Maleeha  Hey guys, after our last super informative episode on colorectal cancer and screening options, make sure to listen to that if you haven’t already, wink wink, Dionne and I had so much fun. We figured we’d stay in the GI system for a little bit longer.

Dionne  Yeah. Our gut told us there’d be another pressing topic that just had to be addressed. This time involving kids.

Maleeha  Our gut, you’re funny girl. I see what you did there. But yes, this year, you would have to be living under a rock if you haven’t heard or seen news about stomach flu and how it’s been spiking this year. And if you’re a parent or teacher, well, you know about it firsthand. It’s been everywhere.

Dionne  Can I just say Maleeha that you did not warn me about this phase during our motherhood pep talks. I thought I would get some reprieve when my son entered kindergarten. And my other two littles did two days of daycare and no, wrong!

Maleeha  Totally wrong, didn’t you see me struggling and complaining about that in residency like all the time? The struggle is real Dionne.

Dionne  Yeah, clearly I forgot. And a struggle is right. In addition to their chronic runny noses. I mean, literally, I call my two year old son Snotty Pippin. I mean, seriously, but they also come home with diarrhea from stomach flu. I mean, how girl I need help.

Maleeha  Dionne, I feel you. I feel you. I have been there and done that. Because there is nothing more humbling than having to clean up projectile vomit. Like why! Even when I give them the bowl to keep beside them somehow they miss. But you know what? I know we’re not alone. Other parents can relate. And I promise you I can help you with which detergents to use to remove curdled milk from a car seat. But I may not be able to help with much more. Lucky for us we have a special guest with us today who can pediatric gastroenterologist Dr. Debora Eseonu. Debora is based in Austin, Texas. She cares for newborns to adolescents who have issues related to the gut, liver and their nutritional status, but also has dedicated time to see children with gut motility disorders. So she is perfect to help us and other parents grapple with this crappy crisis. Get it?

Dionne  Crappy crisis. Wow. Wow. Only you Maleeha I know I know.But on another note, our guests name is familiar. Hmm. Okay, just kidding. Debora is my younger sister who if I may add, I inspired to get into medicine. And who wouldn’t even be here without me?

Maleeha  That is so something you would say.

Dionne  I mean, I’m just I just need the world to know this. Okay.

Maleeha  Older sister, yes.

Dionne  You know how it is that okay, okay, maybe it’s only partially true. But seriously, she has become our family’s on call pediatrician who we hit up for everything, especially gi related issues. And I’m so glad we have her here today to chat with us. Welcome Debbie Darlin.

Debra  Thanks so much for having me ladies and Dionne, I knew you’re gonna say that totally predictable.

Dionne  I couldn’t help myself. You know me. But seriously, so proud of you and glad we can tap into your wealth of knowledge and share it with our audience. So let’s get into it.

Maleeha  Yes, let’s jump in Debora, with all this talk about stomach flu. What exactly is it?

Debra  The name stomach flu is actually a misnomer. It’s not the flu or related to the flu at all. It also doesn’t only affect the stomach but also affects other parts of the digestive system, like your intestines and colon. The medical term for it is gastroenteritis. And it’s primarily caused by viruses but can also be due to bacteria, fungi or parasites. When a person is infected, these bugs target the lining of the gut and cause irritation. That irritation is what leads to lots of vomiting and diarrhea.

Dionne  Hmm, yikes. Yeah, yeah,

Debra  It’s really not fun for kids or the parents. Even though stomach flu can be caused by different types of bugs, viruses or hand is down the most common. The number one offender for adults and now children is norovirus. In the past, rotavirus was the number one virus to cause it in kids. But with the rotavirus vaccine, the number of cases have gone down significantly. And now norovirus has taken the crown for causing stomach flu in kids in the United States. I will say, however, that worldwide rotavirus is still the number one cause in children.

Dionne  Vaccines are amazing, and they make such a huge impact. I know some caretakers probably wish there was one for norovirus right now.

Debra  Health care workers too. This past year we’re already seeing norovirus really hit our pediatric population hard. Recent data showing one in 40 children will visit the ER with norovirus by the age of five. There’s already been two large outbreaks that have occurred in elementary schools this year alone.

