Stomach & Intestinal Infections

Appendicitis (inflammation of the appendix) requires immediate medical attention. So it’s important to know its symptoms — and how they differ from a run-of-the-mill stomachache — so you can get medical care right away if your child has them.

The first symptoms of appendicitis usually are a mild fever and pain around the bellybutton. The pain usually worsens and moves to the lower right side of the belly. Vomiting, nausea, and loss of appetite are other common symptoms.

Call your doctor immediately if you suspect that your child has appendicitis. The earlier it’s caught, the easier it will be to treat.

About Appendicitis

The appendix is a small finger-like organ that’s attached to the large intestine in the lower right side of the abdomen. The inside of the appendix forms a cul-de-sac that usually opens into the large intestine.

When the appendix is blocked, it becomes inflamed and bacteria can overgrow in it. Blockage can be due to hard rock-like stool (called a fecolith), inflammation of lymph nodes in the intestines, or even infections like parasites.

If the infected appendix isn’t removed, it can burst and spread bacteria. The infection from a ruptured appendix is very serious — it can form an abscess (an infection of pus) or spread throughout the abdomen (this type of infection is called peritonitis).

Appendicitis mostly affects kids and teens between 10 and 20 years old, and is rare in infants. It’s one of the most common reasons for emergency abdominal surgery in kids. Appendicitis is not contagious.

Symptoms

Call the doctor immediately if your child shows symptoms of appendicitis, including:

• significant abdominal pain, especially around the bellybutton or in the lower right part of the abdomen (perhaps coming and going and then becoming consistent and sharp)
• low-grade fever
• loss of appetite
• nausea and vomiting
• diarrhea (especially small amounts, with mucus)
• swollen or bloated abdomen, especially in infants

There is no way to prevent appendicitis, but with the right diagnostic tests and antibiotics, most cases are identified and treated without complications.

If appendicitis is not treated, the inflamed appendix can burst 24 to 72 hours after the symptoms begin. If the appendix does burst, the pain may spread across the whole abdomen and the child’s fever may be very high, reaching 104°F (40°C).

The symptoms of appendicitis can vary according to a child’s age. In kids 2 years old or younger, the most common symptoms are vomiting and a bloated or swollen abdomen, accompanied by pain.

If you suspect that your child has appendicitis, call your doctor immediately and don’t give your child any pain medicine or anything to eat or drink unless instructed to by the doctor.

Diagnosis

Because the symptoms of appendicitis can be so similar to those of other medical conditions (like kidney stones, pneumonia, or even a urinary tract infection), it’s often a challenge for doctors to diagnose it.

To confirm or rule out appendicitis, a doctor will examine the abdomen for signs of pain and tenderness, and order blood and urine tests. The doctor also might order other tests, like an X-ray of the abdomen and chest, ultrasound, or a CAT scan. If the doctor suspects appendicitis, you may be told to stop giving your child any food or liquids in order to prepare for surgery.

Treatment

Appendicitis is treated by removing the inflamed appendix through an appendectomy. Surgeons usually either make a traditional incision in the abdomen or use a small surgical device (a laparoscope) that creates a smaller opening. An appendectomy usually requires a 2- to 3-day hospital stay.

Before and after surgery, intravenous (IV) fluids and antibiotics will help prevent complications and decrease the risk for wound infections after surgery. If needed, your child will receive pain medicine.

An infected appendix that bursts also will be removed surgically but might require a longer hospital stay to allow antibiotics to kill any bacteria that have spread into the body.

Ascariasis is an intestinal infection caused by a parasitic roundworm. While globally it is the most common human infection caused by worms, ascariasis is rare in the United States. Most cases happen in areas with poor sanitation or crowded living conditions.

Signs and Symptoms

Kids are more likely than adults to develop gastrointestinal symptoms with an ascariasis infection because their smaller intestines are at greater risk for intestinal blockage. The greater the number of worms involved, the more severe the symptoms are likely to be.

Symptoms seen with mild infestation include:

• worms in stool (poop)
• coughing up worms
• loss of appetite
• fever
• wheezing

More severe infestations can cause more serious signs and symptoms, including:

• vomiting
• shortness of breath
• abdominal distention (swelling of the abdomen)
• severe stomach or abdominal pain
• intestinal blockage
• biliary tract blockage (includes the liver and gallbladder)

Description

Ascariasis occurs when worm eggs of the parasite Ascaris lumbricoides (commonly found in soil and human feces) are swallowed. This can happen from contaminated food, drink, or soil. The roundworms range in size from 5.9 to 9.8 inches for adult males and 9.8 to 13.8 inches for adult females. The worms can grow to be as thick as a pencil and can live for 1 to 2 years.

Ascariasis is often found in developing countries with poor sanitary conditions or in areas where human stool is used as fertilizer. After the eggs are swallowed, they pass into the intestines, where they hatch into larvae. The larvae then begin to move through the body.

Once they get through the intestinal wall, the larvae travel from the liver to the lungs through the bloodstream. During this stage, pulmonary symptoms such as coughing (even coughing up worms) may occur. In the lungs, the larvae climb up through the bronchial tubes to the throat, where they are swallowed. The larvae then return to the small intestine where they grow, mature, mate, and lay eggs. The worms reach maturity about 2 months after an egg is ingested.

Adult worms live and remain in the small intestine. A female worm can produce up to 240,000 eggs in a day, which are then discharged into the feces and incubate in the soil for weeks. Children are particularly susceptible to ascariasis because they tend to put things in their mouths, including dirt, and they often have poorer hygiene habits than adults.

Ascariasis is common in warmer or tropical climates, particularly in developing nations, where it can affect large segments of the population. Ascariasis is rare in the United States, due to strict sanitation rules and regulations.

Contagiousness

Ascariasis is not spread directly from one person to another. To become infected, an individual has to consume the worm’s eggs.

Prevention

The most important measure of protection against ascariasis is the safe and sanitary disposal of human waste. People living in areas of the world that use human feces as fertilizer must thoroughly cook all foods or clean them with a proper iodine solution (particularly fruits and vegetables).

