What Should I Do If My Child Has Norovirus?

If your child has a stomach bug, it could be norovirus—a highly contagious stomach virus that causes diarrhea and vomiting. Cases of this virus are on the rise in New York City and much of the northeastern United States, according to the Centers for Disease Control and Prevention.

While typically mild in older children and adults, lasting usually only a few days, norovirus can cause severe dehydration in babies and kids with certain underlying conditions. Knowing how to care for them is crucial.

In this Q&A, Tessa Scripps, MD, a pediatrician at the Mount Sinai Kravis Children’s Hospital, and Assistant Professor of Pediatrics at the Icahn School of Medicine and Mount Sinai, answers your questions about the disease, including what to do if your child is sick.

What is norovirus, and what are norovirus symptoms?

Norovirus is a common contagious virus that inflames the intestines, causing nausea, diarrhea, and throwing up. Sometimes it can also cause fever. The disease is spread when particles from an infected person’s feces or vomit spreads to others, typically in bathrooms, but also by eating or drinking contaminated foods and beverages; using contaminated utensils; touching contaminated surfaces; or having any direct contact with someone who is infected. Norovirus is highly transmissible, and infected people can actually shed billions of norovirus particles at a time, but it can take fewer than 100 norovirus particles to make another person sick. People are most contagious when they actively have symptoms and in the few days after their symptoms have resolved.

Tessa Scripps, MD

How can I protect my child from catching norovirus?

The most common way norovirus is spread is through close contact with an infected person, so it’s a good idea to keep kids some distance from people who are sick, or who have recently recovered from being sick. Norovirus can infect an entire family at the same time, since even simple contact with others can lead to infection. So, the most important thing is for kids to wash hands frequently with soap and warm water, and for adults to do the same, especially if any of you have been in contact with a person who has symptoms. Alcohol-based sanitizers do not work as effectively against preventing transmission.

My child has norovirus. How does their age or health condition affect their risk for severe illness?

Newborn babies and children who have underlying chronic illnesses such as kidney disease and diabetes are at higher risk for becoming dehydrated and severely ill because excessive fluid losses can affect their kidney and their liver function. It’s important they get medical attention right away if symptoms last longer than three days or if they’re unable to keep hydrated.

What symptoms might indicate my child needs medical help?

Watch for symptoms of dehydration, such as decreased or less frequent urination and small volume- or very dark or strong-smelling urine. If it has been more than eight hours from when your child has had a wet diaper or used the toilet to pee, reach out to your doctor for advice. A rapid heart rate or a significant change in your child’s activity can also be a sign of dehydration. If you notice that your child seems very lethargic and listless, you should seek medical advice right away.

What can I do to help my child recover from norovirus?

Once the virus has passed and the vomiting and diarrhea have subsided, make sure they are well hydrated and rested. For newborns and infants, you can give them small amounts of breast milk or formula. Toddlers, older children, and adults should drink small volumes of fluids—about one to two ounces every one to two hours—to ensure fluids get absorbed and to prevent recurrent vomiting. Drinking water and electrolyte fluids like Pedialyte®, Gatorade, or watered down apple juice can be very useful to maintain hydration, and can help prevent complications from norovirus. They can also have bland foods like rice, dry cereal, applesauce, bananas, and crackers.

Are there any medications I can give my child to ease their norovirus symptoms?

There are no over-the-counter anti-diarrheals or anti-nausea medicines that are recommended for children. In rare cases, pediatricians may prescribe Zofran, an anti-emetic, to help children stop vomiting so they can re-hydrate without the need for intravenous fluids.

How do I prevent norovirus from spreading to my other kids?

It is important that everyone in your house washes their hands regularly with warm water, and avoid sharing food and drinking cups with anyone who is sick. You should also wipe down any contaminated surfaces with a bleach-based disinfectant, especially toilets and sinks after an infected child has used them. And everyone should try to maintain some distance from infected household members while they’re actively sick.

Is there a test for norovirus I can give my child?

Testing is available. However, norovirus is similar to other types of stomach infections, such as rotavirus, and symptom management is the same, so testing isn’t useful. If there has been an outbreak at your child’s school and they are sick, there is a good chance they have norovirus.

How Do I Set Up a Personal Exercise Routine?

We all know regular exercise is important for optimal health. But it is less clear how to set up an exercise routine that will work best, just for you. Here are some tips and insights from Hannah Kittrell, MS, RD, CDN, EP-C, Director of the Mount Sinai Physiolab, located at Mount Sinai Morningside.