Maleeha  Wow, that’s a lot. I mean, these norovirus outbreaks have been all over the news. So today, we really want to focus on that specific bug norovirus, because I believe that’s pretty top of mind for most parents, including us. Oh, yeah. Why is it that this year showing more incidents than others? Or at least it seems like it’s getting a lot more attention?

Debra  Well, the initial points I made probably sound alarming, but in actuality, the number of norovirus cases is not astronomically higher than in previous years. What is causing a lot of the commotion related to this virus is the fact that these outbreaks are occurring during the post pandemic era. When the world was in lockdown, we were really stopped seeing many of the common viruses that swept through our communities in a seasonal pattern. Now that COVID restrictions have been lifted and people are in close proximity, viruses like norovirus are resurfacing spreading quickly and occurring outside of their normal timeframe. For young children, “the COVID babies”, these viruses coming back can be particularly difficult as their immune systems have never really been exposed to them before.

Dionne  COVID really did a number on us in so many ways, most, especially to our COVID babies. That to have this on top of that just stinks. No pun intended. I need help. I know I’m so immature. But seriously. I mean, the way this has been discussed on the news, it seems like a mini epidemic in and of itself, something we really don’t need. So for those who don’t know, what does stomach flu look like, typically, and how long should we expect our kids to be sick.

Debra  The typical symptoms of norovirus include abdominal pain, stomach cramping, nausea, vomiting, and diarrhea. The symptoms usually come on pretty hard and fast, around 12 to 48 hours after being exposed and lasts for one to three days. For other children, Norovirus can take longer to clear and they can develop fever and body aches. It really just depends on if they have a weakened immune system, or the viral strain that is circulating that season.

Dionne  It seems like Norovirus is very contagious. How exactly is it transmitted? Like how does one get infected with it?

Debra  Norovirus is highly transmissible, it only takes a few viral particles to get a person sick, and it can be picked up from contaminated food, sharing food or utensils with others being in direct contact with someone who has norovirus or touching surfaces or objects that have the virus on them. The most common way people get exposed to it is by being in direct contact with a person who has norovirus. And unfortunately, people can remain contagious for up to two weeks after they have recovered from the virus themselves.

Maleeha  Whoa, you can remain contagious for up to two weeks after recovery. That’s a long time. I mean, no wonder why all these kids are getting sick at daycare and at school.

Dionne  Listen, I know these days, people are all about getting detox cleanses, but I can almost guarantee that doing it via norovirus is not on their list. Okay. So how can one decrease the spread? I’m just saying it’s not. So how can one decrease the spread so it doesn’t pass through every member of the household.

Debra  Preventative measures are key. Washing your hands thoroughly with soap and water is the most important step in avoiding norovirus. You can use hand sanitizer but really only after washing your hands with soap and water. Hand sanitizers is not an adequate substitute for soap and water because norovirus is resistant to alcohol. When handling food make sure to wash your fruits and vegetables before us and really cook through shellfish and oysters because they sit tend to be the ones that carry norovirus more often. Also, use bleach to clean and disinfect countertops faucets and other surfaces in your home. And lastly, if you know or suspect that you were or your child was sick with norovirus, try to avoid being in contact with others to reduce the spread.

Maleeha  Hey guys, after our last super informative episode on colorectal cancer and screening options, make sure to listen to that if you haven’t already, wink wink, Dionne and I had so much fun. We figured we’d stay in the GI system for a little bit longer.

Dionne  Yeah. Our gut told us there’d be another pressing topic that just had to be addressed. This time involving kids.

Maleeha  Our gut, you’re funny girl. I see what you did there. But yes, this year, you would have to be living under a rock if you haven’t heard or seen news about stomach flu and how it’s been spiking this year. And if you’re a parent or teacher, well, you know about it firsthand. It’s been everywhere.

Dionne  Can I just say Maleeha that you did not warn me about this phase during our motherhood pep talks. I thought I would get some reprieve when my son entered kindergarten. And my other two littles did two days of daycare and no, wrong!

Maleeha  Totally wrong, didn’t you see me struggling and complaining about that in residency like all the time? The struggle is real Dionne.

