How to Handle Vomiting and Diarrhea

What Causes Vomiting and Diarrhea?

Viral Gastroenteritis (Most Common)

This is what most people mean by “stomach flu” or “stomach bug.” Common viruses include rotavirus (less common now due to the vaccine), norovirus (very contagious, spreads quickly), and adenovirus (can cause respiratory symptoms too).

Typical pattern: sudden-onset vomiting, with diarrhea starting 12–24 hours later. Usually lasts 24–72 hours, sometimes up to 7 days. May come with a low-grade fever, and is highly contagious.

Food Poisoning

Illness from contaminated food or water — common culprits include undercooked meat, poultry, or eggs, unpasteurized dairy, unwashed produce, or contaminated water.

Typical pattern: symptoms start 1–48 hours after eating contaminated food, with sudden vomiting and/or diarrhea, sometimes severe cramping. Usually resolves in 24–48 hours.

Other Causes

Vomiting only (no diarrhea): cough/cold with post-nasal drip, motion sickness, migraine, ear infection, appendicitis (with severe abdominal pain), head injury, too much milk or food, or a new food allergy/intolerance.

Diarrhea only (no vomiting): antibiotics, too much juice or fruit, food intolerance (lactose, etc.), parasites (like Giardia from contaminated water), or chronic conditions such as celiac disease or inflammatory bowel disease.

Vomiting: What to Expect and How to Help

Typical Vomiting Timeline

Step 1: Rest the Stomach (First 30–60 Minutes After Vomiting)

After each vomiting episode, stop all food and fluids for 30–60 minutes to let the stomach settle. Keep your child calm and resting, and have a bucket or bowl nearby. Giving fluids too soon can trigger more vomiting.

Step 2: Start Tiny Sips (After the Rest Period)

Start with 1 teaspoon every 5 minutes, using a medicine dropper, syringe, or teaspoon — a timer helps you avoid giving too much too fast. Best fluids are oral rehydration solution (Pedialyte, Enfalyte), breast milk for babies, clear liquids (water, diluted apple juice), or ice chips for older kids.

• Babies: 1–2 teaspoons every 5 minutes
• Toddlers: 1–2 tablespoons every 10–15 minutes
• Older kids: 2–3 tablespoons every 15 minutes

Step 3: Gradually Increase

If there’s no vomiting after 30 minutes, increase to 2 tablespoons every 15 minutes. If that’s tolerated for 1–2 hours, increase to 2–4 ounces every 30–60 minutes. The goal is small amounts frequently, not large amounts at once.

Step 4: Introduce Bland Foods (After 4–6 Hours of No Vomiting)

Start with saltine crackers, plain toast, applesauce, bananas, rice, or plain pretzels — the classic BRAT diet (bananas, rice, applesauce, toast) is still helpful, but don’t restrict your child to only these. Gradually add plain chicken, plain pasta, scrambled eggs, mashed potatoes, and yogurt.

Avoid for the first 24 hours: dairy (except yogurt, since the probiotics help), greasy or fried foods, spicy foods, high-sugar foods, and acidic foods like oranges or tomatoes.

Diarrhea: What to Expect and How to Help

Types of Diarrhea

• Watery diarrhea: very liquid, frequent stools — common with viral infections and the biggest dehydration risk
• Loose/mushy stools: softer than normal but formed — less concerning, may just be a diet change
• Bloody diarrhea: blood streaks or red/black color — call your doctor immediately, as this may indicate a bacterial infection
• Mucousy diarrhea: jelly-like mucus in stool — can be normal with a viral infection, but call your doctor if it’s severe or persistent

Typical Diarrhea Timeline

Note: diarrhea often lasts longer than vomiting — 7 to 10 days is common.

Step 1: Fluids, Fluids, Fluids

Unlike with vomiting, you don’t restrict fluids with diarrhea. Keep offering oral rehydration solution (Pedialyte is the best choice — it replaces lost sodium and potassium in the right balance, and comes in flavors, popsicles, and powder), breast milk or formula for babies (continue normally), water, or diluted juice (50/50 with water).

