Diarrhea, Vomiting and Dehydration

The Top 12 Reasons Kids are Excluded from School Part Five

Hemera

Children with diarrhea and/or vomiting are high on the list for school exclusions. Children can be perfectly well in the morning, eat breakfast and go off to school. A parent may get a call in a few hours that he threw up in the classroom; or that he didn’t make it to the bathroom and had diarrhea.

I was in my first grade class. We were terrified of Miss Rider who ran our classroom like a prison camp. She had made it a personal mission to train all of us not to use class time for using the toilet. We were supposed to do these things at recess, but when you only have ten minutes to whoop it up with your friends, you don’t want to waste it standing in line at the bathroom. Subsequently, many of us sat quietly, legs tightly crossed, hoping to make it to lunch. If you desperately needed to go to the bathroom, you had to raise your hand (so everyone else knew), beg for permission, listen to her endless diatribe, all the while trying to keep from peeing yourself. The price for this classroom disruption was the loss of a recess — the first grade equivalent of a prison sentence.

Betty Jane raised her hand and asked to use the toilet. As Miss Rider’s chastised her, she started to quickly walk to the door (without permission).

“I am sick!” she begged.

No sooner than she made that statement, a stream of diarrhea ran down her legs, much to our surprised horror. Having proven her point, Betty Jane was allowed to finally go to the bathroom. It was my job to fetch Cletus the Janitor. Cleat, as we called him, got his bucket and mop and followed me.

Most cases are due to gastrointestinal viruses, but there can be other causes, such as food poisoning. It is rare to see a bacterial or parasitic cause, but it does happen from time to time. Leaving an egg salad sandwich unrefrigerated for hours in a warm classroom is just asking for a gastrointestinal response. Eating a street taco or having a glass of water in Tijuana is other effective way to challenge the gut.

My friend, Terry, had to go real bad… REAL bad. He was cramping and bending over, but hated to use our friend’s bathroom. I should add that the family was having dinner and their only bathroom was adjacent to the table. Sweat was pouring down his grimaced face. He didn’t look well. Finally, out of desperation and fear that he would not even make it to the woods, he asked to use the toilet. Seconds later, the loud expulsion of his bowels could be heard as far as the garage, where we were playing pool. Why do we remember these things?

Working in pediatrics, I get used to vomiting and diarrhea. When kids are excluded from school, it is my job to fix ‘em so they can go back. Much to the horror of parents, we rarely treat these common afflictions in kids. We do not recommend Pepto Bismol, Kaopectate or Imodium. Most of the time, we allow Nature to just orchestrate the cure.

Vomiting and diarrhea are purging mechanisms — the body is trying to get rid of something, usually a viral toxin. Who am I to challenge the wisdom of the human body? If someone repeatedly vomits, we will medically intervene with medication to control it, so they will not become dehydrated. I usually wait for several hours to see if things settle down before interfering with this process. True diarrhea is frequent and watery stools. In the vast majority of cases, this, too, will settle down without medical intervention. Did you know that diarrhea and dehydration is the leading cause of death in children worldwide? It is.

The smaller the person, the more serious vomiting and diarrhea can be in the way of dehydration. Adults can go a few days without drinking or eating very much; babies can become dehydrated in less than a day. One of the more common causes of viral gastroenteritis would be a rotavirus infection. We now immunize babies for this once-common disease.

As you might image, kids who puke on their school desks, or poop in their pants are going to be sent home from school. Viral gastroenteritis can last several days, even a week. It can spread to parents and other siblings. A father brought in a sick child one evening to my clinic and he looked worse than the child. They were both hovering over a puke bucket. After examining and treating the child for repeated vomiting, I casually mentioned that I cannot treat the father. However, if he did take two of the tablets I was giving to his child, I couldn’t stop him. He was unbelievably grateful.

Kids need to stay home with a caregiver until symptoms settle down. In most cases, vomiting will stop within the day, but diarrhea may persist for several days. Replace lost fluids with just about anything the kids will drink )avoiding any liquid you are not willing to clean up if it comes back up). Water, electrolyte solutions, flat ginger ale or Seven-Up (put a carbonated drink in a blender for a few seconds to remove the bubbles), sports drinks and chicken soup are about all anyone would need (or want) for a day or so.

When kids are better, you can send them back to school.

Read more from the series:

What’s the worst case of diarrhea or vomiting that you’ve ever seen? Post your comments on the Ear, Nose and Throat Community.