February 10, 2019

I hate having to watch my child get a really nasty case of the flu! That’s why I thought I would share my expertise as a dietitian to give parents out there some help in knowing how to use nutrition (food, drink, and supplements) to help their child during the flu.

First, when we say “flu” we often mean the stomach flu, or gastroenteritis, aka vomiting. In this situation one may vomit and/or have diarrhea after they eat or have a loss of appetite for a short time. It mainly affects our intestines. However technically the “flu” is called influenza, a viral infection that affects our respiratory system (nose, throat, lungs).

Both types of “flu” can lead to mild, moderate, or severe dehydration in your child. Dehydration occurs when a child loses more fluid than they take in and the body cannot perform its normal functions. While anyone can become dehydrated, it is especially dangerous in children. Infants and children have a higher surface area to volume area which means they lose a higher proportion of their fluids from high fevers, diarrhea, and vomiting.

You can usually correct mild to moderate dehydration by drinking more fluids, but severe dehydration will need immediate medical attention. (However, if you are worried it is always best to seek help from your pediatrician. Better safe than sorry!).

Sometimes infants/children aren’t aware or cannot tell us they are dehydrated. Thirst usually isn’t the best indicator of the body’s need for fluids. Oftentimes by the time we feel “thirsty” it already means we are dehydrated. The signs and symptoms of dehydration in infants and children are also different from adults.

Symptoms of dehydration to watch for in infants/children:

· Dry mouth or tongue

· No tears when crying

· No wet diapers for three hours

· Sunken eyes, cheeks

· Sunken soft spot on the top of skull

· Restlessness or irritability

Here are signs to look for to help you know when you should take your child to the doctor….

The Mayo Clinic advises parents with children suffering from either type of flu illness to seek medical attention by their doctor right away if they:

· Have a fever of 102°F or higher

· Seem unusually lethargic or very irritable

· Very uncomfortable or in a lot of pain

· Has black or bloody diarrhea

· Can’t keep fluids down for greater than 24 hours

· Have worrisome dehydration symptoms (see below).

Nutrition does play a part in the recovery from both of these types of flu illnesses. Let’s talk about what to do in each scenario…..

Viral Gastroenteritis (aka Stomach Flu)

Most cases of the stomach flu resolve themselves within 1-2 days, however, occasionally they can last up to 10 days.

Common symptoms

· Watery diarrhea (if bloody see a doctor immediately)

· Abdominal cramps and pain

· Nausea and/or vomiting

· Occasional muscle aches or headache

· Low-grade fever (higher than 98.6°F and lower than 100.4°F in a 24-hour period)

When your child is sick and has vomiting/diarrhea episodes:

1. Focus on Hydration. One of the most important things you can do (nutritionally) for your infants/children is to make sure to give extra water at the first signs of illness. It is better to try to prevent or treat mild dehydration rather than wait for it to get worse. Try having a glass or sippy cup or water by your child at all times and frequently remind them to take sips in between vomiting/diarrhea episodes. A good goal is to have your child drink or take in a few sips, or 1-2 ounces, of fluid about every 30 minutes. Choose water over sports drinks (Gatorade, PowerAde, etc.) or soda (sprite, ginger ale, etc.) as it is often better tolerated and more appropriate for your children’s needs (see below). Usually your child will not have an appetite, but if they want something besides water, offering clear liquids like jello (gelatin) and/or popsicles (preferably 100% fruit juice or low added sugar varieties) can help. Both of these are still considered “liquids”. I would recommend to avoid solid food until after vomiting/diarrhea has passed. Liquids are less likely to stimulate further vomiting. For infants who are breastfeeding or formula fed, continue to breastfeed or provide formula (however, I would recommend consulting your pediatrician as well).

Vomiting and diarrhea removes fluid and electrolytes from our body that is needed to keep our body healthy and stable. At times when vomiting/diarrhea episodes are more frequent, your child can lose large amounts of fluid from their body and become dehydrated. Also, in general the higher the fever, the more dehydrated your child will become. Dehydration can get worse if your child has vomiting, diarrhea, and a fever. If your child is excessively sweating, this will also increase risk for dehydration while sick.

2. Rehydration Therapy as needed. If your child is having frequent vomiting/diarrhea episodes for several hours then oral rehydration therapy (i.e. Pedialyte) may be appropriate. Oral rehydration therapy is a special oral drink or liquid designed to replenish the correct ratios of electrolytes and fluid for your child to correct mild-moderate dehydration. If you have questions or hesitations about using an oral rehydration solution, advise your pediatrician.

