Feeding a sick baby: fluids, food and when to get help

Fluids come first

Babies and young children get dehydrated more easily than adults. The AAP explains that their bodies are less efficient at holding on to water, and because they’re small, it takes less fluid loss to cause a problem. Fever, vomiting and diarrhea all make it more likely.

Keep up milk feeds. Breast milk or formula is still the best drink for a sick baby.

• Breastfeeding: carry on as normal. If your baby is being sick, offer small feeds more often than usual (NHS).
• Formula: keep making it at its usual strength. Never water formula down, even when your baby has diarrhea or is vomiting (NHS).
• Small and often. If your baby is vomiting, small amounts every few minutes are more likely to stay down than a big feed. The AAP suggests aiming for at least 1 oz (30 ml) an hour. If your baby won’t take a bottle or cup, try a spoon, a medicine cup or an oral syringe.

Oral rehydration solution (ORS). These are special drinks with the right balance of sugar and salts to replace what’s lost through vomiting and diarrhea. Ask your pediatrician or pharmacist which one to use and how much. The AAP says to use a store-bought solution: don’t make your own at home. Most children with mild diarrhea don’t need one.

Drinks to avoid: fruit juice, soda and fizzy drinks can make diarrhea worse (NHS). The AAP’s diarrhea advice adds that juices, soups, sports drinks and boiled milk have the wrong amounts of sugar and salt, and may make your child sicker. The US and UK differ on water and diluted juice: see below.

What about food?

A sick baby often wants less solid food, and that’s OK for a short time. The AAP says that if your child is otherwise healthy, missing a meal or two while they’re nauseous or vomiting won’t hurt them, as long as they keep getting fluids. For babies under 1, breast milk or formula is still their main nutrition anyway.

• Fever or a cold: offer food if your baby wants it (NHS). Don’t push.
• Diarrhea without vomiting: most children can keep eating their usual foods, and keep having breast milk, formula or milk (AAP).
• Vomiting: for the first day or so, the AAP suggests focusing on fluids and limiting solid food, then slowly going back to your baby’s usual diet as the vomiting eases.

The BRAT diet isn’t needed. Bananas, rice, applesauce and toast used to be the standard advice, but the AAP says it’s no longer considered useful: those foods are low in protein, fat and fiber. Ideally, children go back to a normal, balanced diet for their age within about 24 hours, including fruit, vegetables, meat, yogurt and grains. Offer familiar foods your baby already eats well, prepared in a safe form for their age, like soft banana, yogurt, oatmeal or chicken.

Hold off on brand-new foods, and especially on first tastes of allergens, until your baby is well again. That way you’ll know whether any reaction comes from the food or the illness.

Signs of dehydration

Watch for these signs, and call your child’s doctor right away if you see any of them (AAP, NHS). In the UK, call 111 if a child under 5 has signs of dehydration.

• fewer wet diapers than usual (for babies, the AAP uses fewer than 6 a day)
• dark yellow, strong-smelling pee
• a dry mouth, lips or tongue
• few or no tears when crying
• a sunken soft spot (fontanelle) on top of the head
• being unusually sleepy, irritable or playing less than usual

Signs of severe dehydration include sunken eyes, cool or discolored hands and feet, wrinkled skin, being very sleepy, and peeing only once or twice a day (AAP). Severe dehydration may need fluids through a drip in the emergency department (AAP). Call 911 or go to the emergency room.Call 999 or go to A&E.Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department.

When to call the doctor

Call your child’s doctor if your child (AAP, NHS):

• is under 3 months old and has a temperature of 100.4°F (38°C) or higher: call right away, day or night, and don’t wait to see if it settles (AAP). In the UK, the NHS lists this as a reason to call 999 (see below)
• is 3 to 6 months old and has a temperature of 102.2°F (39°C) or higher (NHS)
• has a temperature that rises above 104°F (40°C) again and again, at any age (AAP)
• has a fever that lasts more than 24 hours and is under 2 years old (AAP), or a fever of 5 days or more (NHS)
• stops breastfeeding or bottle feeding, won’t eat or drink, or hasn’t had a drink in 8 hours while awake (NHS)
• keeps vomiting and can’t keep fluids down, or vomits for more than 12 to 24 hours (AAP)
• has diarrhea for more than 7 days, or blood in their poop
• has a swollen tummy
• has a rash as well as a fever
• still acts sick once the fever comes down, or seems to be getting worse
• has a long-term health condition or a weakened immune system

The NHS says to call 111 if you’re worried about any baby under 12 months. Trust your instincts: if you think something is seriously wrong, get help.