Children who are adopted from developing nations are often screened for worms as a precautionary measure. Kids who live in underdeveloped areas of the world may be prescribed a preventive deworming medication.

These practices are recommended for all children:

• Try as much as possible to keep kids from putting things in their mouths.
• Teach kids to wash their hands well and often, especially after using the bathroom and before eating.

Professional Treatment

Doctors usually prescribe antiparasitic medication to be taken orally to kill intestinal roundworms. Sometimes the stool will be re-examined about 3 weeks after treatment to check for eggs and worms. Symptoms usually disappear within 1 week of starting treatment.

Very rarely, surgical removal of the worms may be necessary (particularly in cases of intestinal or liver-related obstruction, or abdominal infection). A child who has ascariasis should be checked for other intestinal parasites, such as pinworm.

Home Treatment

If your child has ascariasis, the medicine prescribed should be given as directed. To prevent reinfection:

• Make sure that your child washes his or her hands often, especially after using the bathroom and before eating.
• Have your pets checked for worms regularly.
• Keep your child’s fingernails short and clean.
• Sterilize any contaminated clothing, pajamas, and bedding.
• Try to find the source of the infection. Additional sanitation measures in or around your home may be necessary.

When to Call the Doctor

If your child has any of the symptoms of ascariasis, contact your doctor right away. Stool samples will be sent to a laboratory to check for eggs and worms to confirm the diagnosis.

Call the doctor if symptoms do not improve with treatment or if new symptoms start.

Campylobacter bacteria, usually transmitted in contaminated food or water, can infect the gastrointestinal tract and cause diarrhea, fever, and cramps. Good hand-washing and food safety habits will help prevent Campylobacter infections (or campylobacteriosis), which usually clear up on their own but sometimes are treated with antibiotics.

Campylobacter infects over 2 million people each year, and it’s a leading cause of diarrhea and foodborne illness. Babies younger than 1 year old, teens, and young adults are most commonly affected.

Causes

Campylobacter is found in the intestines of many wild and domestic animals. The bacteria are passed in their feces (poop), which can lead to infection in humans via contaminated food, meats (especially chicken), water taken from contaminated sources (streams or rivers near where animals graze), and milk products that haven’t been pasteurized.

Bacteria can spread from person to person when someone comes into contact with fecal matter from an infected person (especially a child in diapers). Household pets can carry and transmit the bacteria to their owners.

Once inside the human digestive system, Campylobacter infects and attacks the lining of both the small and large intestines. The bacteria also can affect other parts of the body. In some cases — particularly in very young kids and those with chronic illnesses or a weak immune system — the bacteria can get into the bloodstream (called bacteremia).

In rare cases, campylobacteriosis can lead to Guillain-Barré syndrome, a rare autoimmune disorder.

Symptoms

Symptoms usually appear 1 to 7 days after ingestion of the bacteria. The main symptoms of Campylobacter infection are fever, abdominal cramps, and mild to severe diarrhea. Diarrhea can lead to dehydration, which should be closely monitored. Signs of dehydration include thirst, irritability, restlessness, lethargy, sunken eyes, dry mouth and tongue, dry skin, fewer trips to the bathroom to urinate (pee), and (in infants) a dry diaper for several hours.

In cases of campylobacteriosis, the diarrhea is initially watery, but later may contain blood and mucus. Sometimes, the abdominal pain seems to be a more serious symptom than the diarrhea. When this happens, the infection may be mistaken for appendicitis or a problem with the pancreas.

Prevention

You can prevent Campylobacter infection by using drinking water that’s been tested and approved for purity, especially in developing countries, and by drinking milk that’s been pasteurized. While hiking and camping, don’t drink water from streams or from sources that pass through land where animals graze.

Kill any bacteria in meats by cooking them thoroughly and eating while still warm. Whenever you prepare foods, wash your hands well before and after touching raw meats, especially poultry. Wash cutting boards, countertops, and utensils with soap and hot water after contact with raw meat.

As you care for a family member who has diarrhea, remember to wash your hands before touching other people in your household and before handling foods. Clean and disinfect toilets after they’re used by the person with diarrhea. Also, if a pet dog or cat has diarrhea, wash your hands often and check with your veterinarian about treatment.

Diagnosis

Your doctor may send a stool sample to the lab to be tested for Campylobacter bacteria. Other lab tests also might be needed, especially if your child has blood in the stool. If your doctor suspects an infection in the bloodstream (bacteremia), a blood culture might be ordered.

Treatment

Most kids with Campylobacter infection will recover without medication. Sometimes, a doctor may prescribe an antibiotic, especially if the child is very young or the symptoms are severe or lasting. If your child receives an antibiotic, give it on schedule for as long as the doctor has ordered. Also, do not give nonprescription medicines for diarrhea without first checking with your doctor.

After seeing a doctor, most kids with Campylobacter infections are treated at home, especially if they show no signs of being seriously dehydrated. They should drink plenty of fluids as long as the diarrhea lasts and be watched for signs of dehydration.

Kids with mild diarrhea and no dehydration should continue to eat normally and increase their fluid intake — but fruit juices and soft drinks can worsen diarrhea and should be avoided. If your child is dehydrated, your doctor may recommend using an oral rehydration solution. Babies with campylobacteriosis who are breastfed should continue to be breastfed throughout the illness.

Diarrhea usually stops within 2 to 5 days. Full recovery usually takes about 1 week. In about 20% of cases, diarrhea can last longer or stop and then come back.

When to Call the Doctor

Call your doctor if your child:

• has diarrhea streaked with blood
• is vomiting
• shows any signs of dehydration
• has abdominal pain
• has a high fever

With some rest, most kids with Campylobacter infection can quickly make a full recovery.

Cholera is a serious and sometimes life-threatening infection that mainly affects people in developing countries, where clean water and other sanitation measures are hard to come by. If you live in the United States, the chances of someone in your family getting cholera are slim.

But if you’re planning to travel to a foreign country, especially one in the tropics, it’s a good idea to know about cholera, and how to prevent it. Taking precautions with your food and water is the best way to avoid the illness.

