Now that we're entering rotovirus season in Michigan, I have a question
about how all of you counsel moms on how to deal with it and breastfeeding
(as far as the vomiting part).

I was taught that the best way to deal with the vomiting part of the
*stomach flu* is to keep the baby/child NPO until the frequent
vomting/heaving stops (usually about 4-6 hours for a baby more than 4-6 m/o,
8-12 hours for a toddler: generally this time period seems to correspond
with a length of time that many babies of the given age might go between
feedings, esp at night) and then to start with small frequent amounts (1
teaspoon every 10-20 minutes, increasing by the hour as tolerated) of
pedialyte for bottle-fed babies and frequent brief nursings of breast milk
for the lucky ones.

My experience has been that the vomiting is the first part of the illness
and is fairly consistent and insistent for 4-12 hours and then markedly
improves while the diarrhea then starts and goes for about a week.

The AAP practice parameter on acute gastroenteritis in young children (March
1996) doesn't mention anything about an NPO period. This is just what my
attendings taught. For vomiting, the AAP recommends giving an oral
rehydration sol'n of 5 cc every 1-2 minutes to treat dehydration. They state
that the vomiting will lessen as the dehydration is treated (I know this is
true).

This parameter doesn't exactly address the situation of a baby/child who has
been vomiting/dry heaves for a couple hours but is not really dehydrated
yet. My thought is why give fluids at this early point when the child is
just going to throw it back up? Whether or not anything is given during this
time, the vomiting seems to be fairly consistent and insistent for the first
4-12 hours.

The reason I have brought this up is my almost 3y/o dtr started vomiting
last night about 10 pm and left her supper on the floor. She vomited smaller
amounts through the night. Wanted to nurse in the morning when we woke up. I
thought: it's been all night since this started and about 4 hours since the
last vomiting, so why not? She nursed quite briefly and could not have
gotten too much milk in. Yep, she vomited it up while we were still in bed.
We tried a couple times over the next six hours and each time she vomited.

My thoughts behind my advice for my patients is that breast milk should be
very well tolerated. I am wondering about my advice: what to give and when.
What do you think? (yes, I know if all babies were exclusively breastfed
there wouldn't be such a big problem: oh well)  TIA

Mari Douma, DO