she has successfully held down, in total: approx. 2 whole graham crackers (about an eighth of a cracker at a time), 8 saltines, 1.5 cups of honey Kix cereal, 2 cups of cinnamon applesauce, a slice and a half of american cheese, and about one 4oz "pouch" of apple(+veggies)sauce. Most food is rejected within seconds of it passing her lips, the nausea and gagging starting before she can even chew. I've noticed that proteins are rejected fastest (any and all meats, eggs, etc). She has tolerated the cheese only in very very small pinches. Gummy vitamins (tried giving a half of one, then a quarter of one) are thrown up within a minute or two. Now she refuses them entirely. The only food she can consistently keep down are small "sips" of applesauce.

As for bowel activity, no bm on days 1 and 2, a normal consistency (though a bit smaller than usual) bm on day 3. No bm on days 4 or 5. Now on day 6, bm x 3 but all very loose (almost diarrheal but opaque, somewhat muddy), decreasing volume with each one. Noted that the second one was almost "grainy". Bm's did not occur until she was given fruit juice (white grape, watered down). In order to increase caloric intake, I strengthened the juice today (day 6--approx half and half). This could explain the increase in bowel activity as well as the loosening of the stool, but not the graininess---i've never seen that before, even at full strength juice. Urine output is sufficient, but not quite as much as normal (she is potty trained and goes in an empty standalone training potty, so I can monitor her outs).

She normally eats heartily, drinks like a fish, and has bowel movements daily. She has suffered constipation issues in the past but she has been regular (via white grape juice daily) for 6 months now. If it matters, when her constipation issues began, her ped at the time ordered her off all dairy products until it was resolved (she was a 24+ oz a day milk drinker). It took almost two weeks and she has not liked milk ever since, will only drink it rarely now; giving calcium and vit d supplementation via orange juice, a daily Tums, etc.

She has a low-grade fever today only after having to wake her (twice--pick up brother from school and make a run to the store for more juice and applesauce in the evening). Other than that she has had no fever. At first, it looked like the rotavirus or norovirus (her brother and I have both had it in the past), or possibly something she swallowed that her body was trying to reject (a lego or perhaps a piece of dog food or something). But the way it's playing out, this does not seem to be either issue.

She is not complaining of any pain, stomach or otherwise, except for when food is in her mouth---she cringes and then starts crying--sometimes a minute or two after swallowing, sometimes while it's still in her mouth.

I'm not a rush-off-to-the-doctor/freak-out-at-every-sniffle kind of person, I know how to keep her hydrated, replace salts, creatively get more calories into her, wait it out, etc... but this progression is perplexing and I honestly am concerned now--because she hasn't begun to improve, I worry that whatever is wrong could be getting worse.

I have not taken her to the doctor yet, was expecting her to start bouncing back, but she threw up again at the store tonight, and then again at home before bed. What on earth could be causing this??

Please forgive me for such a long "question", just wanted to provide all possible info to give an accurate picture.
Greetings,

Thank you for the detailed history. The history of vomiting, loose stool, low grade fever suggest a viral infection. Viral infection often passes off in 3-5 days , sometimes can prolong though. You are giving symptomatic treatment with fluid replacement, that is good. There can be lethargy in viral infection. So she is sleeping more than usual. Adequate rest is a part of treatment in case of viral illness. Try to keep well hydrated by giving plenty of fluid, easily digested food like banana, rice, toast, etc. Sometimes, after a viral episode bacterial infection supervenes. It that case, start of antibiotic will be helpful. Small children can worsen very easily. As after 6 days, the symptoms are continuing, you should contact doctor for evaluation and to find out the precise cause.

Any query, please feel free to ask.
It will be my privilege to assist you.
Regards.
Customer: replied 5 years ago.
But the low grade fever (99) has only occurred today (was gone in under an hour), day 6, and only after being manually woken from a deep sleep. And the loose stool has only occurred today (day 6) after giving her a juice that causes loose stools for her. She has had virtually no other stool at all. This doesn't fit with viral infection at all (or bacterial). She throws up bananas, rice, and toast.

