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Norovirus

A Quick Guide to Hydration Beverages: What Liquids To Give Your Kids and When

By March 28, 2016 2 Comments
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When I was a kid, Kool-Aid, Tang, and Hi-C juice boxes were the norm for kids’ beverages. You were super cool if you had Capri-Sun, water was boring, and tea was for grown-ups.

Clearly, things have changed.

Nowadays teenagers proudly tote tea-based beverages, and bottled water is a blank canvas for those trendy flavored squirtables and stick-packs. Coconut water, maple water, and now even cactus water continue to gain popularity, and classic sports beverages like Gatorade are continuously evolving to stay relevant.

This is all very amusing and confusing for parents, who want to keep their children hydrated and healthy but who clearly had far fewer options and health-based marketing messages to deal with as kids themselves. The bottom line for parents is that kids often want something that tastes good (and if possible, makes them super cool like Capri-Sun did for us as kids). They’re likely far less influenced by healthy trends or sports nutrition, and much more influenced by the example that you set for them. You may urge them to drink water, the #1 go-to and mainstay, but it doesn’t always work. So how do you strike a balance between health, hydration, and taste?

To answer this question, we have to target our focus to three specific scenarios with three different kids: the sick kid, the sports kid, and the everyday kid. Each situation comes with its own challenges, which I’ll address below:

Scenario #1: When your kid is sick

When your kid is exploding from both ends, they’re losing vital nutrients, electrolytes and, of course, water. It’s crucial to remember that kids lose different proportions of nutrients through vomit and diarrhea than they do through sweat. Hydration drinks like Pedialyte and sports beverages like Gatorade or Powerade are both popular options for re-hydration during gastrointestinal distress, and especially Gatorade because the flavors vary and the viscosity seems more palatable (to the adult palate). But in the case of a system blow-out, Pedialyte is the better option for your kids, since it is specifically designed to replace the nutrients lost through vomiting and diarrhea. The nutrient levels in Pedialyte also meet the requirements of the American Academy of Pediatrics for rehydration in infants and children.

To illustrate why that is: One study found that Gatorade worked as well as Pedialyte for mild dehydration, but that the Gatorade group had a lingering potassium deficiency after treatment. That’s critical to avoid in dehydrated children, as low potassium can be life-threatening depending on its severity. At the minimum, it can lead to weakness, fatigue, muscle cramps, and constipation. More worrisome is when it causes abnormal heart rhythms. So staying on top of a proper electrolyte balance is very, very important.

Pedialyte label on the left, Gatorade on the right

Pedialyte label on the left, Gatorade Low Carb on the right

Breaking down the nutrient components for a closer look: one serving of Gatorade’s G2 Fierce Grape has 7 grams of sugar from sugar and dextrose, with 160 mg sodium and 45 mg potassium. It’s Pedialtye cousin in the Strawberry flavor has 6 grams of dextrose, with 240 mg sodium, 180 mg potassium and 10% of the RDA of zinc. While the sodium levels are comparable, Pedialyte has at least twice the potassium, and Gatorade doesn’t have zinc at all.

One Gatorade study did confirm what thousands of moms, dads, and hungover college students already know, though – sick kids much prefer the taste of Gatorade to Pedialyte. That’s likely biased but I can’t argue with it, because I’ve had both…and…yuck. Still, if you can’t get your kid to drink Pedialyte it may be tempting to give them a sports beverage or fruit juice instead – but I’d urge you to reconsider. The sugars in these drinks draw water into the intestine, which makes diarrhea worse.  The frozen pops might be a better bet – since the “slimy” factor is less noticeable

And as always – your child’s physician should be consulted if they are ill. Hydration needs vary depending on the severity of the illness and your child’s age/height/weight, so it is imperative that you contact their doctor in the process of trying to keep them well-hydrated.

Scenario #2: When your kid plays sports

If your kid is doing light activity for less than one hour or moderate activity for less than thirty minutes, the AAP guidelines are clear – water is just fine. However, if your kid is doing moderately strenuous activity for at least one hour, or high intensity activity for thirty minutes, a sport beverage may be the better option.

http://www.safekidsoregon.org

My teen’s not going to drink that much water! http://www.safekidsoregon.org

There are three major benefits to sports beverages: #1 – They taste good, which means your kid is more likely to drink them then water, and therefore less likely to become dehydrated. #2 – They contain the electrolytes needed to replace those lost through sweat. #3 – A sports beverage can provide the body with instant fuel when sipped during activity. These three benefits only hold true when the sports beverage is sipped during physical activity, and if the activity is strenuous enough (an idea of what that means can be found here). In other words, if your toddler is wandering the soccer field for a total of twenty minutes, water will most likely suffice.

Some ask, well, what about coconut water? Before swapping regular water or a sports beverage with coconut water, it’s important to read labels. Some brands of coconut water have added sugar – more so than an average sports beverage. Other brands have very low sodium, which needs to be replaced after strenuous or prolonged exercise. It’s also important to consider that the high potassium content in coconut water is a real taste barrier to some people. What’s the point in getting a “healthier alternative” sports beverage that your kids won’t even drink?

