Dehydration in Children – Children’s Health Issues

By

Christopher P. Raab

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Reviewed/Revised Feb 2023

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Dehydration is loss of water from the body, usually caused by vomiting and/or diarrhea.

• Dehydration occurs when there is significant loss of body water About Body Water Water accounts for about one half to two thirds of an average person’s weight. Fat tissue has a lower percentage of water than lean tissue and women tend to have more fat, so the percentage. .. read more and, to varying amounts, electrolytes Overview of Electrolytes Well over half of the body’s weight is made up of water. Doctors think about the body’s water as being restricted to various spaces, called fluid compartments. The three main compartments are… read more .

• Symptoms include thirst, underactivity, dry lips/mouth, and decreased urination.

• Severe dehydration can be life-threatening.

• Treatment is with fluid and electrolytes given by mouth or, in serious cases, by vein (intravenously).

Dehydration Dehydration Dehydration is a deficiency of water in the body. Vomiting, diarrhea, excessive sweating, burns, kidney failure, and use of diuretics may cause dehydration. People feel thirsty, and as dehydration… read more occurs when the body loses more water than it takes in. Substances called electrolytes Overview of Electrolytes Well over half of the body’s weight is made up of water. Doctors think about the body’s water as being restricted to various spaces, called fluid compartments. The three main compartments are… read more are lost also. Electrolytes are minerals in the bloodstream and within cells that are essential to life. Sodium Overview of Sodium’s Role in the Body Sodium is one of the body’s electrolytes, which are minerals that the body needs in relatively large amounts. Electrolytes carry an electric charge when dissolved in body fluids such as blood… read more , potassium Overview of Potassium’s Role in the Body Potassium is one of the body’s electrolytes, which are minerals that carry an electric charge when dissolved in body fluids such as blood. (See also Overview of Electrolytes.) Most of the body’s… read more , chloride, and bicarbonate are examples of electrolytes.

Dehydration is usually caused by

• Excessive fluid loss, such as from vomiting Vomiting in Infants and Children Vomiting is the uncomfortable, involuntary, forceful throwing up of food. In infants, vomiting must be distinguished from spitting up. Infants often spit up small amounts while being fed or… read more and/or diarrhea Diarrhea in Children Diarrhea is a very common problem in children (see also Diarrhea in adults). Diarrhea is frequent, loose, or watery bowel movements (BMs) that differ from a child’s normal pattern. Sometimes… read more

A less common cause of dehydration is

However, not every episode of vomiting, diarrhea, or both causes dehydration.

Dehydrated infants need medical care right away if

• The soft spot on their head is sunken.

• Their eyes are sunken.

• They have no tears when they cry.

• Their mouth is dry.

• They are not producing much urine.

• They have reduced alertness and are underactive (lethargic).

Mild dehydration typically causes a dry mouth and lips and increased thirst, and children may urinate less frequently.

Moderate dehydration causes children to be less interactive or playful, have a dry mouth, and urinate less frequently. Moderate and severe dehydration can cause a rapid heartbeat and lightheadedness.

Severe dehydration causes children to become sleepy or lethargic, which is a sign they must be evaluated by a doctor or taken to a hospital or urgent care clinic right away. They have no tears. They may develop a bluish discoloration to the skin (cyanosis Cyanosis Cyanosis is a bluish discoloration of the skin resulting from an inadequate amount of oxygen in the blood. Cyanosis occurs when oxygen-depleted (deoxygenated) blood, which is bluish rather than… read more ) and breathe rapidly. Sometimes dehydration causes the concentration of salt in the blood to fall or rise abnormally. Changes in salt concentration can make the symptoms of dehydration worse and can worsen lethargy. In severe cases, the child can have seizures Seizures in Children Seizures are a periodic disturbance of the brain’s electrical activity, resulting in some degree of temporary brain dysfunction. When older infants or young children have seizures, they often… read more or coma Stupor and Coma Stupor is unresponsiveness from which a person can be aroused only by vigorous, physical stimulation. Coma is unresponsiveness from which a person cannot be aroused and in which the person’s… read more or suffer brain damage. Severe dehydration can be fatal.

Doctors examine children and note whether they have lost body weight. A loss in body weight over only a few days is very likely caused by dehydration. The amount of weight lost, if known, helps doctors decide whether the dehydration is mild, moderate, or severe.

For moderately or severely dehydrated children, doctors usually do blood and urine tests to determine the levels of electrolytes in their body, the degree of dehydration, and the amount of fluid replacement required.

Dehydration is treated with fluids containing electrolytes, such as sodium and chloride.

If dehydration is mild, fluids are generally given by mouth. Special oral rehydration solutions are available but are not always necessary for children who have had only mild diarrhea or vomiting.