While sports drinks (i.e. Gatorade, PowerAde, etc.) or soda pop (i.e. sprite, ginger ale, etc.) are commonly used and accepted as stomach flu remedies in our culture, they do not have the correct ratios of electrolytes and they have too much sugar for proper rehydration, especially in children. Some experts even say that drinking sports drinks and soda may make the symptoms worse in some people. Sugary drinks are likely not going to be tolerated by a child who is sick. Blood sugar spikes from added sugars are likely going to leave a child feeling even more yucky and irritable. Also, the high amounts of added sugars found in soda and sports drinks can make diarrhea worse too.

3. Keep a close eye on your infant/child. Watch for signs of dehydration as listed above. If you can, ask your child how they are feeling often. Try using a scale of 1-10 or different scaled smiley faces to gauge if they are feeling better or worse. If you ever have concerns, its best to just consult your pediatrician or doctor.

4. Rest. Let your child and infant rest. Rest is essential for your body to fight off any illness. Keep them home from school or activities. Give them extra attention and comfort while spending time with them. A warm bath may help relieve some symptoms of congestion or provide comfort.

5. Don’t forget to disinfect! The stomach flu virus is easy to spread!

When your child is on the mend/after they are sick:

As your child starts to feel better, they will likely get their appetite back! Once vomiting and diarrhea has resolved, it’s best to start reintroducing solid food! Here are some suggestions:

1. Try reintroducing foods in their regular diet. Many doctors/dietitians may recommend a B.R.A.T. diet (bananas, rice, applesauce, toast) right after vomiting/diarrhea. This is likely fine to do if those foods sound good to your child. But, most pediatricians agree that once a child is rehydrated, returning to their normal diets is just fine. If your child is still a little nauseous or doesn’t have a huge appetite try small, nutrient dense meals/foods they can snack on until they get their appetite back.

Some examples of foods you could try with your child are:

· Plain cereal (Chex, Cherrios, etc)

· Fresh fruit (grapes, strawberries, blueberries) – whatever your child can tolerate

· Rice with a little butter, salt & pepper

· Mashed potatoes

· Bread

· Milk

· Yogurt

· Lean protein (chicken breast, scrambled eggs)

· Cooked Vegetables

· Broths/chicken soup

Until your child is fully recovered and re-nourished, it is best to avoid foods high in fat (including fried foods), added sugars (candy, juice, soda, sports drinks, etc.), and drinks with caffeine (coffee and tea, some soft drinks). Sometimes people can be sensitive to lactose, a sugar found in milk and milk products, while recovering from the stomach flu. Although uncommon, in certain cases problems digesting lactose can be experienced for up to a month after experiencing the stomach flu. If you feel like your child is experiencing this even after a few days, reach out to your pediatrician and dietitian. A dietitian could be especially helpful in this situation.

Influenza (aka the Flu)

For most people influenza resolves on its own. But, sometimes influenza can be serious in under 5 (especially under 2).

While the flu vaccine (flu shot) isn’t 100 percent effective in influenza prevention each year, it is still the best and doctor recommended way to battle against the flu. The Centers for Disease Control and Prevention (CDC) recommends everyone get an annual flu shot over the age of 6 months.

Also, if you suspect you have influenza, see your doctor within 48 hours after you notice your first symptoms. They can prescribe you antiviral drugs that have proven to reduce illness time and severity of symptoms if taken within the first 48 hours.

Common symptoms

· High Fever (higher than 100.4°F)

· Muscle aches

· Chills and Sweats

· Headache

· Dry, persistent cough

· Fatigue and weakness

· Nasal congestion

· Sore throat

· Occasionally there can be vomiting/diarrhea, although this is rare.

When your child is sick with influenza try these suggestions:

1. Focus on Hydration. One of the most important things you can do (nutritionally) for your infants/children is to make sure to give extra water at the first signs of illness. Remember that even if your child is not vomiting or having diarrhea, fevers cause dehydration, especially in infants/children. It is better to try to prevent or treat mild dehydration rather than wait for it to get worse. Try having a glass or sippy cup or water by your child at all times and frequently remind them to take sips every 15 minutes, especially in between vomiting/diarrhea episodes. A good goal is to have your child drink or take in a few sips, or 1-2 ounces, of fluid about every 30 minutes. Choose water over sports drinks (Gatorade, PowerAde, etc.) or soda (sprite, ginger ale, etc.) as it is often better tolerated and more appropriate for your children’s needs (see below). You can also try other liquids like jello (gelatin) or popsicles (preferably 100% fruit juice or low added sugar varieties). For infants who are breastfeeding or formula fed, continue to breastfeed or provide formula (however, I would recommend consulting your pediatrician as well).