Sorry I am opting out of your question, & let other experts help you.
Customer: replied 5 years ago.
Thank you for trying.
You are always welcome to JA.
Regards.
Customer: replied 5 years ago.
Relist: Other.
The expert was unable to answer my question and opted out.
So even though she now has had symptoms for 6 days her symptoms still are most consistent with a viral gastroenteritis or "stomach flu/bug". She doesn't need fevers to have this. Her loose stools, not feeling 100%, and the vomiting I would consider part of the same illness. I do have a suggestion that may make a difference though. Relax on the caloric intake and try to concentrate solely on electrolytes. She will eat when she is feeling better. I would stop giving her juice to rehydrate especially now that you are giving more concentrated juice as this can lead to even more diarrhea. Give her an electrolyte solution Pedialyte if she tolerates it, or Gatorade something of this nature to drink and only worry about fluid input. You can offer her other foods and if she takes them she feels like eating them, if she refuses them she doesn't. Your goal with the food is not to make her not vomit (as what will come up will come back up and there is nothing to do to prevent i)t. As you noticed quite astutely! The things that take longer time to digest are more likely to come back up in the next vomit. There are no good over the counter vomiting meds. Return to normal diet when the child is ready is the quickest way to resolve the symptoms. Applesauce I would trade for yogurt again for the fruit sugar thing that can prolong her diarrhea. Yogurt contains live active cultures (try organic varieties for kids with low sugar) that may help repopulate her intestinal wall back with the normal bacterial flora sooner. You can also go out and buy probiotics but they are expensive and not that easily to find. OK why doesn't it sound like something more serious is going on. She doesn't have extreme pain that would make me think of some type of abdominal process like apendicitis or intestinal issues. She is active in between times when she feels bad and continues to play. The amount of output is not enormous enough so as to dehydrate her right away as in bacterial "stomach bugs", and she has no blood in her vomit or stool. I would keep on holding on if I were you. Time is on your side. Her symptoms should improve soon.....less vomiting and stool normalizing. Even when a child has symptoms for up to 1-2 weeks (hope yours doesn't last that long!) but they have a normal exam and nothing too concerning I wait before doing workup as long as they look good. Use your judgement on whether or not to take her in. If she worries you more go.....if not and you feel comfortable waiting it is OK to wait. If others start to have similar symptoms at home virus is your answer.
Dr. Navitsky, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1037
Experience: US Pediatrician licensed in California living abroad.
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Customer: replied 5 years ago.
If her bowel movements cease when I stop the juice, would that suggest a different possibility?

She has never been a fan of yogurt. If she won't take it, can I open a probiotic capsule and put it into her drink?

I guess I didn't rule out pain because I remember not being able to recognize or express it at a young age to the point that I required surgical intervention by the time it was discovered by my parents.

Thank you SO MUCH!
No her bowel movements should be less loose when you cut the juice and this only shows that the juice made her runny (we give juice to constipated kids as a first line "natural" laxative. If you have probiotics go for it! Put it in the applesauce better or a semi-solid. You need the kiddie variety culturelle Jr etc...... If my best experience most parents know when their child has pain. She would be less active and although may not say it hurts me there she can't bend, twist, get up and down with significant abdominal pain. You seem very very observant and I doubt that it would slip by you!! Also I'm assuming that your surgical intervention was for apendicitis....sometimes it can have a very mild course until it bursts but this is RARE and most of the time you know something is very wrong and will go to the doctor. So far you daughter has no warning signs so she should be OK!
Please accept if you feel I have helped you in what you were looking for. I will be online and happy to answer any other thought you may add on for the next few hours just add it onto the same question. Thanks and hope she feels better soon!
Customer: replied 5 years ago.
oh, also, i forgot to note (if this matters to your answer), in the home are myself, her 9 year old brother, her 6 month old brother, and a 10 month old girl I watch for a friend. None of us have shown any inkling of illness. That was my other reason for suspecting a possible condition and not an illness.

All in all though, I GREATLY appreciate your answer. Very thorough and insightful and you took everything I said into consideration. I cannot thank you enough! You gave an honest and knowledgeable response with actionable advice. Exactly what I needed.
I still would think first and second and third of virus. Incubation time sorry to tell you is between 3-even 10 days so there is still time for all of you! If the others get sick the same goes......electrolyte fluids lots, rest, and don't push foods. If something changes or her symptoms drag on go to her doctor as often time gives us new clues! Good Luck and thanks for the kind words.

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