Treatment of dehydration in children of any age who are vomiting is more effective if the child is first given small, frequent sips of fluids about every 10 minutes. The amount of fluid can slowly be increased and given at less frequent intervals if the child can keep the fluid down without vomiting. If diarrhea is the only symptom, larger amounts of fluid can be given less often.

If children have both vomiting and diarrhea, they are given small, frequent sips of fluids containing electrolytes. If this treatment increases the diarrhea, children may need to be hospitalized for fluids given by vein (intravenously).

Infants and children who are unable to take in any fluids, or who develop listlessness and other serious signs of dehydration, may require more intensive treatment with fluids and electrolytes given intravenously or electrolyte solutions given through a thin plastic tube (nasogastric tube) that is passed through the nose and down the throat until it reaches the stomach or small intestine.

In infants, dehydration is treated by encouraging an infant to drink fluids that contain electrolytes. Breast milk contains all the fluids and electrolytes an infant needs and is the best treatment when possible.

If an infant is not breastfeeding, oral rehydration solution (ORS) should be given. ORS contains specific amounts of sugars and electrolytes. ORS can be bought as powders that are mixed with water or as premixed liquids at drug or grocery stores without a prescription. The amount of ORS to give a child in a 24-hour period depends on the child’s weight, but generally should be about 1½ to 2½ ounces of ORS for each pound the child weighs (100 to 165 milliliters per kilogram). Thus, a 20-pound infant should drink 30 to 50 ounces total over 24 hours (a 10-kilogram infant should drink 1,000 to 1,650 milliliters total over 24 hours).

Children older than 1 year may try small sips of clear broths or soups, clear sodas, gelatin, or juice diluted to half-strength with water, or popsicles. Plain water, undiluted juice, or sports drinks are not ideal for treating dehydration at any age because the salt content of water is too low and because juice has a high sugar content and ingredients that irritate the digestive tract.

ORS is an alternative, particularly for moderate dehydration.

If children are able to tolerate fluids for 12 to 24 hours, they may resume their normal diet.

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Dehydration and diarrhea in children: Prevention and treatment

What is diarrhea?

Diarrhea is a very common problem in babies and children. It is usually mild and brief.  “Acute” diarrhea lasts less than 1 week, and no longer than 14 days.

A child has diarrhea if they have more bowel movements than usual, and if stools are less formed and more watery. Sometimes children with diarrhea have other symptoms, such as fever, loss of appetite, nausea, vomiting, stomach pains, cramps, and blood and/or mucus in the bowel movement.

Diarrhea can be dangerous if not managed properly because it drains water and salts from your child’s body. If these fluids are not replaced quickly, your child can become dehydrated and may need to be hospitalized.

How does diarrhea spread?

Diarrhea germs spread easily from person to person, and especially from child to child. They usually spread quickly among children who have not learned to use the toilet.

What causes diarrhea?

There are many different causes of diarrhea. The most common are viral infections.

How can I prevent diarrhea?

Proper handwashing and safe food handling are the best ways to prevent the spread of germs that cause diarrhea.

What should I do if my child has diarrhea?

Children with diarrhea need to keep drinking the right amount of fluids to avoid dehydration.

• If you are breastfeeding, keep feeding on demand. You can also offer your child the foods he or she usually eats.
• If you are formula feeding, do not dilute the formula. Continue formula feeding and offer your child the food he or she normally eats.
• If you’re not breastfeeding or formula feeding, offer your child a variety of fluids more frequently, in addition to the foods they normally eat.
• At any age, if your child is not taking other fluids well, offer an oral rehydration solution (ORS), in addition to the feeding recommendations above. 

What is dehydration?

Dehydration is caused by a loss of body fluids, which are made up of water and salts. When children have diarrhea, they can lose large amounts of salts and water from their bodies can become dehydrated very quickly. Children can get dehydrated even more quickly if they are vomiting.

Dehydration can be very dangerous, especially for babies and toddlers.

What are the signs of dehydration?

Call your child’s doctor or seek medical advice at a local clinic or hospital if you see signs of dehydration, including:

• decreased urination (fewer than 4 wet diapers in 24 hours in infants and fewer than 3 wet diapers in 24 hours in older children),
• increased thirst, 
• absence of tears, 
• dry skin, mouth and tongue, 
• faster heartbeat, 
• sunken eyes, 
• grayish skin, 
• sunken soft spot (fontanelle) on your baby’s head. 

Healthy children can spit up, vomit or have a loose stool once in a while without being in danger of becoming dehydrated.

What is an oral rehydration solution?

An oral rehydration solution (ORS) is a mixture of water, salts and sugar in specific amounts. These solutions can be absorbed even when your child has large amounts of diarrhea or is vomiting.    

Oral rehydration solutions can be used to:

• keep children well hydrated when they have significant amounts of diarrhea. 
• replace lost fluids when children show signs of mild dehydration. 