Scenario #3: When you’re packing their lunch

It’s an average day and you’re in charge of packing your kid’s lunch in the mornings. Water is obviously the best option here, but if they need a little incentive, what can you give them to ensure and entice them to stay hydrated throughout the day? Water add-ins like Mio and Crystal Lite can make drinking water more appealing, plus these yummy mix-ins can be lower-calorie, lower-sugar options than fruit juice.

A word of warning, though. Make sure these options are caffeine-free (you can read my post on safe caffeine levels in drinks for kids here), and remember that “No Sugar Added” does NOT mean low-sugar! Also, for younger kids you’ll want to prepare these water mixes ahead of time so you don’t risk your kid consuming the Mio or Crystal Lite packet straight, sans water.

For older kids and teens, green tea may seem like a great option given all the health benefits associated with consuming green tea. Remember that kids under 18 can have up to 100 mg caffeine per day, so green tea is a much better option than a soda or Red Bull. The watch out with tea-based beverages is that some high-sugar teas may seem healthier than they actually are because of tea’s healthy image. Make sure to double-check labels for sugar content and to make sure that tea (preferably green) is one of the most prominent ingredients.

The other watch out here is that it’s important to talk to your kid about limiting caffeine intake. TRUST ME when I say this conversation is as important as the one about the birds and bees, as caffeine intake awareness may save their life one day! Red Bull and V8 V-fusion + Energy both have 80 mg caffeine per 8 ounce can, but the caffeine from the V8 comes from green tea. That means the V8 is a better option, but too much caffeine is still too much caffeine, no matter where it comes from — even if it’s green tea!

The Bottom Line

The effects of dehydration can be as minor as tiredness and fewer wet diapers or as severe as extreme infant
fussiness, fever, and low blood pressure.
 It can also be difficult to gauge dehydration in younger children since their ability to communicate or understand thirst is limited, so speaking to their physician about warning signs and symptoms is key to learning how to gauge dehydration in your own child.

When it comes to hydration beverages, no one solution is perfect for every kid in every situation. Understanding what your kid likes, combined with your kid actually needs is important to their sustaining their overall health in this arena – because healthy hydration options only work if your kids actually drink them.

 

 

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Categories: Food, Nutrition, + Infant Feeding, School-Aged Children, Tweens + Teens

When NOT Washing your Hands Is a Crime: What We Can Learn From The Chipotle Sanitation Nightmare

By January 18, 2016 2 Comments
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Chipotle touts organic and fresh ingredients, making it a fan favorite for many parents, but perhaps not anymore, given the terrible year that the fast-food chain is struggling to recover from. 2015 ended poorly for Chipotle, with at least five viral or bacterial outbreaks in various branches of their restaurant chain between July and December. Three of those five outbreaks were associated with naturally occurring bacteria in food (Salmonella and E.coli) and possible food mishandling; the other two outbreaks were directly linked to sick employees (who had the norovirus) who spread their illness through improper hand-washing. These type of issues are both a public health and a parenting nightmare, since the spread of those three contagions are enough to make anyone violently ill, and for children, dangerously so. And soon, it seems, spreading the latter through poor hand hygiene in the workplace could be considered a crime. 

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Categories: Food, Nutrition, + Infant Feeding, Infectious Disease + Vaccines

Your ‘Stomach Flu’ Isn’t a Real Thing, You’ve Caught Something Much Grosser

By December 16, 2015 2 Comments
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The stomach flu isn’t a real diagnosis – there’s no such thing.  I remember finding that out as a kid and being confused; after all, everyone around me had had it at one point or another. How could everyone be wrong? We’ve all used this term at some point to describe an illness that’s forced us to pray to (or sit with) the porcelain gods. However, it turns out it’s one of those generational quirks of language that’s been passed down, and it’s not founded in science.

The viruses or bacteria that we attribute to “the stomach flu” are very real, however, as I can tell you from personal experience.  There’s just no such thing in epidemiology as a family of viruses or bacteria called “the stomach flu.”

Let’s start off by defining what the flu is. “Flu” is short for influenza, which is a viral infection that affects your respiratory system, namely your nose, throat, and lungs. Symptoms include coughing, congestion, fever, and muscle aches. According to the CDC, there are 3 types of influenza viruses: A, B, and C. The seasonal flu is typically an A or a B type, and it runs in cycles that are heavily skewed to wintertime in the United States. The C type is considered milder, and isn’t seasonally dependent or the type that’s a cause for epidemic concern. All three types are spread through contact with an infected person’s respiratory secretions, meaning contagious droplets of water that you inhale or get in your eyes, nose, mouth, when an infected person talks, coughs, or sneezes around you. Ewwwww.

The stomach flu, on the other hand is what we colloquially call a variety of digestive-related illnesses that involve distressing gastrointestinal symptoms (i.e. vomiting, diarrhea, stomach cramps, etc.) combined with malaise, and a low-grade fever, when in reality it’s a form of gastroenteritis (“gas-tro-enter-EYE-tis”). Gastroenteritis is caused by viruses and bacteria (and rarely, parasites) that infect the digestive tract, none of which are members of the influenza family.

