With a stomach bug, fluids are the only thing that matters in the first 24 hours. Give oral rehydration solution in small amounts often, a teaspoon at a time to a child who is vomiting, and let food come back when the child wants to eat. There is no special diet that shortens the illness. The child stays home until 48 hours after the last vomit or bout of diarrhoea.
The stomach bug arrives at night, without warning, and then the whole family is at home for three days. What you do in the first few hours decides how hard it gets, and it is almost entirely about fluids. Here is what our nannies have learnt from being with families when the stomach bug strikes.
Day one: fluids only, in small amounts
- Oral rehydration solution (vätskeersättning) from the pharmacy, ready mixed or as a powder. Always keep a pack at home.
- A teaspoon every two minutes to a child who is vomiting. It sounds ridiculously little, but it stays down. Big gulps come straight back up.
- Increase slowly once an hour has passed without vomiting: a tablespoon, then small sips from a glass.
- If the child refuses the rehydration solution: diluted squash, broth, ice lollies made from squash, water. Anything is better than nothing.
- Breastfeeding carries on as usual, more often and for shorter spells.
The first night, hour by hour
| When | Do | Skip |
|---|---|---|
| The first vomit | Towel, bucket, change the bedding, calm the child. No drinks for the first twenty minutes. | Giving a whole glass of water straight away, it comes back up |
| After half an hour | A teaspoon of rehydration solution. Wait two minutes. Another. | Juice, milk, fizzy drinks |
| After an hour without vomiting | A tablespoon at a time, still often | Going back to sleep without having everything ready by the bed |
| The morning | Small sips from a glass, maybe a rusk if the child asks | Forcing breakfast |
| Day two | Fluids as usual, small portions of ordinary food when the child wants them | Fried food, fat, sweets and large amounts of milk |
Have everything ready before you go back to bed: the bucket, a pile of towels, a bottle of rehydration solution, a teaspoon, a spare sheet and a spare pair of pyjamas. Hunting for clean sheets at three in the morning with a crying child is what turns a stomach bug into a memory.
When the appetite comes back
Usually after about a day. Then there is no reason to wait: give small portions of ordinary food. The old advice about nothing but rusks and tea has no support, and children recover faster by eating. But start with what is easy to get down.
| Usually works | Wait a few days for |
|---|---|
| Porridge, välling (Swedish cereal drink), white bread, rusks | Fried and fatty food |
| Boiled potatoes, rice, pasta | Large amounts of milk, if the stomach is still loose |
| Banana, apple sauce, boiled carrot | Raw vegetables and lots of fruit |
| Chicken, fish, egg in small amounts | Sweets, fizzy drinks, juice |
| Yoghurt and fil (Swedish soured milk) once the diarrhoea has settled | Spicy food |
Expect the appetite to be smaller than usual for almost a week, and the stomach to stay loose for just as long. That is normal. A child who is bright, playing and drinking does not need to eat much on those days. What should worry you is a child who is not drinking, not a child who is not eating.
Babies under one
Babies get dehydrated faster than older children, because they are small and because they cannot tell you they are thirsty. A breastfed baby should carry on breastfeeding, more often and for shorter spells. A formula-fed baby gets formula as usual, in smaller amounts and more often, with rehydration solution in between. If your baby is under one and is both vomiting and has diarrhoea at the same time, or is under six months and vomits repeatedly, call 1177 (the national healthcare helpline) on the first day. More on small children and illness in our guide to Baby with a cold.
Signs of dehydration
- Weeing much less than usual, a dry nappy for six hours or more
- Dry mouth, no tears when the child cries
- Listless, hard to wake, no energy to play
- Sunken eyes, in babies a sunken fontanelle
- Rapid breathing, cold and pale skin
One or more of those signs: call 1177. If the child is very listless and hard to get a response from, call 112.
Contagion
Stomach viruses spread incredibly easily. Wash hands with soap, not just hand sanitiser, use separate towels, and wash vomit stains straight away. Siblings usually catch it anyway. Förskola (municipal preschool, from age one) wants the child at home until 48 hours after the last symptom, and in many groups that applies to siblings too. How the infection spreads and how to protect the rest of the family is covered in our guide to Stomach bugs in children.
Siblings, work and förskola
Count on the family being at home for a week when the stomach bug arrives: two days for the first child, then two days for the sibling who falls ill three days later, and often a parent in between. Call förskola on the first morning and ask what applies to siblings, as the rules differ between groups. Vård av barn, or VAB (paid leave to care for a sick child), applies to whoever stays home, and how to split the days is in our guide to VAB. And wash everything that has been near the sick child at 60 degrees, including the cuddly toy.
How we do it with our families
When the stomach bug is over and you need to get back to work while your child still has to stay home for 48 hours, the nanny can take those days if she is free. She knows what the child usually eats and takes it easy with the food. And she washes her hands more than anyone else. Sanna has been with a family in Järfälla on exactly those days: porridge in the morning, water and rehydration solution in small cups all morning, a banana when the child asked for one, and no förskola to get to. The note to the parents says how much the child has drunk, how many times they have weed and what they have eaten, so the parents can call 1177 with real numbers if they need to.
This text is general information and does not replace advice from BVC (the child health clinic every family in Sweden is enrolled in), your vårdcentral (local health centre) or 1177. If you are worried about your child, call 1177. In an emergency, call 112.
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Read more: Constipation in children · Stomach bugs in children · A nanny when your child is sick · Frequently asked questions
Frequently asked questions
What should a child drink with a stomach bug?
Oral rehydration solution from the pharmacy is best, because it contains the right amount of salt and sugar. Small amounts often: a teaspoon every two minutes to a child who is vomiting, more once it stays down. Water and diluted squash work if the child refuses the rehydration solution, but neat squash and juice make the diarrhoea worse.
When can the child eat again?
When they want to. The appetite comes back once the vomiting has stopped, and there is no reason to hold off food then. Start with small portions of what the child usually eats, ideally porridge, bread, potatoes or banana, and wait a few days for fried food, sweets and large amounts of milk.
How long should the child stay home?
48 hours after the last vomit or bout of diarrhoea, which is the rule most preschools follow. It is the contagion, not how the child feels, that decides. A child who is bright on day two is still contagious, and siblings at the same förskola often get the same rule.
When should we seek medical help?
If the child is weeing much less than usual, is listless and hard to get a response from, has blood in the stool, vomits everything for more than 24 hours, or is under one and is vomiting and has diarrhoea at the same time. Call 1177. If the child is very listless and hard to wake, call 112.
Can we make rehydration solution ourselves?
Yes, if the pharmacy is closed. According to 1177, you mix one litre of water with half a teaspoon of salt and six teaspoons of granulated sugar, and give it the same way as the pharmacy version. Measure carefully, as too much salt is dangerous for small children. Buy a ready-made pack as soon as you can, it is safer and tastes better.