About Cholera

Cholera is an intestinal infection caused the bacterium Vibrio cholerae. This bacterium produces a potent toxin that binds to the walls of the intestines. The body responds by secreting large amounts of water, causing watery diarrhea, vomiting, and subsequent dehydration as fluids and salts exit the body.

As a result, people with cholera can become dehydrated very quickly. Untreated severe dehydration can cause serious health problems like seizures and kidney failure. A person who doesn’t get the proper medical treatment might even die.

The good news is, cholera is easy to treat if it’s caught early. Kids who have mild to moderate cases usually get better within a week. Even people with severe cases of cholera recover fully in a week or so if they get medical care.

Cholera is mostly found in hot, tropical climates — in particular Asia, Africa, Latin America, India, and the Middle East. Although it’s rare in the United States (the last outbreak was in 1911), cases can still happen. Travelers from countries where cholera is more common can bring it into the country, and some people in the U.S. have become sick from eating raw or undercooked shellfish from the Gulf of Mexico.

How It Spreads

People get cholera from eating or drinking food or water that’s been contaminated with the feces (poop) of someone who has cholera.

This is one reason why cholera is rare in countries with good sanitation systems. Things like flush toilets, sewer systems, and water treatment facilities keep poop out of the water and food supply. Cholera epidemics also sometimes happen after a disaster (like an earthquake or flood) if people are living in tent cities or other places without running water or proper sanitation systems. Less commonly, the bacteria that cause cholera are found in brackish rivers and coastal waters.

Cholera is not contagious, so you can’t catch it from direct contact with another person.

Signs & Symptoms

When someone is infected with the cholera bacterium, symptoms can appear in a few hours or as late as 5 days later. Many kids with cholera have no signs or symptoms, but some cases can be severe and life-threatening.

Common symptoms of cholera and the dehydration it causes include:

• watery, pale-colored diarrhea, often in large amounts
• nausea and vomiting
• cramps, particularly in the abdomen and legs
• irritability, lack of energy, or unusual sleepiness
• glassy or sunken eyes
• dry mouth and extreme thirst
• dry, shriveled skin
• low urine output and a lack of tears
• arrhythmia (irregular heartbeat) and low blood pressure

If your child develops symptoms like these, especially after visiting an area where cholera is likely or common, call your doctor or get medical help right away. Severe dehydration can happen very quickly, so it’s essential to start replacing lost fluids right away to avoid damage to internal organs.

Diagnosis

To confirm a diagnosis of cholera, doctors may take a sample of stool or vomit or rectal swab to examine for signs of the bacteria. Rapid, dipstick-style tests are now available, which help health care providers in remote areas identify the disease more quickly and control outbreaks more effectively. All confirmed cases of cholera must be reported to local health officials.

Treatment

Since severe dehydration and death can occur within hours, cholera needs to be treated immediately. Most kids recover with no long-term problems as long as they receive prompt treatment.

The goal of treatment is to replace all the fluids and salts lost through diarrhea and vomiting. For mild dehydration, a doctor may recommend giving your child an over-the-counter rehydration solution. Kids with more severe cases of cholera may need to stay in the hospital and get intravenous (IV) fluids.

Sometimes doctors prescribe antibiotics to treat cholera. The antibiotics are not as important as rehydration, but can help shorten the length of time someone is sick. They also might make cholera-related diarrhea less severe. Sometimes doctors may prescribe zinc supplements.

Anti-diarrheal medicines can actually make the symptoms of cholera worse, so if your child has cholera (or you think your child has it), do not offer them.

Prevention

Some countries have cholera vaccines that can help protect people against cholera for a short while. Because cholera isn’t a problem in the United States, the vaccine is not offered here.

If you’re going to an area that has cholera, you can greatly reduce your family’s chances of getting sick by following a few simple precautions while you’re there:

• Boil or disinfect any water that you’ll use for drinking, washing or preparing food, making ice, making coffee or tea, or brushing your teeth. Choose bottled water or other drinks that come in sealed cans or bottles. Be sure to wipe the outside of the can or bottle before you drink from it. Avoid tap water, fountain drinks, and drinks with ice cubes.
• Fully cook all food, especially seafood. Avoid food from street vendors. Instead, eat packaged foods and meals that are freshly cooked and served hot. Avoid sushi and any other raw or partly cooked seafood.
• Avoid raw vegetables, including salads, and fruits that have already been peeled or cannot be peeled (like grapes and berries). Bananas, avocados, and oranges are better choices.
• Dairy foods are often contaminated, so be careful with things like ice cream, milk, and cheese. Eat only pasteurized dairy and be sure dairy foods are refrigerated and kept cold.
• Wash your hands well and often with soap and clean water, especially after you use the bathroom or before you prepare food. If no soap and water are available, use a hand cleaner that’s at least 60% alcohol.

Dengue fever is a tropical disease caused by a virus carried by mosquitoes. The virus can cause fever, headaches, rashes, and pain throughout the body. Most cases of dengue fever are mild and go away on their own after about a week.

Dengue fever rarely strikes in the United States (the last cases were reported in Texas in 2005), but if you plan to travel to a foreign country — especially one in the tropics — it’s wise to guard against dengue fever. Wearing insect repellant, covering sleep areas with netting, and avoiding the outdoors at dusk and dawn (when mosquitoes are most active) can help lower the chances of infection.

About Dengue Fever

Dengue (DEN-gee) fever is caused by four similar viruses spread by mosquitoes of the genus Aedes, which are common in tropical and subtropical areas worldwide.

When an Aedes mosquito bites a person who has been infected with a dengue virus, the mosquito can become a carrier of the virus. If this mosquito bites someone else, that person can be infected with dengue fever. The virus can’t spread directly from person to person.

Many kids with dengue fever don’t have symptoms; others have mild symptoms that appear anywhere from 4 days to 2 weeks after being bitten by an infected mosquito. Symptoms typically last for 2 to 7 days. Once kids have had the illness, they become immune to that particular type of the virus (although they can still be infected by any of the other three types).

In rare cases, dengue fever can lead to a more serious form of the disease called dengue hemorrhagic fever (DHF). DHF can be life threatening and needs to be treated right away.