Where do I even start while creating an exercise routine?

Three key elements are particularly important to keep in mind: consistency, variety, and fun.

Let’s start with consistency. Generally, we recommend spreading out your workouts between at least three to five times a week. This will help to increase the health benefits, improve your fitness at a faster rate so that you’ll get less tired during the workouts, and reduce your risk of injury. While we suggest five days a week, always check with your doctor before you start a new exercise routine.

Variety is also important—both because it’s fun to mix it up and also because you will work different muscles and improve your overall fitness when you include a variety of activities. Mix it up between aerobic activity, muscle and bone strengthening exercises, flexibility, and balance exercises.

Last—and most important—make it fun. No one wants to do an exercise routine that feels like a chore, so be sure to find the activities that make you the happiest, whether power walking through your favorite park, or biking to your favorite coffee shop. And if the activity itself isn’t enough to get you out the door consistently, find a friend who is happy to join you.

How much exercise should I plan for?

With aerobic activity, the American College of Sports Medicine (ACSM) recommends aiming for between 150 to 300 minutes of moderate intensity exercise or 75 to 150 minutes of vigorous activity each week. Keep in mind that aerobic activity includes anything that gets your heart rate up, from a run to a dance party in your kitchen. For muscle and bone strength work, the ACSM recommends two to three sessions per week. As we talked about before, it’s better to spread this activity out across several days in the week—ideally at least three.

What is the difference between moderate and vigorous intensity exercise?

With moderate intensity exercise, you should be able to carry on a conversation—but you should not be able to sing along to your favorite song. With vigorous activity exercise, you should not be able to talk in full sentences; instead, you’ll find yourself taking a breath every few words.

Why do I need a personalized health and fitness assessment?

A lot of the recommendations you find online or on gym equipment are generalized. They’re based on formulas, but don’t speak to your personal physiology. We’re all individuals, and a one-size-fits-all approach often doesn’t work. For example, you burn two main energy sources during exercise: fat and carbohydrates. Depending on your goal, you will want to incorporate different amounts of exercise that stimulate fat burning vs. carbohydrate burning. You typically burn fat when you’re at rest or doing low- to moderate-intensity exercise. Most exercise equipment, such as a treadmill or elliptical at the gym, will highlight a “fat-burning zone,” but the equipment doesn’t calculate this zone for you specifically. For instance, we know some people can continue to burn fat at higher intensities of exercise, while other individuals only burn fat up to moderate intensity exercise.

The best way to understand your body’s response to exercise is through assessment of your unique metabolism during a bout of exercise. When you have this individualized information, you can fine-tune your exercise routine to meet your goals efficiently.

How can a professional help me put together an exercise routine?

An exercise professional can help you develop a more targeted direction for your routine. You’ll want to look for either a certified personal trainer or an ACSM-certified exercise physiologist. Another option is to come into a health facility that can assess your metabolism and provide evidence-based advice on diet and exercise—like the Mount Sinai Physiolab. At our site, you can be evaluated on our metabolic equipment and work with our staff exercise physiologist. We can deliver the data points on your body composition and innate physiology that might be helpful in setting specific goals. Every test also includes a post-test counseling session to discuss what all the information means and help you figure out how to apply it to your daily life.

 

What You Need to Know About the Latest COVID-19 Variant

You may have noticed that more people you know have gotten COVID-19 recently. One reason is the virus that causes COVID-19 continues to evolve into variants that are more contagious.

The latest one is known as XBB.1.5, and since early December it has become the predominant variant in the New York metropolitan area, according to the Centers for Disease Control and Prevention (CDC).

This variant is thought to be highly transmissible due to its ability to partially evade antibodies produced through vaccines or past infections. However, the vaccines still offer excellent protection against severe illness and death.

New Guidance on COVID-19 Vaccines: In April 2023, the Food and Drug Administration and the Centers for Disease Control and Prevention announced some major changes for COVID-19 vaccines. Click here to read more about what you need to know.

In this Q&A, Bernard Camins, MD, MSc, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System, explains more about the new variant and how to protect yourself.

No matter the variant, it is important to remember that COVID-19 is not going away. The key is to reduce transmission to those who are at risk of getting seriously ill:

  • If you feel sick, stay at home.
  • If you want to be more vigilant, wear a high-quality mask, avoid being unmasked at large indoor gatherings (such as eating at restaurants), especially when infection rates in your area are very high.
  • If you are at high-risk for a serious infection, talk with your medical provider so you are prepared should you get infected.
  • Don’t forget to get your flu shot; you can get that at the same time you get your COVID-19 booster shot.