• Toddlers: 4–8 oz after each diarrhea episode
• Older kids: 8–10 oz after each episode
• Babies: continue normal feeding schedule plus extra fluids

Avoid full-strength juice (high sugar can worsen diarrhea), sports drinks (too much sugar, wrong electrolyte balance for kids), and soda (sugar plus carbonation makes diarrhea worse).

Step 2: Continue Feeding — Don’t Restrict

Older advice was “nothing by mouth until diarrhea stops.” Current guidance is to continue an age-appropriate diet, since it helps the gut heal faster. Offer complex carbohydrates (rice, pasta, bread, potatoes, oatmeal), lean proteins (chicken, turkey, eggs), cooked vegetables (carrots, squash, green beans), bananas, yogurt with probiotics, and applesauce.

Avoid greasy or fried foods, high-sugar foods or drinks, dairy temporarily (except yogurt), raw fruits and vegetables (except bananas), spicy foods, and high-fiber foods like bran or beans.

For babies: continue breastfeeding normally (breast milk is protective), continue formula at full strength on a normal schedule, and don’t dilute formula, since this can cause an electrolyte imbalance.

Step 3: Protect the Skin (Diaper Rash Prevention)

Diarrhea is acidic and irritates delicate skin. Change diapers immediately after each bowel movement, rinse with warm water and a soft cloth or squirt bottle, let the area air-dry for 5–10 minutes if possible, and use a thick barrier cream (zinc oxide or petroleum jelly) at every change. Diaper-free time, when possible, also helps.

If a rash develops, continue the steps above, use a thick barrier cream every change, and consider a blow dryer on a cool setting held 6–12 inches away to help dry the area. Call your doctor if the rash is severe, has blisters or bleeding, or isn’t improving in 2–3 days.

Step 4: Probiotics (May Help)

Probiotics — the “good bacteria” that help restore gut balance — may shorten the duration of diarrhea by about a day. Options include yogurt with live cultures (easiest for kids), probiotic supplements, and kefir. They’re safe for all ages, including babies on solids.

Dehydration: The Biggest Concern

Young children — especially babies — can become dehydrated very quickly with vomiting or diarrhea. This is the thing to watch most closely.

Tracking Hydration

• Wet diapers/bathroom trips: babies should have at least 6 wet diapers in 24 hours; toddlers should pee at least every 6–8 hours; older kids at least every 8–12 hours
• Urine color: pale yellow means good hydration; dark yellow/amber means your child needs more fluids
• Tears when crying
• Moisture in the mouth
• Energy level

When It’s Both: Vomiting and Diarrhea

This is the toughest combination for parents to manage. Priority one is preventing dehydration: focus on tiny, frequent sips between vomiting episodes, offer fluids after each diarrhea episode, and treat oral rehydration solution as essential. If vomiting is severe, wait 30–60 minutes after an episode, start with 1 teaspoon every 5 minutes, go slowly, and try popsicles for steady intake.

Priority two is watching for dehydration every few hours: when was the last wet diaper, are there tears when crying, is the mouth moist, is your child alert or very sleepy.

Age-Specific Guidelines

Babies (0–12 Months)

Babies are extra vulnerable — their small body size means they dehydrate faster, they can’t tell you they’re thirsty, and they rely entirely on you for hydration.

If vomiting: breastfed babies should nurse more frequently in shorter sessions; formula-fed babies should get smaller, more frequent bottles; start Pedialyte if vomiting more than 2–3 times in a few hours.

If diarrhea: continue normal feeding (breast or formula), don’t dilute formula, and watch diaper count closely.