Signs & Symptoms

In the past, dengue fever was known as “breakbone fever,” which might give you an idea of the symptoms it can cause — that is, if a person ends up having any symptoms at all. The fever isn’t actually breaking any bones, but it can sometimes feel like it is.

Common signs and symptoms of dengue fever include:

• high fever, possibly as high as 105°F (40°C)
• pain behind the eyes and in the joints, muscles and/or bones
• severe headache
• rash over most of the body
• mild bleeding from the nose or gums
• bruising easily

Symptoms are generally mild in younger children and those who are infected with the disease for the first time. Older kids, adults, and those who have had a previous infection may have moderate to severe symptoms.

People with DHF will have the regular symptoms of dengue fever for 2 to 7 days. After the fever eases, other symptoms get worse and can cause more severe bleeding; gastrointestinal problems like nausea, vomiting, or severe abdominal (belly) pain; and respiratory problems like difficulty breathing. Dehydration, heavy bleeding, and a rapid drop in blood pressure (shock) can follow if DHF goes untreated. These symptoms are life threatening and need immediate medical care.

Diagnosis

If you think your child’s symptoms might be caused by dengue fever, call a doctor right away. You should also call a doctor if your child has recently been to a region that has dengue fever and develops a fever or severe headache.

To make a diagnosis, the doctor will examine your child and evaluate the symptoms. The doctor will ask about your child’s medical history and recent travels, and send a sample of your child’s blood to be tested for the disease.

Treatment

No specific treatment is available for dengue fever. Mild cases can be treated by giving lots of fluids to prevent dehydration and getting plenty of rest. Pain relievers with acetaminophen can ease the headaches and pain associated with dengue fever. Pain relievers with aspirin or ibuprofen should be avoided, as they can make bleeding more likely.

Most cases of dengue fever go away within a week or two and won’t cause any lasting problems. If someone has severe symptoms of the disease, or if symptoms get worse in the first day or two after the fever goes away, seek immediate medical care. This could be an indication of DHF, which is a medical emergency.

To treat severe cases of dengue fever at a hospital, doctors will deliver intravenous (IV) fluids and electrolytes (salts) to replace the fluids lost through vomiting or diarrhea. This is usually enough to effectively treat the disease, as long as fluid replacement therapy begins early. In more advanced cases, doctors may have to perform a transfusion to replace lost blood.

In all cases of dengue infection, regardless of how serious symptoms are, efforts should be made to keep the infected person from being bitten by mosquitoes. This will help prevent the illness from spreading to others.

Prevention

There is no vaccine to prevent dengue fever, so if children live in or will be visiting areas where dengue fever is likely, the only way to protect them from the disease is to minimize their chances of being bitten by an infected Aedes mosquito.

In such cases, take these precautions:

• Use screens on doors and windows, and promptly repair broken or damaged screens. Keep unscreened doors and windows shut.
• Have kids wear long-sleeved shirts, long pants, shoes, and socks when they go outside, and use mosquito netting over their beds at night.
• Use insect repellant as directed on your child. Choose a repellant with DEET or oil of lemon eucalyptus.
• Limit the amount of time kids spend outside during the day, especially in the hours around dawn and dusk, when mosquitoes are most active.
• Don’t give mosquitoes places to breed. Mosquitoes lay their eggs in water, so get rid of standing water in things like containers and discarded tires, and be sure to change the water in birdbaths, dog bowls, and flower vases at least once a week.

By taking these precautions and keeping your kids away from areas that have a dengue fever epidemic, the risk of contracting dengue fever is small for international travelers.

Most kids battle diarrhea — frequent, runny bowel movements (poop) — from time to time. The good news is that it usually doesn’t last long and is more annoying than dangerous. Still, it’s important to know how to relieve and even prevent diarrhea.

What Causes Diarrhea?

Diarrhea is usually brought on by gastrointestinal (GI) infections caused by germs (viruses, bacteria, or parasites).

Viruses

Viral gastroenteritis (often called the “stomach flu”) is a common cause of diarrhea and, often, nausea and vomiting. It can spread through a household, school, or childcare center quickly. The symptoms usually last just a few days, but kids (especially babies) who can’t get enough fluids can become dehydrated.

Rotavirus infection, a frequent cause of diarrhea in kids, can bring on explosive, watery diarrhea. Outbreaks are more common in the winter and early spring months, especially in childcare centers. A very effective rotavirus vaccine is now recommended for infants.

Enteroviruses, particularly coxsackievirus, also can cause diarrhea in kids, especially during the summer months.

Bacteria and Parasites

Many different types of bacteria and parasites can cause GI and diarrhea, including E. coli, Salmonella, Campylobacter, and Shigella bacteria; and Giardia and Cryptosporidium parasites.

Sometimes, diarrhea can be due to a non-infectious disease or condition, especially if it lasts several weeks or longer. In those cases, it could be a sign of a food allergy, lactose intolerance, or diseases of the gastrointestinal tract, such as celiac disease and inflammatory bowel disease.

What Are the Symptoms?

Symptoms usually start with crampy abdominal pain followed by diarrhea that usually lasts no more than a few days. Infections with many of the viruses, bacteria, and parasites that cause diarrhea also can bring on other symptoms, such as:

• fever
• loss of appetite
• nausea
• vomiting
• weight loss
• dehydration

In cases of viral gastroenteritis, kids often develop fever and vomiting first, followed by diarrhea.

When to Call the Doctor

Call your doctor if your child has diarrhea and is younger than 6 months old or has:

• a severe or long-lasting episode of diarrhea
• fever of 102°F or higher
• repeated vomiting, or refusal to drink fluids
• severe abdominal pain
• diarrhea that has blood or mucus

Call the doctor immediately if your child seems to be dehydrated. Signs include:

• dry or sticky mouth
• few or no tears when crying
• eyes that look sunken
• in a baby, the soft spot (fontanelle) on top of the head looks sunken
• peeing less or fewer wet diapers
• dry, cool skin
• irritability
• drowsiness or dizziness

How Can I Care for My Child?