Dionne  Yeah, clearly I forgot. And a struggle is right. In addition to their chronic runny noses. I mean, literally, I call my two year old son Snotty Pippin. I mean, seriously, but they also come home with diarrhea from stomach flu. I mean, how girl I need help.

Maleeha  Dionne, I feel you. I feel you. I have been there and done that. Because there is nothing more humbling than having to clean up projectile vomit. Like why! Even when I give them the bowl to keep beside them somehow they miss. But you know what? I know we’re not alone. Other parents can relate. And I promise you I can help you with which detergents to use to remove curdled milk from a car seat. But I may not be able to help with much more. Lucky for us we have a special guest with us today who can pediatric gastroenterologist Dr. Debora Eseonu. Debora is based in Austin, Texas. She cares for newborns to adolescents who have issues related to the gut, liver and their nutritional status, but also has dedicated time to see children with gut motility disorders. So she is perfect to help us and other parents grapple with this crappy crisis. Get it?

Dionne  Crappy crisis. Wow. Wow. Only you Maleeha I know I know.But on another note, our guests name is familiar. Hmm. Okay, just kidding. Debora is my younger sister who if I may add, I inspired to get into medicine. And who wouldn’t even be here without me?

Maleeha  That is so something you would say.

Dionne  I mean, I’m just I just need the world to know this. Okay.

Maleeha  Older sister, yes.

Dionne  You know how it is that okay, okay, maybe it’s only partially true. But seriously, she has become our family’s on call pediatrician who we hit up for everything, especially gi related issues. And I’m so glad we have her here today to chat with us. Welcome Debbie Darlin.

Debra  Thanks so much for having me ladies and Dionne, I knew you’re gonna say that totally predictable.

Dionne  I couldn’t help myself. You know me. But seriously, so proud of you and glad we can tap into your wealth of knowledge and share it with our audience. So let’s get into it.

Maleeha  Yes, let’s jump in Debora, with all this talk about stomach flu. What exactly is it?

Debra  The name stomach flu is actually a misnomer. It’s not the flu or related to the flu at all. It also doesn’t only affect the stomach but also affects other parts of the digestive system, like your intestines and colon. The medical term for it is gastroenteritis. And it’s primarily caused by viruses but can also be due to bacteria, fungi or parasites. When a person is infected, these bugs target the lining of the gut and cause irritation. That irritation is what leads to lots of vomiting and diarrhea.

Dionne  Hmm, yikes. Yeah, yeah,

Debra  It’s really not fun for kids or the parents. Even though stomach flu can be caused by different types of bugs, viruses or hand is down the most common. The number one offender for adults and now children is norovirus. In the past, rotavirus was the number one virus to cause it in kids. But with the rotavirus vaccine, the number of cases have gone down significantly. And now norovirus has taken the crown for causing stomach flu in kids in the United States. I will say, however, that worldwide rotavirus is still the number one cause in children.

Dionne  Vaccines are amazing, and they make such a huge impact. I know some caretakers probably wish there was one for norovirus right now.

Debra  Health care workers too. This past year we’re already seeing norovirus really hit our pediatric population hard. Recent data showing one in 40 children will visit the ER with norovirus by the age of five. There’s already been two large outbreaks that have occurred in elementary schools this year alone.

Maleeha  Wow, that’s a lot. I mean, these norovirus outbreaks have been all over the news. So today, we really want to focus on that specific bug norovirus, because I believe that’s pretty top of mind for most parents, including us. Oh, yeah. Why is it that this year showing more incidents than others? Or at least it seems like it’s getting a lot more attention?

Debra  Well, the initial points I made probably sound alarming, but in actuality, the number of norovirus cases is not astronomically higher than in previous years. What is causing a lot of the commotion related to this virus is the fact that these outbreaks are occurring during the post pandemic era. When the world was in lockdown, we were really stopped seeing many of the common viruses that swept through our communities in a seasonal pattern. Now that COVID restrictions have been lifted and people are in close proximity, viruses like norovirus are resurfacing spreading quickly and occurring outside of their normal timeframe. For young children, “the COVID babies”, these viruses coming back can be particularly difficult as their immune systems have never really been exposed to them before.

