Wednesday, November 10, 2010

Rehydration Recipe for a Vomiting Baby


We've arrived at the time of the year when influenza and various stomach viruses reek havoc on many tiny bellies. One of the chief concerns for an ill child - especially an infant whose body can become off balance very quickly - is dehydration. For a baby who is not breastfed, this can be even more devastating, more rapidly, because the gut is not lined with the protective antibodies needed to prevent further downward spiraling from the body's protective reaction (vomiting and diarrhea) to unfriendly viruses and bacteria.

In his excellent book, Take Charge of Your Child's Health, Dr. George Wootan, M.D., writes:
Vomiting is a much more serious problem than diarrhea, although most people have come to associate the two and consider them as more or less equal threats. The danger of dehydration is much greater with vomiting than with diarrhea, and the smaller the child, the faster her condition can become serious. You must be extremely vigilant when dealing with an infant who is vomiting. If the baby is breastfed, the vomiting will generally occur shortly after a feeding. (Spitting up a small amount of milk after nursing is normal and not a cause for concern; if the baby is really vomiting, most of a feeding will come back up again, and the milk will smell sour, as it is partially digested.) In this case, put the baby back on the nearly empty breast, and let her nurse again. If she vomits again, you'll have to cut down the amount of milk she is receiving. You may assume that this means that you should cut back to, say, 15 minutes of nursing, since you normally nurse for 30 minutes. However, since a baby can empty 90% of the milk in a breast in seven minutes, this will not significantly change the amount she receives. 
Instead, Wootan suggests following a rehydration/feeding schedule as described below. He assures parents that, while difficult, "following this schedule of nursing and waiting will prevent dehydration in the vast majority of cases, so it is well worth enduring your baby's mild discomfort" to avoid a more traumatic hospital stay that would otherwise result due to dehydration. Wootan has been teaching this technique to parents in his practice for the past 20 years now, and said he does not know of any case where it has failed to work (to ward off dehydration and need for hospitalization).

Note: The following rehydration schedule is meant for babies and toddlers under the age of four.


For those who are nursing, or have access to human milk (including that which is pumped and given by bottle, supplemental nursing system, syringe, cup, or wet nurse):

If baby solely has diarrhea, without vomiting:

Nurse, nurse, nurse. On cue, and for as long as baby wishes to nurse. Diarrhea alone is not as serious as vomiting, and as long as a baby is still nursing throughout the day and night, with wet diapers or trips to the bathroom to pee, s/he should be okay. Human milk is thee best thing for baby (of any age) at this point, and no other foods should be given to those under the age of 2 until they feel better. For babies and young children over the age of 2, allow them to eat foods as they wish, but it is wise to cut out cow's milk products which often increase gut irritation and diarrhea.


If baby has vomiting (with or without diarrhea) follow this pattern. If at any point baby vomits, go back two steps and continue again:

Nurse 15 seconds, wait 15 minutes. If baby has not vomited again, continue:
Nurse 30 seconds, wait 14 minutes.
Nurse 35 seconds, wait 13 minutes.
Nurse 40 seconds, wait 12 minutes.
Nurse 45 seconds, wait 11 minutes.
Nurse 50 seconds, wait 10 minutes.
Nurse 55 seconds, wait 9 minutes.
Nurse 1 minute, wait 8 minutes.
Nurse 65 seconds, wait 7 minutes.
Nurse 70 seconds, wait 6 minutes.
Nurse 75 seconds, wait 5 minutes.
Nurse 80 seconds, wait 4 minutes.
Nurse 85 seconds, wait 3 minutes.
Nurse 90 seconds, wait 2 minutes.
Nurse 95 seconds, wait 1 minute. If baby has not vomited again at this point, s/he should be safe to resume nursing on cue, as s/he wishes. If vomiting begins again, repeat the cycle starting at 15 seconds of nursing to 15 minutes of waiting and continue.