Mild diarrhea usually isn’t cause for concern if your child is acting normally and drinking and eating enough. It usually passes in a few days, and kids recover with home care, rest, and plenty of fluids.

Kids who aren’t dehydrated or vomiting can continue eating and drinking as usual. In fact, continuing a regular diet may even shorten the diarrhea episode. You may want to serve smaller portions of food until the diarrhea ends.

Do not give your child an over-the-counter anti-diarrhea medicine unless your doctor gives the OK.

The goal when treating diarrhea is to replace the lost fluids and electrolytes (salts and minerals). For kids who aren’t dehydrated, doctors recommend:

• Continuing with a regular diet and giving more liquids to replace those lost while the diarrhea continues.
• Offering additional breastmilk or formula to infants.

For kids who show signs of mild dehydration, doctors often recommend rehydration with an oral rehydration solution (ORS). These are available in most grocery stores and drugstores without a prescription and replace body fluids quickly. Your doctor will tell you what kind to give, how much, and for how long.

Kids should never be rehydrated with water alone because it doesn’t contain the right mix of sodium, potassium, and other important minerals and nutrients.

In some cases, kids with severe diarrhea may need to get IV fluids at the hospital for a few hours to help combat dehydration.

Can Diarrhea Be Prevented?

It’s almost impossible to prevent kids from ever getting diarrhea. But here are some ways to make it less likely:

• Make sure kids wash their hands well and often, especially after using the toilet and before eating. Hand washing is the most effective way to prevent diarrheal infections that pass from person to person. Dirty hands carry germs into the body when kids bite their nails, suck their thumbs, eat with their fingers, or put any part of their hands into their mouths.
• Keep bathroom surfaces clean.
• Wash fruits and vegetables well before eating.
• Wash kitchen counters and cooking utensils thoroughly after they’ve been in contact with raw meat, especially poultry.
• Refrigerate meats as soon as possible after bringing them home from the store. Cook cook them until they’re no longer pink. Refrigerate all leftovers as soon as possible.
• Never drink from streams, springs, or lakes unless local health authorities have certified that the water is safe for drinking.
• Avoid washing pet cages or bowls in the same sink that you use to prepare food. And keep pet feeding areas separate from family eating areas.

Food poisoning can really throw you for a loop. After eating germ-infected food, a person can develop sudden and severe symptoms like vomiting and diarrhea. Medical treatment is usually not needed, but home care is important.

If your child develops food poisoning, make sure he or she drinks plenty of fluids to prevent dehydration. Rest is also important.

Food poisoning usually runs its course, so your child should feel better in a few days.

About Food Poisoning

Food poisoning happens when bacteria (and, sometimes, viruses or other germs) get into food or drinks. You can’t taste, smell, or see these germs, but even these tiny organisms can have a powerful effect on the body.

Once the germs that cause food poisoning get into a person’s system, some of them release toxins (or poisons, hence the name “food poisoning”) that can cause diarrhea and vomiting.

Doctors often use “food poisoning” to describe an illness that comes on quickly after eating contaminated food. People typically get diarrhea or start vomiting within a few hours after being infected. Food poisoning usually goes away quickly too, and most people recover in a couple of days with no lasting complications.

In a few cases, food poisoning can be severe enough to require a visit to the doctor or hospital. When people need medical treatment for food poisoning, it’s often because of dehydration, the most common serious complication of food poisoning.

Causes

Eating or drinking something that’s contaminated with germs can cause food poisoning. Often, people get food poisoning from animal-based foods — like meat, poultry, eggs, dairy products, and seafood. But unwashed fruits, vegetables, and other raw foods also can get contaminated and make someone sick.

Foods and liquids can be contaminated at many points in the food preparation, storage, and handling process. For example:

• Water that is used to grow food can become infected with animal or human feces (poop).
• Meat or poultry may come into contact with infectious microorganisms during processing or shipping.
• Foods can become infected with bacteria if they’re stored at the wrong temperature or kept too long.
• Cooks or other food handlers can contaminate foods if they don’t wash their hands properly or they use unclean utensils or cutting boards when preparing food.

People with health conditions (like chronic kidney disease) or weakened immune systems are more at risk of getting ill from food poisoning than those who are in good health.

Common Food Poisoning Germs

A number of microorganisms can cause food poisoning. Common culprits include:

Salmonella. Salmonella bacteria are the leading cause of food poisoning in the United States. These bacteria usually get into foods when they come into contact with animal feces. The main causes of salmonella poisoning are eating dairy products, undercooked meat, and fresh produce that hasn’t been washed well.

E. coli (Escherichia coli). E. coli bacteria, too, usually get into food or water when they come into contact with animal feces. Eating undercooked ground beef is the most common cause of E. coli poisoning in the United States.

Listeria. These bacteria are mostly found in unpasteurized dairy products, smoked seafood, and processed meats like hot dogs and luncheon meats. Listeria bacteria also can contaminate fruits and vegetables, although that’s less common.

Campylobacter. These bacteria most commonly infect meat, poultry, and unpasteurized milk. Campylobacter also can contaminate water. As with other kinds of bacteria, these usually get into foods through contact with infected animal feces.

Staphylococcus aureus. These bacteria (which can be found in meats, prepared salads, and foods made with contaminated dairy products) spread through hand contact, sneezing, or coughing. That means the infection can be transmitted by people who prepare or handle food.

Shigella. Shigella bacteria can infect seafood or raw fruits and vegetables. Most of the time these bacteria are spread when people who prepare or handle food don’t wash their hands properly after using the bathroom. Sometimes, an infection causes blood in the stool (poop).

Hepatitis A. People mostly get this virus from eating raw shellfish or foods that have been handled by someone who is infected. It can be hard to pinpoint the source of an infection because people may not get sick for 15 to 50 days afterward.

Noroviruses. These viruses usually contaminate food that’s been prepared by an infected handler.

Signs of Food Poisoning

How food poisoning shows up depends on the germ that caused it. Sometimes a child will start to feel sick within an hour or two of eating or drinking contaminated food or liquid. Other times, symptoms may not appear for a number of weeks. In most cases, symptoms will clear up within 1 to 10 days.