Dionne  COVID really did a number on us in so many ways, most, especially to our COVID babies. That to have this on top of that just stinks. No pun intended. I need help. I know I’m so immature. But seriously. I mean, the way this has been discussed on the news, it seems like a mini epidemic in and of itself, something we really don’t need. So for those who don’t know, what does stomach flu look like, typically, and how long should we expect our kids to be sick.

Debra  The typical symptoms of norovirus include abdominal pain, stomach cramping, nausea, vomiting, and diarrhea. The symptoms usually come on pretty hard and fast, around 12 to 48 hours after being exposed and lasts for one to three days. For other children, Norovirus can take longer to clear and they can develop fever and body aches. It really just depends on if they have a weakened immune system, or the viral strain that is circulating that season.

Dionne  It seems like Norovirus is very contagious. How exactly is it transmitted? Like how does one get infected with it?

Debra  Norovirus is highly transmissible, it only takes a few viral particles to get a person sick, and it can be picked up from contaminated food, sharing food or utensils with others being in direct contact with someone who has norovirus or touching surfaces or objects that have the virus on them. The most common way people get exposed to it is by being in direct contact with a person who has norovirus. And unfortunately, people can remain contagious for up to two weeks after they have recovered from the virus themselves.

Maleeha 

Whoa, you can remain contagious for up to two weeks after recovery. That’s a long time. I mean, no wonder why all these kids are getting sick at daycare and at school.

Dionne  Listen, I know these days, people are all about getting detox cleanses, but I can almost guarantee that doing it via Norovirus is not on their list. Okay. So how can one decrease the spread? I’m just saying it’s not. So how can one decrease the spread so it doesn’t pass through every member of the household.

Debra  Preventative measures are key. Washing your hands thoroughly with soap and water is the most important step in avoiding norovirus. You can use hand sanitizer but really only after washing your hands with soap and water. Hand sanitizers is not an adequate substitute for soap and water because Norovirus is resistant to alcohol. When handling food make sure to wash your fruits and vegetables before us and really cook through shellfish and oysters because they sit tend to be the ones that carry norovirus more often. Also, use bleach to clean and disinfect countertops faucets and other surfaces in your home. And lastly, if you know or suspect that you were or your child was sick with norovirus, try to avoid being in contact with others to reduce the spread.

Maleeha  Wow, those were some really great points you just made. I mean, we have gotten so used to those Purell pumps. That doesn’t work for these bugs. We use those everywhere all the time, right? Yeah. So, yeah, the wash your hands before you eat sounds old fashioned, but it’s really timeless advice. Deborah, I also read that you can get norovirus multiple times is that true?

Debra  Yet another unfortunate thing about this virus, I know it sounds terrible, but there are just so many different strains of norovirus and a short span of time when you’re infected. So the body really doesn’t have enough time to mount a lasting response. However, after your first infection, the symptoms of the next infection are less severe.

Dionne  Okay, well, that’s good to know. Now, Deborah, you mentioned earlier that stomach flu could be caused by parasites, bacteria and toxins, not just viruses. As a parent, how do I know if it’s just a run of the mill virus versus something else? When do parents need to come in and see their pediatrician?

Debra  That’s a great question. And it can honestly be tough to parse out what you’re dealing with because his symptoms for each of these categories of gastroenteritis overlap. However, symptoms that should grab your attention and think that something other than a virus is the cause is high fevers and bloody diarrhea. If you notice those symptoms, bring your child to the emergency room, or the pediatrician depending on the severity of symptoms. We typically see these symptoms with bacterial gastroenteritis, so treatment is actually necessary. Another reason to bring them in to see their pediatrician would be if they have diarrhea for several weeks, that could be a sign of a parasite induced infection.

Maleeha  Okay, so some good points there. Just to recap bloody diarrhea, high fevers, or diarrhea for several weeks are all red flags, go to the doctor, perhaps for further testing,

Debra  Right. In those cases, there’s testing and specific treatment that the doctor can prescribe.

Maleeha  Okay, so let’s go back to our run of the mill norovirus anything over the calendar that parents can use to help with a symptom relief, or do we just have to tough it out.