How does this new variant differ from the earlier variants?

The nature of COVID-19 is that the new variants are likely going to be more contagious than the older ones. There is currently no evidence that this latest variant is more dangerous. The symptoms do not appear different.

 Does the newest, updated booster shot help protect me from this new variant?

According to the CDC, being up to date with the bivalent booster that became available in September 2022 offers the best protection against COVID-19. (It is the only booster now available.) The updated bivalent booster specifically targets both the BA.5 sub variant of Omicron, of which XBB.1.5 is a descendent, and the original SARS-CoV-2 virus. The original COVID-19 monovalent vaccines, and the monovalent booster that became available in the fall of 2021, only target the original virus, and therefore potentially offer less protection against the Omicron subvariants.

 I was recently infected with COVID-19. How long should I wait to get the latest bivalent booster?

You may consider waiting up to 90 days from your last infection before getting the bivalent booster. Reinfection is less likely in the weeks and months after infection. But you may want to talk with your provider if you are at increased risk of severe disease.

 I never got any vaccines. Can I skip the first and second monovalent vaccines and just get the bivalent booster?

No. Before you can get the bivalent booster, you still need to get two doses of the monovalent vaccine.

 I received my bivalent booster more than two months ago. Has my immunity started to wane?

Your immunity does begin to wane after three to four months, probably more so if you’re older, such as older than 50.

 Can I get another dose to bolster my immunity?

No. Currently, there are no more recommended doses after you have already gotten the bivalent booster, regardless of how long it has been.

 Will the bivalent booster and antiviral medications prevent me from developing long COVID?

We do not have definitive data yet to know how much protection the bivalent booster and antiviral medications such as Paxlovid™ offer against the development of long COVID. But we do know that being vaccinated certainly reduces your risk of developing it.

I am at high risk for complications from COVID-19. What should I do to protect myself from the latest subvariant?

Because COVID-19 is so widespread now, it’s hard to avoid getting infected or exposed. While it is reasonable to take precautions to avoid a COVID-19 infection, the goal should be to reduce the severity or prevent complications when you do get COVID-19. High-risk individuals should have a plan for how to get antiviral medications, which can prevent severe illness or death. For this to work, you must take the medications within the first five days of symptom onset. If you have not done so already, you should talk with your doctor or your care provider to create a plan for what antivirals you would need and how to get them. Having a plan is also important because you may be on medications that interact with certain antivirals, and you may need to stop taking those medications temporarily to prevent drug interactions. Those at high risk include older adults, those with chronic medical conditions, such as diabetes, and those with reduced ability to fight infections, such as those being treated for some cancers.

Is Bariatric Weight-Loss Surgery the Best Option for Me?

If you are struggling with obesity, you’re not alone. More than 25 percent of New Yorkers are overweight or obese, according to the Centers for Disease Control and Prevention. Obesity is related to a number of common medical conditions, including type 2 diabetes, high blood pressure, sleep apnea, and back pain.

If you’ve tried to lose weight and are still struggling, you may want to consider bariatric weight loss surgery. A popular and often ideal option for people who have not been successful losing weight on their own, bariatric surgery involves surgically altering the digestive system in ways that make weight loss easier.

However, the decision to undergo bariatric surgery should not be made lightly, and there is much to consider beforehand. In this Q&A, two of Mount Sinai’s leading bariatric surgeons answer some commonly asked questions about these surgeries.

Danny Sherwinter, MD, is Chief of Surgery at Mount Sinai Brooklyn and Assistant Professor of Surgery at the Icahn School of Medicine at Mount Sinai, and Patrick Dolan, MD, is Assistant Professor of Metabolic, Endocrine and Minimally Invasive Surgery.

What are the different bariatric surgery weight loss options?

There are three types of bariatric surgeries:

  • Lap band surgery decreases the amount of food needed to feel full. It involves placing an adjustable band around the stomach, restricting the amount of food consumed.
  • Sleeve gastrectomy is the most common bariatric surgery in the United States. It involves reducing the stomach to about 20 percent of its original size, significantly reducing the volume of food required to make you feel full.  It also has an effect on hunger hormones.
  • Gastric bypass surgery (also referred to as Roux-en-Y for the way surgeons perform this) is a procedure in which the surgeon creates a small pouch from the stomach and connects it directly to the small intestines. As a result of the surgery, the amount of food a patient will be able to consume is reduced, and even the food and calories they do eat will not be fully absorbed. 