Typically, someone with food poisoning will have:

• nausea
• abdominal pain and cramps
• vomiting
• diarrhea
• fever
• headache and overall weakness

In rare cases, food poisoning can make someone feel dizzy, have blurry vision, or notice tingling in the arms. In very rare cases, the weakness that sometimes goes along with food poisoning will cause trouble breathing.

Certain types of infectious microorganisms, including Listeria and E. coli, can cause potentially dangerous heart, kidney, and bleeding problems.

When to Call the Doctor

Most cases of food poisoning don’t require medical attention, but some do. The most common serious problem that happens with food poisoning is dehydration. A child who is healthy is unlikely to get dehydrated as long as he or she drinks enough fluids to replace what is lost through throwing up or diarrhea.

Call the doctor if your child has any of these symptoms:

• vomiting that lasts for more than 12 hours
• diarrhea with a fever higher than 101°F (38.3°C)
• severe abdominal pain that doesn’t go away after a bowel movement
• bloody feces (diarrhea or regular poop) or bloody vomit
• bowel movements that are black or maroon in color
• a racing or pounding heart

It’s important to watch for signs of dehydration, which include:

• extreme thirst
• making little or no urine (pee)
• dizziness
• sunken eyes
• lightheadedness or weakness

If your family recently been to a foreign country and your child starts having diarrhea or other stomach problems, call your doctor.

Food poisoning (especially dehydration) can be more serious for people with weakened immune systems or health conditions. If your child has a health condition (such as kidney problems or sickle cell disease), call your doctor right away. Pregnant women also should let their doctors know if they get food poisoning as some germs can affect the unborn child.

Treating Food Poisoning

A doctor will ask about what your child ate most recently and when symptoms began. The doctor will do an exam, and might take a sample of blood, stool, or urine and send it to a lab for analysis. This will help the doctor find out which microorganism is causing the illness.

Usually, food poisoning runs its course and kids get better on their own. Occasionally, though, doctors prescribe antibiotics to treat more severe types of bacterial food poisoning. If dehydration is severe, a child may need to be treated in a hospital with intravenous (IV) fluids.

At-Home Care

Food poisoning usually goes away on its own in a few days. To help your child feel better in the meantime, make sure he or she:

• Gets plenty of rest.
• Drinks fluids to protect against dehydration. Electrolyte solutions work, but anything except milk or caffeinated beverages will do.
• Takes small, frequent sips to make it easier to keep the fluids down.
• Avoids solid foods and dairy products until any diarrhea has stopped.

Do not give over-the-counter anti-diarrhea medications. These can make the symptoms of food poisoning last longer. When diarrhea and vomiting have stopped, offer your child small, bland, low-fat meals for a few days to prevent further stomach upset.

If symptoms become serious or you see signs of dehydration, call your doctor.

Preventing Food Poisoning

Following these tips can help reduce your family’s risk of food poisoning:

• Teach everyone in your family to wash their hands thoroughly and often, especially after using the bathroom, before touching food, and after touching raw food. Use soap and warm water and scrub for at least 15 seconds.
• Clean all utensils, cutting boards, and surfaces that you use to prepare food with hot, soapy water.
• Don’t serve unpasteurized milk or food that contains unpasteurized milk.
• Wash all raw vegetables and fruits that you can’t peel yourself.
• Keep raw foods (especially meat, poultry, and seafood) away from other foods until they’re cooked.
• Use perishable food or any food with an expiration date as soon as possible.
• Cook all food from animal sources to a safe internal temperature. For ground beef and pork, this means at least 160°F (71°C). For solid cuts of meat, the safe temperature is 145°F (63°C). For chicken and turkey (ground and whole), it’s at least 165°F (74°C). Cook chicken eggs until the yolk is firm. Fish generally is safe to eat once it reaches a temperature of 145°F (63°C).
• Refrigerate leftovers quickly, preferably in containers with lids that can be snapped tightly shut.
• Defrost foods in the refrigerator, a microwave, or cold water. Food should never be thawed at room temperature.
• If food is past its expiration date, tastes funny, or smells strange, throw it out.
• If you’re pregnant, avoid all raw or undercooked meat or seafood, smoked seafood, raw eggs and products that might contain raw eggs, soft cheeses, unpasteurized milk and juice, patés, prepared salads, luncheon meats, and hot dogs.
• Don’t drink water from streams or untreated wells.

If someone in your family develops food poisoning, tell your local health department. Officials there might be able to pinpoint the cause and stop a potential outbreak that could affect others.

Giardiasis, an illness that affects the digestive tract (stomach and intestines), is caused by a microscopic parasite called Giardia lamblia. The parasite attaches itself to the lining of the small intestines in humans, where it interferes with the body’s absorption of fats and carbohydrates from digested foods.

Giardia is one of the chief causes of diarrhea in the United States, and spreads through contaminated water. It can survive the normal amounts of chlorine used to purify community water supplies, and can live for more than 2 months in cold water. As few as 10 of the microscopic parasites in a glass of water can cause a severe case of giardiasis in a human being who drinks it.

Young kids are more likely to have giardiasis than adults, so some experts think that our bodies gradually develop some form of immunity to the parasite as we get older. But it isn’t unusual for an entire family to have giardiasis, with some family members having diarrhea, some just crampy abdominal pains, and others with few or no symptoms.

Signs and Symptoms

Between 1% and 20% of the U.S. population has giardiasis, and this number may be 20% or higher in developing countries, where giardiasis is a major cause of epidemic childhood diarrhea. More than two thirds of people who are infected may have no signs or symptoms of illness, even though the parasite is living in their intestines.

When the parasite does cause symptoms, the illness usually begins with severe watery diarrhea, without blood or mucus. Giardiasis affects the body’s ability to absorb fats from the diet, so the diarrhea contains unabsorbed fats. That means that the diarrhea floats, is shiny, and smells very bad.