Toddlers (1–3 Years)

Toddlers may refuse to drink, can’t always communicate symptoms, and being active makes it harder to keep them resting. Try making fluids fun with a special cup or silly straw, offer Pedialyte popsicles, use small rewards like a sticker for drinking, distract with a show while sipping, and offer choices (“water or Pedialyte?”).

Older Kids (4+ Years)

Older kids can tell you how they feel, understand the need to drink, and can use the bathroom independently. Set fluid goals (“let’s drink this whole cup in the next hour”), offer ice chips if nauseous, try flat diluted ginger ale for ages 6+, or peppermint tea to soothe the stomach.

Preventing the Spread — It’s Very Contagious

Stomach bugs spread through the fecal-oral route, direct contact with contaminated surfaces, contaminated food or water, and vomit particles, which can become airborne. The contagious period runs from when symptoms start until 48–72 hours after they stop.

For the Sick Child

• Isolate if possible — keep away from siblings
• Use a separate bathroom if possible, or disinfect after each use
• Use separate towels and linens
• Use disposable dishes and utensils if practical

Handwashing — the Most Important Step

Wash hands frequently: after using the bathroom, after changing diapers, before eating, and after touching a sick child. Use soap and water for 20 seconds — hand sanitizer doesn’t kill norovirus well. Everyone in the household should wash hands frequently.

Cleaning

Disinfect high-touch surfaces daily — doorknobs, light switches, toilet and sink surfaces, toys, tablets and phones. Use a bleach-based cleaner for norovirus, since it resists many other cleaners (mix ¼ cup bleach per gallon of water, let sit 5–10 minutes, then rinse). Wash contaminated clothing and bedding in a hot water cycle, separately from other laundry, adding bleach if safe for the fabric.

For vomit cleanup: wear gloves, clean up immediately since the virus spreads from droplets, disinfect the area with a bleach solution, dispose of waste in a sealed bag, and wash your hands thoroughly afterward.

When to Keep Home from Daycare or School

Keep your child home if they have active vomiting or diarrhea, had vomiting or diarrhea in the last 24 hours, have a fever, or are too sick to participate. They can return once they’ve gone 48 hours with no vomiting or diarrhea, been fever-free for 24 hours without medicine, and are eating, drinking, and participating normally.

When to Call Your Doctor

Common Mistakes Parents Make

Special Situations

Pregnant Caregiver

Wear gloves when changing diapers or cleaning up vomit, wash hands frequently, and consider having a partner handle sick-child care when possible — some stomach viruses, like norovirus, can be worse during pregnancy.

Multiple Kids Sick

Set up “sick stations” with buckets, towels, and fluids; use a timer for fluid reminders; tag-team with a partner if possible; lower other expectations for a bit; and consider ordering food if it helps you stay on top of everyone’s care.

Traveling

Pack hand sanitizer as a backup to handwashing, bring anti-nausea bags for the car or plane, know where the nearest ER or urgent care is, bring Pedialyte packets to mix with bottled water, and look up a local pediatrician option before the trip.

What About Medicine?

Avoid

• Anti-nausea medicine (Zofran, etc.): generally not recommended for kids with a simple stomach virus — it may mask symptoms of something more serious, and can have side effects. A doctor may prescribe it in specific situations.
• Anti-diarrhea medicine (Imodium, Kaopectate): can be dangerous for children and cause serious complications — diarrhea is the body’s way of clearing infection. Never give without a doctor’s approval.
• “Pink stuff” (Pepto-Bismol): not safe for kids under 12 — it contains an aspirin-like substance with a risk of Reye’s syndrome.

May Help

• Probiotics: may shorten the duration of diarrhea; safe for all ages (yogurt with live cultures, probiotic supplements)
• Ginger for nausea: small amounts in food for ages 2+; flat diluted ginger ale or ginger tea for ages 6+
• Fever medicine (Tylenol/Motrin): if fever is making your child uncomfortable — it doesn’t treat the vomiting or diarrhea itself

Your Vomiting/Diarrhea Action Plan