When to call for emergency help

Call 911 or go to the emergency room if your baby:Call 999 or go to A&E if your baby:Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your baby:

• has blue, gray, pale or blotchy skin, lips or tongue (on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet)
• is struggling to breathe, breathing very fast, grunting, or sucking in their tummy under the ribs
• is floppy, very sleepy, hard to wake, or not responding as usual
• has a weak, high-pitched or nonstop cry
• has a rash that doesn’t fade when you press it
• has a seizure (fit)
• vomits green or yellow-green fluid, blood, or something that looks like coffee grounds
• has a sudden, severe tummy ache
• has a stiff neck, or is bothered by light
• has cold hands and feet, or skin that feels cold or clammy
• has a very low temperature, below 96.8°F (36°C), or feels cold to touch or is shivery
• is under 3 months old with a temperature of 38°C or higher, or 3 to 6 months old with 39°C or higheris under 3 months old with a temperature of 100.4°F (38°C) or higher and you can’t reach your doctor right away: the AAP says a fever in the first 12 weeks needs medical attention straight away
• hasn’t had a wet diaper or peed in 12 hours

These signs come from the NHS and AAP. Don’t wait to see if they pass.

Medicines

• Don’t give medicine to stop diarrhea to young children. The AAP says these medicines aren’t recommended under 2 years and can also be harmful in older children, so check with your doctor first at any age. The NHS says not to give children under 12 medicine to stop diarrhoea, such as loperamide.
• Never give aspirin to children under 16 (NHS).
• For pain or fever, check the packaging to make sure a medicine like paracetamol (acetaminophen) or ibuprofen is suitable for your child, or ask a pharmacist or doctor. Age limits differ between the US and UK: see below. Don’t alternate the two medicines unless a doctor or nurse tells you to (NHS).

Stopping it spreading

Stomach bugs pass easily between family members. Wash your hands with soap and water often, especially after diaper changes, and wash dirty clothes and bedding separately on a hot wash (NHS). The NHS advises staying home until there’s been no vomiting or diarrhea for at least 2 days.

Where US and UK advice differs

• Water while sick. The AAP says babies aged 6 to 12 months who are vomiting should have breast milk or formula, then an oral rehydration solution if milk isn’t kept down, and not plain water. The NHS says babies on formula or solid food can have small sips of water between feeds.
• Juice and sports drinks for toddlers. For children over 1 who are vomiting, one AAP page lists diluted apple juice or a diluted sports drink (half and half) as options next to oral rehydration solutions, and warns that sports drinks can be high in sugar. The AAP’s diarrhea page says juices and sports drinks can make a child sicker. The NHS says not to give fruit juice or fizzy drinks when a child has diarrhoea or vomiting. Store-bought oral rehydration solution is the safest choice in both countries. No juice under 12 months in either case.
• Fever thresholds. Both treat a temperature of 100.4°F (38°C) or more in a baby under 3 months as urgent: the AAP says call your doctor right away, and the NHS urgent-help page says call 999. The NHS also gives 39°C (102.2°F) or more for babies aged 3 to 6 months.
• Pain and fever medicines. The AAP says not to give ibuprofen under 6 months, or acetaminophen under 2 years, unless your doctor tells you to. The NHS says not to give paracetamol under 2 months, and not to give ibuprofen to a child who is under 3 months, weighs under 5 kg (11 lb), has chickenpox or is dehydrated, or to a child with asthma unless a doctor recommends it.
• Who to call. In the US, call your pediatrician’s office.In the UK, call NHS 111 or use 111 online. They can arrange a call back from a nurse or doctor.Call your doctor or your local health advice line.

For everyday drinks, see water for babies and juice for babies.