Debra  Like other viruses, there are no pills or antibiotics that can be used to treat it. And at this point in time, there’s no vaccine available for norovirus. The best way to treat it is symptom management. The biggest concern is dehydration due to the frequent vomiting and diarrhea. So providing anti nausea medicine and encouraging lots of fluid intake is really important. If the dehydration is mild, you can use any decaffeinated fluids to maintain hydration. However, if dehydration is more severe than oral rehydration solutions like Pedialyte are preferred because they give the body back the electrolytes it’s losing from the sickness. It might be hard for kids to drink large volumes because the abdominal pain and cramping but as long as you can get them to take frequent small sips, you can reach the same goal.

Dionne  Okay, we talked about the importance of hydration with Pediatrician Dr. Amina Khan on a previous episode, wink wink. She suggested keeping a water bottle or sippy cup nearby so that they can take sips throughout the day. Debbie, do you recommend any treatment or measure specific to certain age groups?

Debra  I would say that for babies in diapers parents should really do their best to prevent diaper rash is very common with stomach flu because there’s so much diarrhea, so skin protective like Aquafor, Vaseline or zinc oxide are important. Be liberal with slathering those products on their bottoms to create a nice skin barrier. It’s also good idea to give those babies some diaper free time to let the skin breathe. But you want to lay some towels down in case of some accidents, okay. But it really helps to clear their skin.

Dionne  You know that you know Greggy were potty training him he’s too so we know all about those accidents. So I know all about putting the towels down. So dehydration is definitely a big concern and can really be a huge problem for children which can land them in the hospital. What are signs of dehydration and a child that a parent should be aware of and when should they seek medical attention.

Debra  For babies things to monitor are the amount of wet diapers. They should have at least six full wet diapers in a day but ideally more. And also just make sure they are producing tears when they cry that their mucous membranes aren’t dry. You can check that by looking at all the pink inside their mouth, and you also want to make sure that they remain active. Any sign that the baby is more sleepy or lethargic or unusually fussy. That would be another time that those internal alarm should go off to bring baby in. For older children and adults they should urinate at least three times a day and the color of the urine should help you to indicate dehydration with darker colors meaning more dehydrated. You can also look inside their mouths for dry mucous membranes as well. And they may also be able to communicate that they feel dizzy or lightheaded.

Dionne  Great point. I think that’s the most important point for parents because dehydration, like I said before can be dangerous, especially for children.

Maleeha  Yes, it really is. I mean, fluid status is so important in kids in this situation and checking urine color is a great tip. It should be if I remember, you know, a light lemonade color. And it should not be like the dark iced tea. We’re not going for the Arnold Palmer here. It’s gotta be light. So what about foods doctor? I know it’s classic to give ginger ale and chicken soup. Maybe some crackers? Those are definitely staples in my house.

Dionne  Same in our house too. Right Deborah? Watching Maury trying to figure out who was or was not the father. Good times. Good times.

Maleeha  Oh my God! Oh, you guys are watching trash TV all the way back then. Yeah. Oh, yeah. Oh, yeah. Are those staples still good, though, Debora. I mean, what would you suggest? Are there certain foods parents should avoid if their children are symptomatic, versus others?

Debra 

Oh, yes, it’s hard to resist the comfort of some chicken noodle soup and ginger ale and a side of trash TV when you’re feeling sick, I get it. When your child or you are in the thick of the symptoms, it’s going to be really hard to tolerate any foods at all. So during this period, it’s useful to focus on foods that are easy to digest and tolerate. The BRAT diet is a diet frequently recommended during illness and it stands for bananas, rice, applesauce and toast. These are helpful to get your child to eat and it’s fine to start with those as their first part of their diet. However, these foods don’t really carry that high nutritional pack for your punch that you really need. Nor do they give lots of calories. So you can also try to offer other foods like mashed potatoes, fruits, vegetables, and lean chicken, like the chicken noodle soup. Once your child is feeling a little better, it’s fine to advance their diet further, but slowly. The idea with trying to advance their diet is that the more calories you get in them, the more energy their body needs and gets to help them fight the infection.

Maleeha  So you’re giving them fuel that makes sense. Now what about foods to avoid?

Debra  Important foods to avoid while you’re sick include fried foods, foods high in sugar and fat as these can really irritate your gut and make the diarrhea worse. So I would probably avoid the ginger ale. Additionally, patients can develop a temporary lactose intolerance after a stomach bug. So avoiding dairy will also be important.

