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Immunization

Getting Rotavirus Ready – An Interview with Dr. Jim Sears

James M. Sears, MD, is the eldest of renowned pediatrician Dr. William Sears’ eight children. “Dr. Jim,” as he is known in the office, is a board-certified pediatrician in private practice with his father and brother in San Clemente, California. Dr. Jim earned his medical degree at St. Louis University School of Medicine in 1996 and completed his pediatric residency at Northeastern Ohio University College of Medicine, Tod Children’s Hospital in Youngstown, Ohio in 1999. Dr. Sears is a member of the teaching faculty at the University of California at Davis School of Medicine. He is an active contributor to the content of AskDrSears.com, and is co-author of The Premature Baby Book, and the best-selling The Baby Book, Revised Edition. Recently, Dr. Jim partnered with the National Healthy Mothers, Healthy Babies Coalition (HMHB) to launch the Are You Rotavirus Ready? campaign, to provide parents with information about this contagious and potentially serious virus. We had the opportunity to talk with Dr. Jim about the topic.

Q. What is rotavirus?

A. Rotavirus is a highly contagious virus, and the leading cause of severe, dehydrating diarrhea. It affects nearly all children by their third birthday. The most common symptom of rotavirus is diarrhea. While mild symptoms of rotavirus can often be successfully managed at home, rotavirus can cause severe diarrhea, which can lead to dehydration. Dehydration can be a serious medical condition and it needs to be acted upon immediately. About 70,000 infants and young children under the age of five are hospitalized every year because of rotavirus.

Q. When does rotavirus become serious?

A. The rapid loss of fluids that accompanies diarrhea can lead to dehydration, during which the body does not have the water and salts (or electrolytes) it needs. Babies under one year of age, and especially those who have a fever, become dehydrated most easily because of their smaller body weights. It is sometimes necessary for children to be rehydrated using intravenous fluids. In the most severe cases of dehydration, a child may even develop convulsions or go into shock, which in rare cases can lead to death. Sadly, about 100 children die each year because of the dehydration brought about by rotavirus.

Q. What are other symptoms of rotavirus?

A. Rotavirus often begins with a fever and is followed by vomiting and an upset stomach, as well as increased amounts of profuse, watery diarrhea several times a day. Anyone caring for small children should know how to monitor the symptoms of rotavirus, and should call a health care provider immediately if a child has any of the symptoms associated with the dehydration it can cause. These symptoms include fever, frequent vomiting, abdominal pain and lethargy (lack of responsiveness). Parents see fewer wet diapers due to less frequent urination. Children might be crying but not releasing tears. The skin is often dry and cool despite fever. The profuse, watery diarrhea is foul-smelling, green or brown. Children with rotavirus might also have sunken eyes. With babies, you might see a soft spot on the top of the head. Older children might complain of extreme thirst.

Q. What should parents do if they think their child is experiencing rotavirus symptoms?

A. When parents sense something’s wrong, it’s always a good idea to monitor things a little more closely. It often helps to keep a log so you can communicate with the child’s health care provider if it becomes necessary. Tracking when they eat and when wet and dirty diapers are changed is helpful. Parents should be prepared to answer questions about feeding and fluid intake. It’s especially important to know the signs of dehydration in order to spot them.

Q. How does a parent know when diarrhea is something to worry about?

A. What is “normal” varies from baby to baby, and parents know their child best. Parents should pay close attention if they notice a difference in their child’s stools. It is usually a good idea to check for fever, monitor appetite and watch for other symptoms of rotavirus. Dehydration is the primary concern, so making sure they get enough fluids is a priority. When in doubt, parents should always contact their health care provider. The health care provider may request a stool sample if the diarrhea is bloody or continues for an extended period of time. Testing of the stool can help verify if a child has a virus or if there is another cause.

Q. How does rotavirus spread?

A. Rotavirus can be spread both before and after children show signs of being sick. Remember, rotavirus is a virus that affects young children – children who are constantly putting their hands in their mouth. If they do so after touching something that has been contaminated by the stool of an infected person, they get rotavirus. Small children forget to wash their hands often or do not always wash hands thoroughly right before eating and immediately after using the toilet. People who care for children can also spread the virus if they don’t wash their hands properly after changing diapers. The virus can survive for a few hours on human hands and for days on hard and dry surfaces. As a result, rotavirus can be easily spread in families, and outbreaks can occur in childcare centers, playgroups, and hospitals.

Q. Can parents keep their children from being exposed to rotavirus?

A. It is extremely difficult to keep a child from being exposed to rotavirus. The virus is so widespread that millions of children become infected each year. Even the cleanest of environments can be infected, but being vigilant about hand washing is always a wise strategy. Children who have previously had rotavirus may be infected again, but repeat infections tend to be less severe. Babies who are actively breastfeeding also receive some immunity against severe cases.

Q. Is rotavirus just a kids’ illness?

A. Adults can be infected with rotavirus, but they tend to have mild cases. Young children between the ages of six months and 24 months are at greatest risk for severe rotavirus. It’s difficult to predict how rotavirus will affect an individual child, but parents can be prepared by being able to spot the warning signs, knowing how to manage symptoms at home and being aware of when to contact a health care provider.

Q. Why are we hearing more about rotavirus now? Is it a new virus?

A. Rotavirus has actually been around for years, but most parents haven’t had a name for it. Most often a child with this virus has been referred to has having a “stomach bug.” But we have identified the virus that causes this set of symptoms and we understand more about complications that can arise from rotavirus. It’s important to get the word out to both parents and health care providers, so that they fully understand how rotavirus can affect children and what to watch for.

Q. How can HMHB members and partners in maternal and child health help parents understand rotavirus?

A. We know that virtually every child is going to get infected with rotavirus by the time they reach kindergarten. We know it causes about half a million visits to pediatricians’ offices and about 160,000 trips to the emergency room every year. We also know most moms (over 70%) have not yet heard about rotavirus. It’s really a matter of whether a child gets a mild or a severe case. So it’s essential that parents know about rotavirus so that they can monitor the symptoms. We need help in getting the word out. The HMHB brochure, done as part of the FAST FACTS for Families series, is a great tool and available for free, even in bulk supply. We hope those who work with parents and small children will take part in the Are You Rotavirus Ready? campaign by ordering their supply of free publications so that they can share this resource with families.


To find out more about rotavirus and order the brochure, visit http://www.rotavirusready.org.

For more about Dr. Jim’s work and information on other child health issues, go to http://www.askdrsears.com.