I repeat: the “stomach flu” is a virus or bacteria that has much grosser consequences, and is not at all related to influenza.

Viral gastroenteritis is the most likely culprit when it comes to most of the so-called “stomach flus,” and it’s typically the result of one of two groups of viruses: Noroviruses or Rotaviruses.  And, ick alert: you typically catch it from direct exposure to an infected person, exposure to infected fecal bacteria (poop), or exposure to things cross-contaminated by fecal bacteria like food that’s been handled by contaminated hands, since it’s so hard to completely sanitize against, as any Celebrity Cruise worker can tell you.

Grossed out yet?Norovirus flu FINAL

A read-through of this horrifying in-depth article from
National Geographic on

the science of the Norovirus
describes how it causes your body to become a walking germ factory; how hard it is to kill it on surfaces including your own skin, and how easy it is to infect those around you as you’re purging liquid from your intestinal tract cells at a rapid rate, and loading up each gram of your diarrhea with five billion Noroviruses. You read that right. Five billion. As for the infectiousness of your vomit? I’ll just leave this article on a the Norovirus Vomit Machine here. I can’t even.

Horrors of science aside, viral gastroenteritis is rotten because in addition to the symptoms listed in our handy-dandy graphic in this article, it’s completely exhausting and there’s nothing you can do other than rest, stick with eating what you can hold down, which may or may not include the once-heavily recommended B.R.A.T. diet (Bananas, Rice, Applesauce, and Toast) to coax your stomach into digestion,  and to stay as hydrated as possible. Dehydration is the danger zone of these type of illnesses, which is where gastroenteritis can turn from miserable to deadly. It’s essential to replace liquids lost from loose stools and vomiting. For parents of kids who have had this, I’m sure you’ve had the hard task of trying to pressure these foods and liquids into your child who is exploding from both ends, and feeling like it’s all a waste because it’s coming back out as quickly as its going in. I’m sorry. You’re doing the right thing, though, since nutrients and liquids are critically important to maintain during these illnesses.

Norovirus

The Norovirus: Courtesy of the CDC

In my recent experience, I went to my local emergency room five days after my symptoms began, but only after I started to have heart palpitations and an unbearable case of heartburn. I managed to stay hydrated as I’d choked down an entire Pedialtye (ack!), but I was wrecked. The doctor attributed my illness to a nasty case of Norovirus, which is circulating in the San Diego area again, but he said those extra symptoms were actually from exhaustion and hunger – I needed more nutrients and rest. How could I get more nutrients if nothing was sticking in my stomach? I asked him. He said to keep eating anyway, since “your body has to finish shedding the diseased lining of your intestines for all of the purging to stop.” Fabulous, right?

Here’s the problem with waiting it out, however. You shouldn’t make the call to simply rest and switch to a BRAT-like diet on your own for you or your children and wait for the symptoms to pass for more than a day or two. Rest, hydrate, and bland diet, yes. However, viral gastroenteritis and bacterial infections (i.e. c.diff., salmonella and e.coli) that affect the digestive tract can initially look the same, be acquired through the same channels (contaminated food, etc.), but can’t be treated the same way.

You must treat the bacterial infections because they don’t just “run their course” without having massive impacts on you or your child’s system – and you likely need medical intervention like antibiotics to make them stop in a timely manner. Below are threshold recommendations per the Mayo Clinic, but your family physicians may have other guidelines so we urge you to contact them first:

Seek immediate medical care if in addition to the previously mentioned symptoms of malaise, stomach cramps, vomiting and diarrhea, you or your child havethe following symptoms:

Adults:

  • You’re not able to keep liquids down for 24 hours
  • You’ve been vomiting for more than two days
  • You’re vomiting blood
  • You’re dehydrated — signs of dehydration include excessive thirst, dry mouth, deep yellow urine or little or no urine, and severe weakness, dizziness or lightheadedness
  • You notice blood in your bowel movements
  • You have a fever above 104 F (40 C)

For kids, seek medical care if they:

  • Have a fever of 102 F (38.9 C) or higher
  • Seem lethargic or very irritable
  • Are in a lot of discomfort or pain
  • Have bloody diarrhea
  • Seem dehydrated — watch for signs of dehydration in sick infants and children by comparing how much they drink and urinate with how much is normal for them

For babies seek medical care if they:

  • Have vomiting that lasts more than several hours
  • Haven’t had a wet diaper in six hours
  • Have bloody stools or severe diarrhea
  • Have a sunken soft spot (fontanel) on the top of his or her head
  • Have a dry mouth or cry without tears
  • Are unusually sleepy, drowsy or unresponsive

As always, self-diagnosis is not the way to go when you’re dealing with an illness, particularly one that’s this high-impact – consult your physician or child’s pediatrician for an exam and testing if you have any of the above symptoms and have a concern about you or your child’s well-being. And remember, until you do, hydrate, eat, and rest as much as you can!

For illness spreading and prevention tips, see this helpful guide.

 

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Categories: Infectious Disease + Vaccines, Science 101 + Mythbusting