Diarrhea and vomiting in children: preventing dehydration and when to go to the ER

Symptoms and causes of diarrhea and vomiting in children

The most common cause is a viral stomach bug such as norovirus, which spreads easily at home, at school and in daycare. Symptoms usually start 12 to 48 hours after exposure:

• Diarrhea (frequent, watery stools).
• Vomiting and nausea.
• Stomach pain.
• Sometimes fever, headache or body aches.

Signs of dehydration in children

Mild to moderate dehydration: plays less than usual, pees less (in babies, fewer than 6 wet diapers a day), has a dry mouth, cries with few tears, or has a slightly sunken soft spot.

Severe dehydration, go to the ER: very fussy or very sleepy, sunken eyes, cool or discolored hands and feet, wrinkled skin, or peeing only once or twice a day.

How to give oral rehydration solution: a little, often

Oral rehydration solution from the pharmacy replaces lost water and salts. Do not water it down.

• If your child is vomiting: start with very small, frequent sips, using a syringe or small spoon. If it stays down, slowly give more.
• For babies with diarrhea: offer the solution in small, frequent amounts, on top of breast milk or formula.
• How much depends on your child’s age and weight: follow the product label or ask the doctor.
• Keep breastfeeding. If you use formula, mix it at full strength unless a doctor tells you otherwise.
• Do not give sports drinks to young babies, or full-strength fruit juice or soda: they can make diarrhea worse.

What can a child with diarrhea eat?

Once the diarrhea starts to ease and your child is hungry, slowly go back to their usual food. Bananas, crackers, toast, pasta and cereal are usually well tolerated. Avoid apple juice, fried foods and full-strength fruit juice. For children over 1, a doctor may suggest holding off on milk for a while. There is no need to withhold food.

When can a video visit help?

An online doctor visit can help if your child is 6 months or older, is peeing, is keeping fluids down and has no warning signs, and you want to know how to give rehydration solution, what to feed them or whether they need to be seen. The doctor will ask about wet diapers or trips to the bathroom, watch your child on camera and tell you if an in-person visit is needed. If appropriate, the doctor can prescribe medication, dosed by weight. We do not prescribe controlled substances.

We do not see babies under 6 months. A baby under 3 months with a temperature of 100.4 °F (38 °C) or higher needs the ER right away. If your child has a fever, see also fever in children.

Antibiotics do not help viral diarrhea. Do not give a child over-the-counter diarrhea medicine without asking a doctor first. The doctor is a general practice physician and is not a pediatrician, and a parent with patria potestad or a legal guardian must be on camera for the whole visit. See the child doctor visit.

Warning signs by age

Call 911 or go to the ER if your child:

• Babies 6 to 12 months: has no wet diaper in 6 hours, has a sunken soft spot, vomits everything they drink or is very listless.
• Children 1 to 5: pees only once or twice a day, has sunken eyes or cold hands, or cannot keep fluids down.
• Children 6 to 17: has severe pain in the lower right belly, testicular pain, or feels dizzy on standing.
• At any age: vomits green or bloody fluid, has blood, mucus or pus in the stool, has severe pain in one spot of the belly, or is very hard to wake.

Going back to school or daycare in Puerto Rico

Norovirus keeps spreading for days after a child feels better. The CDC advises staying home until 48 hours after symptoms stop. Check your school or daycare's rules too. Wash hands with soap and water for at least 20 seconds, especially after the bathroom or diaper changes. If you need a school note after a visit, read school health forms in Puerto Rico. For adults, see stomach bug.

Frequently asked questions

What should I give my child for vomiting and diarrhea?

Oral rehydration solution in small, frequent amounts: if your child is vomiting, start with very small sips and slowly give more, following the label or the doctor’s advice. Keep up breast milk or formula. Avoid soda and full-strength juice.

How can I tell if my child is dehydrated?

They pee less (in babies, fewer than 6 wet diapers a day), have a dry mouth, cry with few tears or play less. If they are barely peeing, have sunken eyes, cold hands or are very sleepy, go to the ER.

When can my child go back to school after a stomach bug?

For norovirus, the CDC advises waiting until 48 hours after symptoms stop. Check your school or daycare's own rules as well.

Does my child need antibiotics for diarrhea?

Almost never. Most diarrhea in children is viral, and antibiotics do not work on viruses. If there is blood in the stool or a high fever, a doctor should see your child in person.

Related pages

• Online doctor for kids
• Online doctor visit
• Fever in children
• Stomach bug (gastroenteritis)
• Prepare your child for a video visit
• School health forms in Puerto Rico
• Emergencies