Do I need to try all non-surgical weight loss options first?

Surgery is never the first choice for weight loss. You should try to lose weight on your own with diet and exercise.  You should also consult with your primary health care provider for their support and input. However, if you find that you are unsuccessful in losing weight despite these best efforts, you are not alone, as most people are unable to lose enough weight to improve their medical conditions and their quality of life.  For those people, surgery is an excellent option.

Who qualifies for bariatric (weight loss) surgery?

In general, most insurance companies are willing to cover bariatric surgery of any kind when a person’s body mass index, or BMI, is over 40 and they’re otherwise healthy; or if their BMI is over 35 and they have medical comorbidities associated with obesity, such as high blood pressure or diabetes. You can determine your BMI using the CDC calculator.

What will my insurance company require in order to get approved?

Most insurance companies will require you to go through a lengthy process to document your need for bariatric surgery. You will need approvals from a nutritionist and a psychologist, and will be required to see a number of other medical practitioners based on your medical history. In many instances, this will require you to visit a gastroenterologist, pulmonologist, cardiologist, and your own doctor. You will need to visit your doctor on a regular basis to document ongoing diet efforts, which you will need to submit to the insurance company for approval. This process, in some instances, takes up to six months or longer. Your bariatric surgeon will be able to guide you through the process.

Will my lifestyle and eating habits change after I have this surgery?

Yes. If patients don’t expect to dramatically change their lifestyle after surgery, then these operations will not result in weight loss. To succeed in the long term, you must fundamentally change your lifestyle, food choices, and how you eat, in addition to the operation. Getting enough exercise will also be important.

What will my diet be like before and after surgery?

A week or two before surgery, patients typically go on a liquid diet so they can lose some weight to make the operation even safer. After the operation, patients continue a liquid diet for a couple of weeks, then switch to a soft puree diet for a few more weeks. Within a month or so after surgery, the patient is put back on a regular diet. When you switch back to a regular diet, there is a risk of vomiting. However, if you avoid eating too fast or swallowing food without chewing, you will reduce this risk. We always recommend that bariatric surgery patients take vitamins, and follow up with their doctor to have vitamin levels checked.

Are there any complications from weight loss surgery?

As with any surgery, bariatric surgeries have possible complications, which are different for each. However, they are extremely safe overall. According to statistics, the risks for all of these operations, even bypass—the most complicated—is about the same as gallbladder surgery, an extremely safe and common ambulatory operation.

Will I be able to get pregnant after weight loss surgery?

In our experience, patients are more likely to become pregnant after weight loss surgery, and their pregnancies are often healthier and safer. Obese patients who are unable to become pregnant before surgery may become more fertile after surgery due to hormonal changes (reduction in elevated testosterone levels); possible ovarian issues (e.g. polycystic ovarian syndrome); and often a reduction in abnormal periods. The weight loss makes the entire birthing process safer. There’s also a higher incidence of gestational diabetes in pregnant women who are obese. We usually recommend waiting about a year after surgery before getting pregnant. But the timing should always be something to discuss with your bariatric surgeon and your obstetrician.

Expert Advice on RSV and Other Respiratory Illnesses in Children

As often happens at this time of the year, physicians are busy caring for children with respiratory illnesses that can range from a common cold to something more serious, including COVID-19. What’s different this season is an increase in the number of cases of respiratory syncytial virus, better known as RSV.

In this Q&A, C. Anthoney Lim, MD, the Director of Pediatric Emergency Medicine for the Mount Sinai Health System and the Medical Director of the Pediatric Emergency Department and Pediatric Short Stay Unit at Mount Sinai Beth Israel, explains what symptoms to look out for, how to help your child if they are sick, and when to seek medical care.

As always, Mount Sinai’s Emergency Departments and Urgent Care centers are available to help any time, and they work closely with your pediatrician and primary care provider. And one important reminder: Be sure your child is up to date with their vaccinations, which is one of the best ways to prevent serious illness.

What pediatric respiratory illnesses are circulating now and who is most at risk of getting them?

All of the respiratory viruses are circulating among most school age children and those in preschool. They all look essentially the same to physicians and parents at the onset. These are the most common ones we’re seeing:

  • Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. It typically affects younger infants, premature infants, and children with underlying medical conditions.
  • Influenza is the seasonal virus that causes the flu. The flu season stated early this year. Like RSV, it especially affects young children and those with chronic illnesses or medical conditions such as asthma.
  • Enterovirus D68 causes a mild cold in most cases. But it produces a more severe illness in some children, possibly requiring hospitalization, especially for those with asthma.
  • COVID-19 has been circulating throughout the year. Children who require hospitalization are those who have not been vaccinated or have not received all of their vaccinations.

