When to Take Your Child to the Emergency Room for Gastrointestinal Illness

Recently, some doctors and public health officials have observed an increase in children presenting with gastrointestinal (GI) symptoms such as vomiting and diarrhea. However, knowing what causes those symptoms and when to seek medical care for them can be difficult.

GI symptoms such as diarrhea, stomach cramps, nausea and vomiting are frequently caused by gastroenteritis. More commonly known as the “stomach bug” or “stomach flu,” gastroenteritis is an inflammation of the stomach and intestines typically caused by a viral or bacterial infection. According to National Library of Medicine, gastroenteritis is the second most common illness in the U.S.

“However, COVID-19 can also cause GI symptoms, especially in children,” says Erin Hoehn, MD, a pediatric emergency medicine physician at University Hospitals Rainbow Babies and Children’s Hospital. “At the moment, we are seeing an increase of COVID-19 cases in our area, likely due to the Omicron BA.2 subvariant that is now dominant in the U.S.”

But how do you know if your child’s GI symptoms are caused by COVID-19 or gastroenteritis? And, regardless of the cause of the symptoms, when should you seek emergency care for your child’s stomach illness?

How Can You Tell if Your Child’s Upset Stomach Is a COVID-19 Symptom?

As it turns out, the only way to determine if your child’s GI symptoms are caused by COVID-19 is with a COVID-19 test. If you suspect your child has COVID-19, contact your pediatrician to determine which type of test is best.

“I’d be more likely to suspect COVID-19 over other viruses when the diarrhea or vomiting occur in the setting of a known COVID-19 exposure or if those symptoms are accompanied by other symptoms more consistent with COVID-19, such as fever, cough, sore throat and body aches,” says Dr. Hoehn.

When to Take Your Child to the Emergency Room?

Most cases of gastroenteritis resolve on their own within a few days and do not require medical treatment. Regardless of whether your child’s GI symptoms are caused by gastroenteritis or a possible COVID-19 infection, you should bring them in to the ER (or a same-day appointment with a pediatrician) if their vomiting and diarrhea continue for more than a few days or if you notice signs of dehydration.

Dr. Hoehn emphasizes the importance of checking for signs of dehydration, as fluid loss and the inability to replenish fluids can lead to kidney failure or other serious complications. Common signs include:

• Little or no urination for six hours or more, or a minimum of 3 wet diapers in a 24-hour period for young children. If your child is producing less than that, you should seek medical care.
• Dry mouth (no saliva) and other dry mucus membranes
• Crying without tears
• Weakness and lethargy
• Lightheadedness or dizziness
• Skin that “tents up” when pinched
• In babies, the soft spot on the top of the head becoming noticeably sunken

You should also seek emergency care for your child if he or she experiences:

• Blood or pus in stool (or a dark, tarry stool)
• Moderate amount of blood in vomit or vomit that looks black like coffee grounds (small flecks of blood can be present in the vomit due to irritation of the stomach lining or esophagus; however, if the vomit becomes more obviously bloody, you should seek medical care)
• Difficulty breathing
• Significant changes in behavior or mental status
• Severe abdominal pain that is constant and causes him or her to want to sit motionless, which can be a sign of appendicitis. Other symptoms of appendicitis include an acute tenderness in the right lower part of the abdomen, vomiting and fever.