Dionne  Okay. I just want to be honest here. I think we lost a bunch of parents with the no ginger ale recommendation. You know, that’s a cultural classic. But the facts of the facts, we appreciate you so much for sharing them.

Maleeha  Or maybe there is a sugar free option we can look at for the ginger ale. But Debora, I think the point about being temporarily lactose intolerant is very interesting because I have always avoided dairy. I think that’s common for people to avoid dairy with an upset stomach, but I wasn’t actually sure why can you explain why that’s the case?

Debra  Yeah, so when the gut gets inflamed and irritated by the infection, the tissue that helps to absorb those nutrients and break down the food are temporarily damaged, and the enzymes that help us to digest dairy is lost due to that damage, which makes it difficult for us to process the dairy. But typically, this only lasts for a few days, so the body will recover and you can eat all the ice cream and dairy that you want.

Dionne 

Thank God, I need my cheese.

Maleeha  I know. Exactly. But that was informative. Okay. Wow, I really learned a lot about stomach flu and norovirus today. Yeah, so let’s just recap some of the main points. Number one, stomach flu isn’t the flu, but mainly caused by norovirus in the United States and affects the whole digestive tract, not just the stomach.

Dionne  Number two, norovirus was on hiatus during COVID. When we are in isolation, now that people are gathering again, we are seeing large outbreaks because it spreads fast. Keep in mind COVID babies were never exposed to it before making it more prevalent this year.

Maleeha  Number three, symptoms can last one to three days on average, but you can be contagious up to two weeks after you’ve recovered.

Dionne  Number four, like washing your hands with soap and water and disinfecting the bleach will help prevent prevent spread. Norovirus is resistant to alcohol, so hand sanitizer is not going to work.

Maleeha  Number five, management for norovirus is supportive. Focus on giving your kids lots of fluids to prevent dehydration. For babies count wet diapers, and for older kids check their urine color. If they look unusually lethargic or fussy, you may need to take them to the hospital.

Dionne  Number six. If you notice your child has high fevers or blood in their stool, or if they have diarrhea for several weeks, they need to be seen by a doctor. This is likely not from norovirus, but another source like bacteria or parasites that can be treated.

Maleeha  Number seven, kids need food for fuel to fight this infection. Start with the BRAT diet and increase from there. Avoid foods high in fat and sugar and dairy temporarily, as these make symptoms worse. Deborah, I think that summed up pretty good. Yes. Some of the major points. Thank you so much for being with us today and answering all our questions. And most importantly, tolerating your sister. Trust me. I know. I do.

Debra  Yeah, it was hard, but I made it.

Dionne  You guys do know I’m still here. Right? Like you’re not muted. My headphones are still on. Anyways. You love me.

Maleeha  We do, we do.

Debra  No, seriously. Thank you ladies so much for having me. This was a lot of fun. And I hope that parents walk away feeling more knowledgeable about how to handle Norovirus in their families.

Dionne  Oh, I’m sure that they did. I certainly did. Hey, guys. For more IVY Drip, head to our website at the TheIVYdrip.co or follow us on Instagram @theIVYdrip_podcast. Email us with your norovirus stories, comments and questions at info@theIVYdrip.co or send us a DM. We love hearing from you all. So if you have a good tip, share it we would love to put in a future episode. Most importantly, don’t forget to subscribe to our podcast. You can find it on all streaming platforms. leave a review and spread the love.

Maleeha  Yes, please subscribe and spread the love now for the tip of the day. Deborah, we’re gonna give you the floor on this one.

Debra  Okay, parents, when seeing their children suffer from what they feel like is nonstop diarrhea will frequently ask for medications to stop the diarrhea like Imodium. Please do not give your kids any medicines that stop diarrhea. The body needs to get rid of the problem and that’s their only way of doing it. It will do more harm than good. Trust me. It’s eventually going to get better but you just have to tough it out. So stay strong parents.

Dionne  That’s a good one.

Maleeha Oh, yeah. Yeah, cuz they sell Imodium like everywhere!

Dionne I mean, no one wants to accidents all over the floor. So I get it. You know!