C. Anthoney Lim, MD

What advice do you have for parents whose children may be sick?

In general, it’s less important to try to tell the differences between these respiratory illnesses. It’s more important that you support your child and their illness by keeping your child hydrated, making sure they are breathing comfortably, and taking care of their symptoms, such as fever. It is helpful to prepare by having some Motrin or Tylenol at home. If your child has an underlying medical condition, you should be prepared to treat other symptoms, such as having an inhaler for those with asthma or carefully managing your child’s sugar levels if they have diabetes.

How do I know if my child is becoming dehydrated?

There are some simple things that you can do to make sure your child is properly hydrated. The most important thing is making sure your child is peeing. A well hydrated infant will urinate about four to six times a day. For young children, that means that you should have a wet diaper about every six or eight hours. If it starts getting longer than that, it’s important to start encouraging your child to drink fluids. If your child continues to go without peeing, it’s time to talk to your doctor. Other signs of possible dehydration are that you may see your child will just be less active. They might cry, but not make any tears. Their mouth might start looking dry as well. All of these can be signs that it’s time to see the doctor.

How can I monitor my child’s breathing?

When your child is breathing comfortably, you should almost barely recognize they are taking breaths. As they start having more trouble breathing, you’ll see them start using all of their body muscles that you don’t typically use to breathe, such as their belly moving. You might see their neck moving or their shoulders. You’ll see their nose flaring. All of those can be signs that your child is now using these muscles to breathe that they don’t normally use. If it goes on for a prolonged period of time, it can be dangerous. So once that starts, it is time to see a doctor.

How do I know if I need to call the doctor?

If you begin treating symptoms and don’t see any improvement, it’s often time to reach out to a doctor. For example, if you’ve been giving your child Motrin or Tylenol and your child is still very tired, and they’re not getting up to drink, then it’s probably time for a conversation with your doctor. If you’ve been giving albuterol every four for hours and it looks like the child’s breathing is not improving, definitely call the doctor. You can expect a variety of symptoms, including cough, runny nose, vomiting, diarrhea, fevers, rashes, just more crying. These typically can last three to five days. If after that time, your treatments are not leading to an improvement in your child’s condition, then it is time to have a chat with your pediatrician.

Any tips for managing symptoms?

When your child has a fever, and they’re fussy and don’t want to eat or drink, and they don’t want to sleep because they’re uncomfortable, giving them Motrin or Tylenol can help them feel comfortable enough so that they’ll drink or get some rest. I often tell parents that if your child is sleeping in the middle of the night and you check on them and they feel a little warm but they’re sleeping and breathing comfortably, there’s no need for wake them up to give Motrin or Tylenol. You are only defeating the whole purpose of the medication, which is to allow them to rest and have the body help with their illness. If your child has asthma and you notice coughing or wheezing, it’s a good time to give your controller medications because they can still have some benefits. For children with other underlying illnesses, make sure you’re keeping up with what your action plans are. Talking with your doctor in advance can be helpful in coming up with a plan to help your child.

Mount Sinai Offers Home Infusion Services

If you need IV therapy, you may be able to receive it at home. Your Mount Sinai care provider may decide you are a good candidate for home infusion services and enroll you in the program. Once you are enrolled in Mount Sinai Home Infusion, Mount Sinai makes all necessary arrangements.

The Mount Sinai team helps by:

  • Coordinating insurance coverage
  • Helping locate co-pay assistance
  • Shipping medication and supplies to your home
  • Arranging for a nurse to provide the infusion
  • Addressing any questions or concerns you may have

Why Mount Sinai Home Infusion?

Mount Sinai Home Infusion is part of the health system you know and trust. We communicate regularly with your doctors about your treatment and condition. In addition, your other Mount Sinai doctors and service providers will know what medicines you are receiving so they can coordinate any other care you may need. If you are interested, you should discuss this with your health care provider.

COVID-19 Safety

We know how important it is to stay COVID safe. Your home care nurse will follow all COVID-19 safety rules.

Questions or Concerns

At Mount Sinai Home Infusion, we are here for you, 24/7, to address any questions or concerns. You can call us at:

212-523-9200 (in New York City)

833-998-4320 (toll free)