2. Focus on nutrient dense foods. If your child is not vomiting or having diarrhea episodes and is not dehydrated, solid food should be acceptable and tolerated. If they are dehydrated, or having vomiting/diarrhea episodes, see directions above. Usually your child will not have an appetite during the worst parts of influenza which may make nourishing their bodies more challenging. Try and offer small, more frequent meals with nutrient dense foods without strong flavors or odors. Here are a few suggestions:

Some examples of foods you could try with your child are:

§ Plain cereal (Chex, Cherrios, etc)

§ Fresh fruit (grapes, strawberries, blueberries, etc)

§ Rice with a little butter, salt & pepper

§ Mashed potatoes

§ Bread

§ Milk

§ Nuts

§ Low sugar granola bars

§ Yogurt

§ Crackers (preferably whole grain, lower in added sugars)

§ Lean protein (chicken breast, scrambled eggs)

§ Cooked Vegetables

§ Broths/chicken soup

If you have an infant who is breastfeeding or taking formula, you should be fine to keep feeding as normal.

3. Rehydration Therapy as needed. If your child is having frequent vomiting/diarrhea episodes for several hours then oral rehydration therapy (i.e. Pedialyte) may be appropriate. See above recommendations under rehydration therapy.

4. Keep a close eye on your infant/child. Watch for signs of dehydration as listed above. If you can, ask your child how they are feeling often. Try using a scale of 1-10 or different scaled smiley faces to gauge if they are feeling better or worse. Occasionally the influenza can turn into more serious conditions such as pneumonia or bronchitis. If you ever have concerns, its best to just consult your pediatrician or doctor.

5. Rest. Let your child and infant rest. Rest is essential for your body to fight off any illness. Keep them home from school or activities. Give them extra attention and comfort while spending time with them. A warm bath may help relieve some symptoms of congestion or provide comfort.

6. Don’t forget to disinfect! Influenza is easy to spread!

When your child is on the mend/after they are sick:

As your child starts to feel better, they will likely get their appetite back! Your child should be able to resume their normal diet focusing on nutrient dense foods from a variety of food groups. It’s best to avoid foods high in fat (including fried foods) and added sugars (candy, juice, soda, etc.) until your child is fully recovered and re-nourished.

References:

1. National Institute of Diabetes and Digestive and Kidney Diseases. Eating, Diet, & Nutrition for Viral Gastroenteritis (“Stomach Flu”). https://www.niddk.nih.gov/health-information/digestive-diseases/viral-gastroenteritis/eating-diet-nutrition. Published May 2018. Accessed February 10, 2019.

2. Toby Amidor. Feeding Your Child: Stomach Bug Edition. http://tobyamidornutrition.com/2013/02/feeding-your-child-stomach-bug-edition/. Published February 2013. Accessed February 10, 2019.

3. Mayo Clinic. Dehydration: Symptoms & Causes. https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086. Published February 15, 2018. Accessed February 10, 2019.

4. About Kids Health. Dehydration. https://www.aboutkidshealth.ca/dehydration. Published August 9, 2013. Accessed February 10, 2019.

5. Patricia Solo-Josephson, MD. Dehydration. https://kidshealth.org/en/parents/dehydration.html. Published June 2017. Accessed February 10, 2019.

6. Monique Richard. Tips to Boost Immunity: Protect Yourself from Cold and Flu Season. https://eatrightrx.com/tips-boost-immunity-protect-cold-flu-season/. Published January 18, 2018. Accessed February 10, 2019.

7. The Academy of Nutrition and Dietetics. Protect Your Health with Immune-Boosting Nutrition. https://www.eatright.org/health/wellness/preventing-illness/protect-your-health-with-immune-boosting-nutrition. Published May 31, 2017. Accessed February 10, 2019.

8. Mayo Clinic. Influenza (flu):Symptoms & Causes. https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719. Published February 5, 2019. Accessed February 10, 2019.

9. Mayo Clinic. Viral gastroenteritis (stomach flu). https://www.mayoclinic.org/diseases-conditions/viral-gastroenteritis/symptoms-causes/syc-20378847. Published October 16, 2018. Accessed February 10, 2018.

10. Today’s Dietitian. Sports Drinks Shouldn’t Be Used for Illness-Related Dehydration, Expert Says. https://www.todaysdietitian.com/news/031618_news.shtml. Published March 16, 2018. Accessed February 10, 2018.

11. Suzy Kuzemchak. 5 Foods to Fight Kids’ Colds & Flu. https://www.parents.com/recipes/scoop-on-food/5-foods-to-fight-kids-colds-flu/. Accessed February 10, 2019.

12. Erin Anderson. The recipe to recovery: Local dietitian has tips for fighting the flu. https://www.kitchenertoday.com/local-news/the-recipe-to-recovery-local-dietician-has-tips-for-fighting-the-flu-1123242. Published November 18, 2018. Accessed February 10, 2019.

13. Jaclyn Anderson. Exactly What to Eat to Stay Healthy During Flu Season, According to a Dietitian. https://www.msn.com/en-ca/health/nutrition/exactly-what-to-eat-to-stay-healthy-during-flu-season-according-to-a-dietitian/ar-BBSZ10W. Published February 4, 2019. Accessed February 10, 2019.