Oral rehydration solutions are available at pharmacies in ready-to-serve preparations. It is best to buy an ORS that has already been mixed.

For the first 4 hours of oral rehydration (for mild dehydration)

If your child refuses to take the ORS by the cup or bottle, give the solution using a medicine dropper, a syringe, a small teaspoon or frozen pops.

If your child vomits, stop foods and other fluids, but continue to give the ORS using a spoon.

• Give 15 mL (1 tbsp.) every 10 min to 15 min until the vomiting stops.
• Increase the amounts gradually until your child is able to drink the regular amounts.
• If your child continues vomiting for longer than 4 to 6 hours, take your child to the hospital.

After 4 hours until 24 hours: Recovery stage

• Keep giving your child the oral rehydration solution until diarrhea is less frequent.
• Continue feeding your child their regular diet if they are not vomiting.
• When vomiting decreases, it’s important to get your child to breastfeed as usual, drink formula or whole milk, or eat regular food in small, frequent feedings.

What should I avoid giving to my child?

• Do not give your child sugary drinks like fruit juice or sweetened fruit drinks, carbonated drinks (pop/soda), sweetened tea, broth or rice water. These do not have the right amounts of water, salts and sugar and can make your child’s diarrhea worse.
• If your child is having frequent diarrhea, make sure they are drinking an oral rehydration solution (not just plain water) and eating food. Bland foods with complex carbohydrates, lean meats, and fruits and vegetables are encouraged. Drinking only water may lead to low blood sugar or low sodium levels in your child’s blood.

Talk to your doctor before giving any over-the-counter medications to stop diarrhea.

When should I call the doctor?

Call your doctor or seek medical advice if your child:

• has diarrhea and is less than 6 months of age.
• has stomach pains that are getting worse.
• has bloody or black stools.
• vomits blood or bile.
• is refusing to drink.
• is still vomiting and unable to drink after 4 to 6 hours.
• has diarrhea and a fever.
• has signs of dehydration (see list above).
• If your child vomits green bile, go to the emergency department right away.

Diarrhea lasting for more than 1 to 2 weeks is not considered acute diarrhea. Talk to your child’s doctor if this is the case.

More information from the CPS

Reviewed by the following CPS committees

• Acute Care Committee
• Nutrition and Gastroenterology Committee
• Public Education Advisory Committee

Last updated: July 2018

Dehydration (Children): Causes, Symptoms, Signs, Treatment, Diagnosis, Prevention

Overview

Dehydration occurs when the body does not have enough fluid to function properly. Often the problem of dehydration occurs in children, especially infants and young children, as children lose fluid faster than adults. Dehydration can be caused by a virus that causes vomiting, fever, or diarrhea. Extreme heat may be the cause. Children with a sore throat or nausea may also become dehydrated because they refuse to drink the amount of fluid they need. In most cases, dehydration is minor. However, without proper treatment, dehydration in children can be serious and life-threatening. Children should always be given plenty of fluids if they vomit, have diarrhea, or are exposed to heat for a long time.

What to expect

Be sure to see a doctor if you suspect your child may be dehydrated. If the dehydration is mild, the doctor may tell the child to drink plenty of fluids. For infants and children under 2 years of age, an oral rehydration method is used with solutions such as nondialyte or rehydralitis instead of water. Note that drinking sugary drinks will only make the symptoms worse. For older children, sports drinks or water soups can help. It is better to drink in small sips than to drink a large amount of liquid at once, since too much liquid can cause repeated vomiting. If you are severely dehydrated, your doctor may put you on an IV in a hospital setting. For the most part, children recover without any complications. Some children need treatment for the underlying cause of dehydration. Mostly this virus goes away on its own in 5-6 days.

May be worsened by

Vomiting, diarrhoea, nausea, mouth ulcers, untreated diabetes.

Diagnosis

The doctor will ask you a series of questions and examine your child. The doctor may also need results from blood and urine tests.

Treatment

Treatment of dehydration in children includes:

– oral rehydration solutions

– other fluids

– intravenous solutions

– Treating the underlying cause, such as an infection

Self-medication

If you are concerned that your child may be dehydrated, seek medical attention. In agreement with the doctor, cases of dehydration can be treated at home. Encourage your child to take oral rehydration solutions often and in small sips. Frozen fruit juice ice cream is an easy way for your child to drink more fluids. However, it is better to aim to prevent dehydration than to treat it after the problem occurs. Give your child more fluids to drink as soon as vomiting or diarrhea starts.

When to see a doctor

See a doctor if your child has been vomiting for 12 hours or more, or has diarrhea that doesn’t go away for 5 days or more. Always see a doctor if your child is sick before the age of 6 months. If your child shows signs of severe dehydration, has not urinated for 8 hours or more, has dry mouth or eyes, no tears when crying, or sunken eyes, see a doctor right away. If your child is unconscious, has no eye contact or any reaction to you, or has trouble breathing, go to the emergency room or call 103.

