Preventing Vomiting/Diarrhea

Just when you thought that you knew how to manage your kids’ vomiting/diarrhea, researchers come up with a slew of new findings that turn your management “skills” into old wives’ tales.

This is part one, Prevention, of a two-part series. Next posting: Treatment.

1. Most cases of vomiting and diarrhea in children are infectious. And person-to-person spread is more common than previously thought.  Until recently, it was believed that most cases resulted from ingesting the disease-causing viruses and bacteria (pathogens) in contaminated food and water. In fact, numerous cases are due to secondary spread: individuals infected by food and water spreading the pathogens to family members and other contacts who then spread them to others – and to others. “Contacts” can be total strangers.    

2. Infants and young children are ideal “spreaders.” Risk factors include being in diapers, attending daycare, touching objects and mouthing them, sucking on fingers, swallowing water while bathing/swimming, and poor hand washing techniques by older children – and often, by adults. Infectious vomitus and stool contain millions of pathogens and, for some diseases, less than a hundred suffice to cause infection. Moreover, children, more than adults, shed pathogens in stool for days after diarrhea ceases, therefore continuing to be infectious.      

3. Many pathogens are very hardy. They remain viable on people’s hands until hands are properly washed, and on objects such as doorknobs and toys for days. Pathogens survive on fabric toys such as stuffed animals for up to twelve days. Moreover, stuffed animals are difficult to sanitize.

4. Vomiting spreads pathogens far and wide. Infants and young children vomit more with intestinal illnesses than do older children and adults. Their vomiting is unexpected and uncontrolled, often propelling bits of vomit and the pathogens it contains into the air for distances up to six feet. The pathogens can be inhaled by others and contaminate nearby surfaces. Even vomiting into toilets and sinks can cause pathogens to become airborne. Close toilets before flushing. When possible, have children vomit into towels. Clean up promptly and disinfect surfaces, preferably while wearing disposable rubber gloves.

5.  Have a plan for changing diapers and disposing of them. Convenient sites for changing may not be sanitary ones. Choose sites that can be easily disinfected, not sofas, rugs or surfaces with minute cracks or crevices such as wood. Avoid excessive shaking and jarring of soiled diapers, clothing and linen; this can release pathogens into the air. Wash such items with detergent at the maximum available cycle length and then machine dry. If possible, have toddlers use regular toilets with special childrens’ seats rather than potty chairs. Ideally, such chairs should be cleaned in utility sinks, not present in most homes. Potty chairs should never be cleaned in sinks used for preparing food or for hand washing.

6. Make your bathroom child-friendly and simple to clean. Uncluttered bathrooms with non-slip stepstools and easily accessible soap and running water encourage children to wash their hands. Keep toothpaste and other bathroom paraphernalia in cabinets making it simpler to wipe surfaces. Have special containers for toothbrushes. Placing them on the sink is unsanitary.

7. Soap in itself does not kill disease-causing organisms. This makes hand washing technique important. It is the mechanical action of rubbing hands together with soap and water and then rinsing and drying that breaks down the tiny bits of grease, fat and dirt on hands that organisms cling to. Antibacterial soap is not significantly better than ordinary soap. Nor is liquid soap appreciably better than bar soap.

8. Hand washing is not child’s play.  Proper hand washing generally requires parental supervision.  Here’s the right way to do it: 

Remove rings and dangling bracelets. Wet hands with running water (warm is marginally more effective than cold). Apply soap.  Rub hands together to make lots of lather. Scrub between fingers and the back of hands and wrists. Keep nails short and wash under nails. Brushing nails is not essential. Rub hands for at least 20 seconds, the time it takes to sing “Happy Birthday” twice or “Twinkle, Twinkle Little Star” once. (Take your pick of songs.) 

9. Use alcohol-based sanitizers only when soap and water are unavailable.  Use ones containing at least 60% alcohol. While such sanitizers quickly reduce the number of organisms on the hands, they do not eliminate all types of organisms, and are less effective when hands are visibly dirty. Apply sanitizer to the palm of one hand, rub hands together, and make sure that the sanitizer covers all surfaces of hands and fingers. Continue until hands are dry. Sanitizers are toxic for children if ingested but taste so bad that ingestion rarely occurs.

10. Proper hand drying is essential. Wet hands transfer pathogens more readily than dry or unwashed hands. Ideally, each family member should have their own towel, especially when illness is present; damp towels in a humid bathroom abet the survival of organisms.

Place disposable paper towels plus a large foot-controlled trash can within easy reach of the sink. This allows children to dispose of towels without contaminating their just-washed hands. According to several studies, hot air dryers, common in public bathrooms, blow organisms from the hands into the air.  

Recommended hand drying methods and drying times

(Courtesy of the Centers for Disease Control)