Other symptoms include:

• abdominal cramps
• large amounts of intestinal gas
• an enlarged belly from the gas
• loss of appetite
• nausea and vomiting
• sometimes a low-grade fever

These symptoms may last for 5 to 7 days or longer. If they last longer, a child may lose weight or show other signs of poor nutrition.

Sometimes, after acute (or short-term) symptoms of giardiasis pass, the disease begins a chronic (or more prolonged) phase. Symptoms of chronic giardiasis include:

• periods of intestinal gas
• abdominal pain in the area above the navel (belly button)
• poorly formed, “mushy” bowel movements (poop)

Prevention

Here are some ways to protect your family from giardiasis:

• Drink only from water supplies that have been approved by local health authorities.
• Bring your own water when you go camping or hiking, instead of drinking from sources like mountain streams.
• Wash raw fruits and vegetables well before you eat them.
• Wash your hands well before you cook food for yourself or for your family.
• Encourage your kids to wash their hands after every trip to the bathroom and especially before eating. If someone in your family has giardiasis, wash your hands often as you care for him or her.
• Have your kids wash their hands well after handling anything in “touch tanks” in aquariums, a potential source of giardiasis.
• Have your water checked on a regular basis if it comes from a well.

Also, it’s questionable whether infants and toddlers still in diapers should be sharing public pools. They certainly should not if they’re having diarrhea or loose stools (poop).

Contagiousness

People and animals (mainly dogs and beavers) who have giardiasis can pass the parasite in their stool. The stool can then contaminate public water supplies, community swimming pools, and “natural” water sources like mountain streams. Uncooked foods that have been rinsed in contaminated water may also spread the infection.

In childcare centers or any facility caring for a group of people, giardiasis can easily pass from person to person. At home, an infected family dog with diarrhea may pass the parasite to human family members who take care of the sick animal.

Diagnosis

Doctors confirm the diagnosis of giardiasis by taking stool samples and sending them to the lab to be examined for Giardia parasites. Several samples may be needed before the parasites are found. For that reason the doctor might order a much more sensitive test, the enzyme-linked immunosorbent assay or ELISA test.

Less often, doctors make the diagnosis by looking at the lining of the small intestine with an instrument called an endoscope and taking samples from inside the intestine to be sent to a laboratory. This is done in more extreme cases, when a definite cause for the diarrhea hasn’t been found.

Treatment

Giardiasis is treated with prescription medicines that kill the parasites. Treatment typically takes 5 to 7 days, and the medicine is usually given as a liquid. Some of these medicines may have side effects, so your doctor will tell you what to watch for.

If your child has giardiasis and your doctor has prescribed medication, be sure to give all doses on schedule for as long as your doctor directs. This will help your child recover faster and will kill parasites that might infect others in your family. Again, encourage all family members to wash their hands well and often, especially after using the bathroom and before eating.

A child who has diarrhea from giardiasis may lose too much fluid in the stool and become dehydrated. Make sure the child drinks plenty of fluids but no caffeinated beverages or juice, as they make the body lose water faster.

Ask the doctor before you give your child any nonprescription drugs for cramps or diarrhea because these medicines may mask symptoms and interfere with treatment.

Duration

The incubation period for giardiasis is 1 to 3 weeks after exposure to the parasite. In most cases, treatment with 5 to 7 days of antiparasitic medicine will help kids recover within a week’s time. Medication also shortens the time that they’re contagious. If giardiasis isn’t treated, symptoms can last up to 6 weeks or longer.

When to Call the Doctor

Call the doctor if your child has:

• large amounts of diarrhea, especially if he or she also has a fever and/or abdominal pain
• blood in the diarrhea
• occasional, small episodes of diarrhea that continue for several days, especially if appetite is poor, and your child is either gradually losing weight or isn’t gaining as much as expected

Helicobacter pylori (H. pylori) bacteria are a common cause of digestive illnesses, including gastritis (the irritation and inflammation of the stomach lining), peptic ulcers (sores in the lining of the stomach, small intestine, or esophagus), and even stomach cancer later in life.

These bacteria are found worldwide, but especially in developing countries, where up to 10% of children and 80% of adults are likely to have had an H. pylori infection — usually without any symptoms.

Signs and Symptoms

Anyone can have an H. pylori infection without knowing it — most H. pylori infections are “silent” and cause no symptoms. When the bacteria do cause symptoms, they’re usually either symptoms of gastritis or peptic ulcer disease.

In kids, symptoms of gastritis may include nausea, vomiting, and abdominal pain, although these symptoms are seen in many childhood illnesses.

H. pylori, which used to be called Campylobacter pylori, also can cause peptic ulcers (commonly known as stomach ulcers). In older kids and adults, the most common symptom of peptic ulcer disease is a gnawing or burning pain in the abdomen, usually in the area below the ribs and above the navel. This pain often gets worse on an empty stomach and improves as soon as the person eats food, drinks milk, or takes antacid medicine.

Kids who have peptic ulcer disease can have ulcers that bleed, causing hematemesis (bloody vomit or vomit that looks like coffee grounds) or melena (stool that’s black, bloody, or looks like tar). Younger children with peptic ulcers may not have such clear symptoms, so their illness may be harder to diagnose.

Contagiousness

Scientists suspect that H. pylori infection may be contagious because the infection seems to run in families and is more common where people live in crowded or unsanitary conditions. Although research suggests that infection is passed from person to person, exactly how this happens isn’t really known.

Diagnosis

Doctors can make the diagnosis of an H. pylori infection by using many different types of tests. A doctor may:

• look at the stomach lining directly. The patient will be under sedation during this procedure, which involves inserting an endoscope — a small, flexible tube with a tiny camera on the end — down the throat and into the stomach and duodenum. The doctor may then take samples of the lining to be checked in the laboratory for microscopic signs of infection and for H. pylori bacteria.
• do blood tests, which can detect the presence of H. pylori antibodies. Blood tests are easy to do, although a positive test may indicate exposure to H. pylori in the past, not an active infection.
• do breath tests, which can detect carbon broken down by H. pylori after the patient drinks a solution. Breath tests are time-consuming, provide no information about the infection’s severity, and can be difficult to perform in young children.
• do stool tests, which can detect the presence of H. pylori proteins in the stool (poop). Like breath testing, stool tests indicate the presence of H. pylori but give no information about an infection’s severity.