For babies and children under age 4 who are not nursing and do not have access to human milk:

When you have access to a pediatric electrolyte solution, such as Pedialyte and Pedialyte popsicles, you may wish to use this. The solution is sold at virtually every grocery store, supermarket, and pharmacy (as well as many gas stations) across the country.

If Pedialyte or a similar pre-made solution is not available, or you wish to make your own for whatever reason, this is the oral rehydration formula put together by the World Health Organization (WHO). It is used extensively in nations where babies are at high risk of dying from dehydration due to bacteria-induced diarrhea (commonplace when babies are not breastfed and face the perils of a disastrous formula mixed with unclean water). The WHO has credited this rehydration recipe with saving hundreds of thousands of babies around the world.

Oral Rehydration Formula
(measure exactly!)
1 teaspoon sodium chloride (table salt)
1/2 teaspoon sodium bicarbonate (baking soda)
4 teaspoons potassium chloride (salt substitute)
1 Tablespoon sugar
1 quart water

Feeding schedule (Pedialyte or home made solution):

In the same way as the nursing schedule (above), you will feed baby tiny amounts, increasing in volume, while decreasing waiting time in between.

Feed 1 tablespoon, wait 15 minutes.
Feed 2 tablespoons, wait 14 minutes.
Feed 3 tablespoons, wait 13 minutes.
Feed 3 1/2 tablespoons, wait 12 minutes.
Feed 4 tablespoons, wait 11 minutes.
Feed 4 1/2 tablespoons, wait 10 minutes.
Feed 5 tablespoons, wait 9 minutes.
Feed 5 1/2 tablespoons, wait 8 minutes.
Feed 6 tablespoons, wait 7 minutes.
...continue to increase, in small amounts, the solution with each feeding, and decrease time. If at any point baby vomits, go back two steps and resume.

NOTE: Unlike with human milk, you can give too much Pedialyte or homemade solution. When nursing, and feeling better, a baby can breastfeed as much and as often as s/he wishes. However, when not nursing, and only preventing dehydration with electrolyte solutions, a baby should not consume more than 2.1 ounces of the liquid per pound of body weight. After this, if baby is consuming formula, then that should be used (mixed correctly with clean water). If baby/toddler is older, s/he should consume clean water to quench thirst for additional fluids beyond the 2.1 oz/lb body weight.

Example:

This means if a baby weighs 15lbs, for example, s/he should not consume more than 31.5 ounces of the solution in one 24 hour period.

15 lbs x 2.1 oz = 31.5 oz

If the child weighs 30lbs, she should not consume more than 63 ounces in one 24 hour period. If your child is still thirsty after this, use clean water to quench thirst. For non-breastfed babies, use formula.

30 lbs x 2.1 oz = 63 oz

A baby who is not receiving human milk should be switched to a formula that is free of lactose if s/he is not already on one. Lactose (and cow's milk proteins) only work to increase gut irritation, diarrhea, and reflux. Also note that this rehydration fluid (no matter which is used) cannot take the place of formula for more than 12 hours if a baby is not breastfeeding and solely receiving nourishment through formula. This is very important as we've seen many babies brought into the emergency care clinic who have lapsed into coma, or are already 'brain dead' as a result of parents watering down formula for weeks on end, believing they were hydrating their baby, but actually starving their infant in the process. Formula *must* be mixed according to the directions on the can. If you are unsure, call your doctor with questions.

Breastfed babies are getting all the nutrients and electrolytes and fluids they need through human milk. They need nothing more. However, formula fed babies will need the electrolyte solution as well as formula to stay nourished, hydrated, and even in their electrolyte balance. The situation for them is much more complicated, and illness more serious, which is one of many reasons we see greater problems (starvation, dehydration, malnourishment) among non-breastfed babies.

After a period of time without vomiting episodes (most physicians will say 12 hours, or when the toddler tells you he feels like eating more), start with small amounts of vegetable juice, fruit juice, chicken broth, homemade broths, jello (or other easy to consume liquid items). If they are well tolerated, move to items like rice, oats, or barley. If this goes well, gradually bring a child back to a normal diet over the course of 3-4 days. Babies under the age of 2 years should continue to exclusively breastfeed for as long as they choose to do so. If your 18 month old only wants to nurse for a solid week (or two!), that is okay and beneficial for him. He is getting all he needs from your milk and there is no reason to push any other foods upon him until he leads the way to do so.


