What is rotavirus, and what can I do for it?

Rotavirus is a common illness that causes vomiting and diarrhea in young children in the spring months. Occasionally, it can be so severe that it is a major cause of death in children in developing countries who do not have access to medical care. Usually children have fever and vomiting for 2-3 days and severe diarrhea for 4-5 days. (Loose stools can persist for a couple of weeks.) The diarrhea is usually very watery, without blood or mucus, but is often very foul-smelling. Sometimes the stools are explosive; sometimes children have more than 20-30 stools a day early in the illness. Rotavirus is most common in children between 4 months and 2 years of age. In central Tennessee, rotavirus is most common between Easter and the early summer, although children can get it any time of year. It is transmitted by coming into contact with infected stool. The virus can live on surfaces for many hours and has been found on toys, water fountains, toilet handles, and telephones.

It takes 1-3 days to come down with symptoms after being exposed. Infants and toddlers tend to spread it to each other in daycare and church nursery settings. Almost all children have had it at least once by age 3, although many of these cases are very mild. About 40% of adults who are around a child with it will become infected and can spread it, usually without showing signs of being infected.

Unfortunately, people can get rotavirus several times during their lifetime.

A rapid test for rotavirus can be run on a child's stool sample. Many times, however, we suspect rotavirus just based on the child's symptoms and appearance. In this case, we may not even test the child's stool sample. Also, regardless of whether your child has rotavirus, or a rotavirus-like illness, it doesn't usually change what we do.

• Give liquids by mouth. For infants, breast milk or formula is the best choice. Most children can keep some breast milk or formula down, even if there is some vomiting. If your child vomits up liquid, try offering it in smaller amounts. The amounts may be very small -- sometimes parents have to give a few tablespoons every 15 minutes. This is tedious, but it will do the trick most of the time!
• Unless your child is dehydrated, there is no need to give Pedialyte. Pedialyte is used to rehydrate dehydrated children as a last resort instead of giving them an IV. It does not prevent dehydration any better than another liquid. Also, it is pretty expensive. Once your child is rehydrated, there is no need to keep using it, even if your child continues to have vomiting and diarrhea.
• Don't give very sweet or concentrated liquids, like fruit juice or soft drinks. These tend to make diarrhea worse. Stick to breast milk or formula for infants; offer older children water, half-strength lemonade, or Popsicles.
• If a child is extremely dehydrated and parents are unsuccessful giving liquids by mouth at home, we will give intravenous (IV) fluids in the hospital. We try to avoid hospitalization because rotavirus can be spread to other children in the hospital, and because of the expense. Fortunately, 98% of children with rotavirus can be treated successfully at home.
• Let your child eat as soon as she or she wants to eat. It is now known that early eating (within 24 hours after symptoms start) actually helps children get better faster. Eating the right kinds of foods stimulates the intestinal tissue to repair itself. Good foods for rotavirus infection are starchy and high in carbohydrates. These include:
  • crackers
  • bread or toast
  • noodles
  • rice or rice cereal (for infants)
  • baked potato (without butter)
  Some people mistakenly think that a child should get only Pedialyte (or other liquids) until he or she is diarrhea-free. This can prolong diarrhea and actually make the child worse. Remember, encourage your child to eat.
• Keep track of your child's intake and output. This will help you assess his or her progress and will give you some information to share with us. See our intake and output flow sheet for a sample.
• Try lactobacillus. There is new information that suggests that lactobacillus, a "good bacteria" found in the intestine, can help children get over rotavirus a little bit faster. Lactobacillus is naturally found in yogurt and can be purchased over the counter at pharmacies. Let us know if you are interested in trying this.
• Try a diarrhea formula. Sometimes children become sensitive to lactose in milk during rotavirus infection. If your child is formula-fed, there are some special infant formulas that are lactose-free and can reduce the amount of diarrhea the child has. After your child gets better, you can switch back to his or her usual formula. (Note: breastfed infants do not usually become sensitized to their mother's lactose and thus do not require switching to formula.)
• Don't give other medications. The American Academy of Pediatrics recommends that diarrhea medications not be given to children with rotavirus. Experts agree that these medications, either prescription or over-the-counter, are generally not helpful in rotavirus infection: "Neither antibiotics, antisecretory drugs (e.g., bismuth subslicylate [Pepto-Bismol]), antimotility drugs (e.g., diphenoxylate, atropine, loperamide [Imodium]), absorbents (e.g., kaolin [Kaopectate]), nor antiemetics (e.g., phenothiazines) play a role in [treating] rotavirus." (Mandell, Principles and Practice of Infectious Diseases, 5th edition.)

  In fact, some of these medications can be harmful for infants and toddlers, which is the age group most likely to get severe rotavirus infection. Therefore, we rarely recommend using these medications.

Watch for signs of dehydration. (Read more about dehydration.) If you think your child is getting dehydrated, and your attempts to keep fluids in your child at home aren't working, please let us know right away. Dehydration is much more common when a child has vomiting and diarrhea. Children with diarrhea alone, even if it is severe, usually don't get dehydrated as long as they can keep enough down by mouth. Children are contagious for a few weeks after coming down with symptoms. Therefore, you'll want to be sure to do the following:

• Vaccinate your baby! There are two vaccines now available that help protect against this nasty disease.
• Wash hands frequently. Teach your children how to wash their hands well with soap several times a day. Unfortunately, a "quick rinse" under the faucet without scrubbing with soap does nothing to kill the virus.
• Wash surfaces well. Clean bathrooms, countertops, etc. with a bleach solution and water.
• Consider using disposable gloves to change infected diapers While not a substitute for handwashing, it will prevent stool particles from getting in hard-to-wash areas (like under fingernails.)
• Breast feed your infant. Breast milk protects against rotavirus infection. Also, breastfed infants who get rotavirus have milder disease.