Treatment

Doctors treat H. pylori infections using antibiotics. Because a single antibiotic may not kill the bacteria, your child will normally be given a combination of antibiotics. Usually, the doctor will also give antacids or acid-suppressing drugs to neutralize or block production of stomach acids.

If your child has symptoms of bleeding from the stomach or small intestine, these symptoms will be treated in a hospital.

Because H. pylori infection can be cured with antibiotics, the most important home treatment is to give your child any prescribed antibiotic medicine on schedule for as long as the doctor has directed.

One way to help soothe the abdominal pain is by following a regular meal schedule. This means planning meals so that your child’s stomach doesn’t remain empty for long periods. Eating five or six smaller meals each day may be best, and your child should take some time to rest after each meal.

It’s also important to avoid giving your child aspirin, aspirin-containing medicines, ibuprofen, or anti-inflammatory drugs because these may irritate the stomach or cause stomach bleeding.

With prolonged antibiotic therapy, H. pylori gastritis and peptic ulcer disease (especially ulcers in the duodenum, a portion of the small intestine) often can be cured.

Prevention

Right now, there’s no vaccine against H. pylori. And because transmission isn’t clearly understood, prevention guidelines aren’t available. However, it’s always important to make sure you and your family:

• Wash your hands thoroughly.
• Eat food that’s been properly prepared.
• Drink water from a safe source.

When to Call the Doctor

Call your doctor immediately if your child has any of these symptoms:

• severe abdominal pain
• vomit that’s bloody or looks like coffee grounds
• stool that’s bloody, black, or looks like tar
• lasting gnawing or burning pain in the area below the ribs that improves after eating, drinking milk, or taking antacids

However, it’s important to remember kids can get stomachaches for many reasons — like indigestion, viruses, tension and worry, and appendicitis. Most stomachaches are not caused by H. pylori bacteria.

Pinworm is an intestinal infection caused by tiny parasitic worms. One of the most common roundworm infections, pinworm infections affect millions of people each year, particularly school-age kids.

If your child develops a pinworm infection, try not to worry. Pinworms don’t cause any harm (just itching), and it won’t take long to get rid of them. And people who have pinworms aren’t dirty — kids can get pinworms no matter how often they take a bath.

How Pinworm Infections Spread

Pinworm infections (also known as “seatworm infection,” “threadworm infection,” “enterobiasis,” or “oxyuriasis”) are contagious.

Pinworms get into the body when people ingest the microscopic pinworm eggs. These eggs can be found on contaminated hands and surfaces, such as:

• bed linens
• towels
• clothing (especially underwear and pajamas)
• toilets
• bathroom fixtures
• food
• drinking glasses
• eating utensils
• toys
• kitchen counters
• desks or lunch tables at school
• sandboxes

The eggs pass into the digestive system and hatch in the small intestine. From the small intestine, pinworm larvae continue their journey to the large intestine, where they live as parasites (with their heads attached to the inside wall of the bowel).

About 1 to 2 months later, adult female pinworms travel from the large intestine to the area around the rectum. There, they will lay new pinworm eggs, which trigger itching around the anus.

When someone scratches the itchy area, microscopic pinworm eggs transfer to their fingers. Contaminated fingers can then carry pinworm eggs to the mouth, where they are go back into the body, or stay on various surfaces, where they can live for 2 to 3 weeks.

If you’re wondering if your family pet could give your child a pinworm infection, it can’t. Pinworms don’t come from animals.

Signs and Symptoms

Often, someone can have a pinworm infection without knowing it. When symptoms are present, the most common one is itching around the rectum and restless sleep. The itching is usually worse at night because the worms move to the area around the rectum to lay their eggs. In girls, pinworm infection can spread to the vagina and cause a vaginal discharge. If the itching leads to broken skin, it can also lead to a bacterial skin infection.

If your child has a pinworm infection, you can see worms in the anal region, especially if you look about 2 or 3 hours after your child has fallen asleep. You also might see the worms in the toilet after your child goes to the bathroom. They look like tiny pieces of white thread and are really small — about as long as a staple. You might also see them on your child’s underwear in the morning.

Abdominal pain and nausea are less common symptoms but can happen if there are many pinworms in the intestines.

Diagnosis and Treatment

Your doctor may ask you to help make the diagnosis of pinworm by placing a sticky piece of clear cellophane tape against your child’s rectum. Pinworm eggs will stick to the tape and can be seen under a microscope in a laboratory. The best time to take a sample of eggs using tape is at night or in the morning before a bath (this is when there is the most pinworm activity around the rectum). The doctor also might take some samples from under a child’s fingernails to look for eggs.

If your child has a pinworm infection, the doctor may recommend an antiworm medication, which is given in one dose and repeated in 2 weeks. The doctor may decide to treat the entire family, especially if your child has had a pinworm infection before.

Although medicine takes care of the worm infection, the itching may continue for about a week. So the doctor may also give your child a cream or other medication to help stop the itching.

Regular hand washing and routine household cleaning (including frequent changing of underwear, and washing everyone’s pajamas and bed linens) also will help prevent the spread of pinworm infection within the family.

When to Call the Doctor

Call the doctor if your child complains of itchy skin or always seems to be scratching the anal or vaginal area.

Also ask about whether pinworms could be to blame if your child has trouble sleeping or has begun to wet the bed. (Pinworms can irritate the urethra — the channel through which urine leaves the bladder and exits the body — and lead to bedwetting.)

Prevention

Here are a few ways to prevent pinworm infections in your family:

• Remind kids to wash their hands often, especially after using the toilet, after playing outside, and before eating.
• Make sure your kids shower or bathe every day and change underwear and swimsuits daily.
• Keep kids’ fingernails short and clean.
• Tell kids not to scratch around their bottom or bite their nails.
• Wash your kids’ pajamas every few days.

Remember that pinworms are quite common among kids and aren’t harmful. By taking medication and following some prevention tips, you’ll be rid of the worms in no time.