Diarrhea and vomiting are among the most common pediatric problems, causing thousands of ER visits monthly in Jordan, especially in summer. The real danger isn't the illness itself but dehydration, which can develop rapidly in infants. The ClinicsJo Editorial Team covers what every parent needs to know.
Causes
Viral Infection (Most Common — 70%)
- Rotavirus: the most common cause of severe infant diarrhea, eliminated by the Jordanian vaccine.
- Norovirus: spreads quickly in daycares and schools.
- Adenovirus.
Bacterial Infection
- Salmonella.
- Shigella (bloody diarrhea).
- E. coli.
- Campylobacter.
Parasitic Infection
- Giardia.
- Amoebiasis.
Other Causes
- Ear infection.
- UTI.
- Tonsillitis.
- Food allergies (dairy, gluten).
- Food poisoning.
- Teething (mild diarrhea only).
Signs of Dehydration — Must Know
Mild (5%)
- Mild thirst.
- Slightly reduced urine.
- Child still active.
Moderate (5–10%)
- Severe thirst.
- Dry mouth and tongue.
- Fewer tears when crying.
- Slight eye sinking.
- Reduced urine (6–8 hours without urine).
- Mild lethargy.
- Sunken anterior fontanelle in infants.
Severe (>10%) — Emergency!
- Extreme thirst or unable to drink.
- Very dry mouth.
- No urine for >8 hours.
- Deeply sunken eyes.
- Cold extremities.
- Rapid breathing.
- Rapid weak pulse.
- Severe lethargy or loss of consciousness.
- Skin slow to rebound when pinched.
Medical alert: Severe dehydration is an emergency requiring IV fluids in the hospital. Don't wait at home — go to a pediatric ER immediately.
When to Take Your Child to the ER
- Infant <6 months with diarrhea or vomiting.
- Signs of severe dehydration.
- Persistent vomiting preventing fluid intake.
- Blood in stool.
- Diarrhea >6 times daily or vomiting >4 times.
- High fever >39°C.
- Severe abdominal pain.
- Green or yellow vomit.
- Child appears very ill.
- Child with chronic disease.
- Symptoms lasting more than 3 days.
Home Treatment
1. Fluid Replacement (Most Important)
Use oral rehydration solution (ORS):
- Hydralite or Pedialyte packets, or the MOH-prepared solution.
- Dose: 5–10 mL/kg after each diarrhea or vomiting episode.
- Give by spoon or needle-less syringe, every 5 minutes if vomiting.
- Total: 50–100 mL/kg over 24 hours.
2. What to Drink
Recommended:
- ORS solution.
- Breast milk (continue feeding).
- Water.
- Light soup.
- Boiled rice water.
Avoid:
- Fruit juices (worsen diarrhea due to sugar).
- Soda.
- Sports drinks (too salty for kids).
- Tea and coffee.
- Cow's milk (>6 months can continue, but may need temporary pause).
3. When to Restart Food?
Modern rule: feed the child early (4–6 hours after vomiting stops):
- Rice, bread, mashed potatoes, banana.
- Boiled chicken, soup.
- Yogurt (for kids >6 months).
- The strict BRAT diet (banana, rice, applesauce, toast) is no longer recommended.
- Avoid fatty, spicy, and sugary foods for days.
Medications
What to Use
- Zinc: 10–20 mg daily for 10–14 days — shortens diarrhea (recommended in Jordan).
- Probiotics: Saccharomyces boulardii, Lactobacillus — shorten diarrhea by 1–2 days.
- Antipyretics as needed.
Don't Use Without Consultation
- Loperamide (Imodium): not given to children — delays microbe clearance.
- Antibiotics: 90% of cases are viral and don't need them. Only given for confirmed bacterial cases.
- Antiemetics (ondansetron): sometimes used in the ER to reduce vomiting before ORS.
Common Mistakes
- Giving apple juice or banana (worsen diarrhea).
- Stopping breastfeeding.
- Giving large amounts of plain water without salts (causes electrolyte imbalance).
- Antibiotics without consultation.
- Withholding food for days (delays recovery).
- Using Imodium for kids.
Prevention
- Wash hands with soap before meals and after the bathroom.
- Rotavirus vaccination.
- Thorough washing of fruits and vegetables.
- Cook meats well.
- Avoid unpasteurized dairy.
- Healthy nutrition to strengthen immunity.
- Breastfeeding strongly protects against diarrhea.
- Avoid crowded places during outbreaks.
If your child has severe diarrhea or vomiting, book an appointment with a pediatrician on ClinicsJo or go to the hospital ER.
