Definition

• Rapid onset of vomiting and diarrhea after eating a bad food

Health Information

Symptoms

• Vomiting, nausea, abdominal cramps and/or diarrhea
• Rapid onset of symptoms within 1 to 12 hours after eating suspected contaminated food
• Fever occurs in less than 10% of cases
• Food poisoning outbreaks are common with food poisoning. Outbreaks mean 2 or more people with like symptoms after eating the same food. This finding helps to confirm food poisoning.
• Rare before 1 year old because not seen with baby foods

Causes

• Caused by toxins from germs growing in foods left out too long.
• The bacteria grow in the food if it is not kept cold.
• The bacteria produce toxins (chemicals) in the food.
• The toxins are what cause nausea and vomiting when they are swallowed. Most toxins are not made in the body.
• There are 2 main toxins that cause food poisoning: Staph toxin and Bacillus cereus toxin.
• Staph toxin. Common dishes are moist ones that have milk, cream, or eggs in them. Examples are potato salad, egg salad or ham. Picnics in summer are always a big risk.
• Bacillus cereus toxin. A bacteria found in rice. When rice is heated and set aside at room temperature, the bacteria can produce toxins. Often occurs with fried rice dishes in poorly managed Asian restaurants.

Care Advice

1. Overview:
   • The main treatment is diet changes to prevent dehydration.
   • The symptoms of food poisoning go away on their own. They usually only last 1 day.
   • Drugs and antibiotics are not helpful.
   • Here is some care advice that should help.
2. Offer Small Amounts of Clear Fluids For 8 Hours:
   • Water or ice chips are best for older children. (Reason: Water is easily absorbed).
   • ORS. If your child vomits water, offer Oral Rehydration Solution (ORS). ORS is a special fluid that can help your child stay hydrated. You can use Pedialyte or the store brand. It can be bought in food or drug stores.
   • Other clear fluids: Use half-strength Gatorade. Make it by mixing equal amounts of Gatorade and water. Can also mix flat lemon-lime soda the same way. Popsicles work great for some kids. ORS (such as Pedialyte) is usually not needed in older children.
   • The key to success is giving small amounts of fluid. Offer 2-3 teaspoons (10-15 ml) every 5 minutes. Older kids can just slowly sip a clear fluid.
   • After 4 hours without throwing up, increase the amount.
   • After 8 hours without throwing up, return to regular fluids.
   • Caution: If vomits over 12 hours, stop using water. Switch to ORS or half-strength Gatorade. 3.
3. Stop Solid Foods:
   • Avoid all solid foods in kids who are vomiting.
   • After 8 hours without throwing up, gradually add them back.
   • Limit solids to bland foods. Starchy foods are easiest to digest.
   • Start with crackers, bread, cereals, rice, mashed potatoes, noodles.
   • Return to normal diet in 24-48 hours.
4. Do Not Give Medicines:
   • Stop using any drug that is over-the-counter for 8 hours.
   • Fever. Mild fevers don’t need to be treated with any drugs. For higher fevers, you can use an acetaminophen (Tylenol) suppository. This is a form of the drug you put in the rectum.
   • Call your doctor if: Your child vomits a drug ordered by your doctor.
5. Sleep:
   • Help your child go to sleep for a few hours.
   • Reason: Sleep often empties the stomach and removes the need to vomit.
   • Your child doesn’t have to drink anything if his stomach feels upset.
6. For Vomiting with Diarrhea:
   • If your child is having both vomiting and diarrhea, follow the advice for vomiting.
   • If your child cannot keep down fluids and diarrhea is more than mild, call back. Reason: increased risk for dehydration.
   • If your child starts having diarrhea alone, keep on a regular diet. Offer as much fluid as your child will drink. Milk is fine for diarrhea. So is half-strength Gatorade.
   • Caution: Do not use fruit juices or soft drinks. Reason: They make diarrhea worse.
7. Report Suspected Restaurant: If a restaurant is suspected as the source of food poisoning, report it. Call your local Public Health Department (PHD).
8. Prevention of Future Food Poisoning
   • High-risk foods are meat, poultry, fish, eggs, dairy products. Dishes that have milk in them are also high-risk.
   • When serving these foods, keep hot foods hot and cold foods cold. Avoid room temperature for these foods.
   • Put leftovers in the fridge promptly. Toss high-risk foods that have been left out for more than 2 hours.
9. What to Expect:
   • Once toxins leave the body, your child should start to feel better. Nausea and vomiting usually last less than 1 day.
   • Diarrhea usually lasts less than 2 days.
   • Food poisoning is usually a brief illness.
10. Return to School:
    • The toxins that cause food poisoning cannot be spread to others.
    • Your child can return to school after the vomiting and fever are gone.

Call Your Doctor If

• Vomits clear fluids for more than 8 hours
• Vomiting lasts more than 24 hours
• Diarrhea lasts more than 2 days
• Signs of dehydration occur
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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