Risk factors

Infants and toddlers, viruses, vomiting, diarrhoea, diabetes, overheating.

How to determine if a baby is dehydrated

Photo

Oksana Kuzmina/Shutterstock

Dehydration in a baby occurs when the body experiences an acute lack of fluid. Unlike adults, very young children are at higher risk of dehydration due to several factors. Despite the fact that there is much more water in the tissues and organs of babies than in adults, their cell membranes are highly permeable, so it evaporates faster. The water molecule “lives” in the body of the crumbs for no longer than 3-5 days, while in the body of an adult, on average, 15 days.

Children actively lose moisture not only during defecation and urination, but also through the lungs during breathing and through the skin with sweat. The second feature of babies is that their water-salt metabolism is much more intense than that of their parents. But it also consumes a lot of fluid, and if its volume decreases and is not replenished, the level of potassium and sodium decreases, which can lead to malfunctions of the kidneys and brain.

Dehydration in babies most often occurs if the mother is young and inexperienced. The first warning signs may be present already at discharge from the maternity hospital. The reason for this may be difficult childbirth. If the baby was born weakened, he may be reluctant to suckle the breast, get very tired of sucking it. In the maternity hospital, this problem is sometimes solved by feeding the baby with milk mixtures instead of teaching the inexperienced mother the skills of breastfeeding.

To avoid such troubles, parents should make sure that the child gets enough fluids through food and drink. The amount of liquid that a baby should consume per day depends on its age and weight. The daily norm for crumbs up to a year is 100 ml of liquid for every kilogram of weight. This includes not only water, but also breast milk and the liquid contained in porridge, puree, etc. Please note that an increase in temperature in the street or in the apartment by 1 ° C in excess of 20-22 ° C that is comfortable for the baby requires the use of an additional 100 ml of liquid.

For this reason, paediatricians recommend offering water to all children, without exception, in addition to the basic diet from the first day of life. If the baby refuses, there is no need to force him, and if he agrees, he should not be limited: he himself knows his norm.

Photo

Alena Ozerova/Shutterstock

Special cases of dehydration

The risk of dehydration in infants increases in the heat, if the baby overheats in the sun, as well as rotavirus and intestinal infections that are accompanied by vomiting and diarrhea. To make sure the diarrhea is not causing dehydration, weigh your baby without diapers at the same time every day before feeding. It is best to do this procedure in the morning. No weight loss – no dehydration. But if the weight began to decrease, urgently call the pediatrician.

Drugs such as Regidron can help your baby with dehydration. The doctor will recommend the dose, frequency of administration and explain how to give the baby a solution. Self-activity is not allowed here. If you vomit, the liquid will have to be injected literally drop by drop every few minutes.

With severe vomiting or diarrhea, the baby is usually hospitalized, because it is impossible to cope with this condition on your own. You need to correct the situation with the help of intravenous infusions.

By the way, in extreme heat and water the child should be given special attention. How exactly? Read the article How to give your baby a drink in the heat: 5 do’s and 2 don’ts

Photo

Africa Studio/Shutterstock

Signs of dehydration in babies

To avoid this scenario, parents should be aware of the signs of dehydration at the baby and keep a close eye on them. There are 3 degrees of dehydration – light, medium and heavy.

• Mild dehydration is almost invisible. Its main indicator is thirst. A baby, of course, will not tell his mother that he wants to drink, but if you carefully observe his behavior, you will notice that he should be offered a drink. Usually the child often licks his lips and reaches for water. Urination may be slightly less frequent.

• With moderate degree of dehydration , the baby’s pulse accelerates a little, lips may dry out, slight shortness of breath may appear, and the fontanel may slightly fall. The tongue will become dry and sticky, the saliva will become viscous, the baby will become very restless and will urinate noticeably less than usual.

• When severe dehydration the baby will stop urinating, his pulse will greatly slow down or accelerate, breathing will slow down, the fontanel will sink, the skin will become lethargic and flabby. The kid becomes lethargic.

Parents should also be alert for fever, dark urine and a completely dry diaper, especially after sleep.

Photo

morrowlight/Shutterstock

How to stay hydrated

To avoid dehydration in infants, make sure that he drinks enough fluids, especially in hot weather. Going for a walk with a child in the warm season, be sure to take bottled water with you. You don’t need to sweeten it. Sugar only increases thirst. For the same reasons, it is not recommended to offer juices and other sweet drinks to crumbs in the heat. Under normal conditions, unobtrusive supplementation will help to avoid dehydration in a healthy baby.

In hot weather, breastfeeding also has a number of significant nuances. Read about it in the article “Breastfeeding in the heat: 7 important questions”

Dehydration risk group

Some babies are at higher risk of dehydration.