What to Expect the Toddler Years (215 page)

For severe diarrhea. Oral rehydration therapy only (although breast milk is okay) for 24 to 48 hours, followed by a bland diet, unless there is vomiting (see below). Start with easy-to-digest, low-fat, low-sugar complex carbohydrate foods, such as bananas, fruit (apple, pear) sauces, rice, plain pasta, potatoes, cereal, and toast. Small amounts of bland protein foods (chicken, cottage cheese) are also appropriate as soon as your child finds them palatable. Gradually return your child to a normal diet over the next couple of days.

For diarrhea with vomiting. Solid food should be withheld until vomiting has stopped. Diluted juices and oral rehydration preparations (in liquid or ice-pop form) are vital, however, to replace lost fluids. Giving fluids a few sips at a time reduces the chance that they will provoke more vomiting. (If vomiting doesn’t cease after 24 hours, call the doctor back.)

Prevention.
Treatment of any underlying condition causing the diarrhea; avoidance or limitation, when possible, of the foods, beverages, and medications that trigger diarrhea; meticulous adherence to food safety rules (see page 527); thorough hand washing by all family members after bathroom use or after changing diapers. Feeding yogurt containing live cultures during antibiotic therapy may also prove helpful—unless, of course, your toddler is allergic to or intolerant of milk.

When to call the doctor.
If your toddler shows signs of dehydration (see page 606). Call
immediately
if there is severe dehydration; acute diarrhea or the fever or vomiting accompanying the diarrhea lasts longer than 24 hours; your child refuses fluids; stools are bloody or the vomited material is greenish, bloody, or looks like coffee grounds; the abdomen is bloated or swollen or there is severe abdominal pain; there is a rash or jaundice (yellowing of the skin). In such cases, the doctor may want to examine your toddler’s stool or send it to the lab, so save a specimen in a plastic bag.

see Otitis Media (page 607)

Symptoms.
Sudden onset of headache and fever (often with chills and shaking), fatigue, general achiness, and a dry cough. As the illness progresses, cold-like symptoms (sore throat, nasal congestion) may develop and the cough intensify. There may also be gastrointestinal symptoms (abdominal pain, nausea, vomiting) and “pinkeye,” or conjunctivitis (an inflammation of the membrane covering the eye). Sometimes, the flu may be difficult to distinguish from a cold, and sometimes there are no symptoms but fever and fatigue. After several days of flu, some children have calf pain that interferes with walking. Occasionally the influenza virus causes croup or pneumonia.

Season.
In the northern hemisphere, most often, December through March, with a peak in February. In the southern hemisphere, May through September. And in the tropics, all year round.

Cause.
Influenza viruses A and B, which occur in epidemic form and of which there are innumerable variations, and virus C.