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6 comments:

  1. Great info.

    I remember when my 3 yo was vomiting like crazy this summer and I went to the doctor. He recommended we give him pedialyte. According to the doc my boy had to drink insane amounts of it in order for us not to worry... My son hated it and refused to drink more than 2 of the portions.

    Luckily, he still breastfeeds. Normally only at morning and nighttime, so I was thrilled that he asked to nurse more often instead of drinking the pedialyte.

    ReplyDelete
  2. My baby vomits everyday. It seems like he does it after every feeding. He's five months old and I honestly cannot remember a time when didn't do this. If he falls asleep nursing - like right now - he just vomits when he wakes up. Sometimes its sold chunks mixed in liquid but sometimes it's pure liquid. And it's a lot, too. That's why I consider it omit and not spit up.

    If I limit his feeding time, he will not be happy and will just scream )-: If he falls asleep, half the time he will wake if I take my breast away. He's always been like this.

    At the moment he has a runny nose, but he demeanor hasn't changed at all. He's always nursed like crazy and always vomitted up half his feeding.

    He's exclusively breastfed, sleeps next to me, is worn, hasn't been vaccinated, is intact ... Any thoughts? How do I know if he is dehydrated?

    ReplyDelete
  3. I'd never use pedialyte. But for some odd reason, dehydration seems to be a big problem for the general population. Every time someone tells me a horror story about sickness, the "emergency" was dehydration. I never understood it until I began researching breastfeeding in our culture...hardly anyone gives human milk to their children and of those who do breastfeed, many of them impose strict schedules or timing on the children, which will prevent rehydration during illness.

    In addition to the above, it seems most mothers fear fever and fear dealing with a "bad" infant. So heavy medication is almost assumed. And a sedated infant will be 1) too tired to work for rehydration and 2) sleeping too much for constant nursing.

    So I suppose at least recommending pedialyte might help those who are really uninformed.

    Seriously, though, every winter I start getting the same stories. "My baby almost DIED from the flu! I took her into the ER and she needed an IV with fluids!"

    Really???

    ReplyDelete
    Replies
    1. What on earth do mothers give to "sedate" their children? Giving tylenol to make an uncomfortable child comfortable is not a bad thing.

      Dehydration is a big problem when a little body gets diarrhea and/or vomiting. Electrolytes get out of balance. It's not rocket science. Not everyone can or chooses to breast feed their child until their bigger, say 4 or 5 years of age, to get out of the small body/dehydration trap.

      Delete
  4. Caro - this sounds more like reflux or a problem in digestion rather than vomiting from illness. If you have not eliminated cow's milk and nuts/soy from your diet, that would be the first thing to try. The proteins from both cow's milk and nuts/soy are impossible for an immature gut to digest, and they go through mother's milk, so for a lot of babies, they come back up. Switch to using vanilla rice milk (found in the refrigerator section of most supermarkets) for a couple weeks and see if this helps the problem. It does for most babies.

    A good book that addresses this is "The Baby Bond"

    http://astore.amazon.com/peacefparent-20/detail/1402226578

    if you'd like to learn more.

    ReplyDelete
  5. Caro, I agree, it does sound like a dairy problem or perhaps soy. My daughter had the same problem along with colic and I removed dairy from my diet and have never looked back :) She is great now a healthy vibrant two year old.

    Just be careful when it comes to buying anything processed, including "health food" bread, cookies, etc. Milk is hidden in a lot of foods and has different names: Whey, Casein, and so on.

    Check out godairy free, they have a list of milk product names:

    http://www.godairyfree.org/Food-to-Eat/Food-Label-Info/Dairy-Ingredient-List.html

    Also, they have recipes, restaurant suggestions, book suggestions, you name it!

    Good luck!

    ReplyDelete

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