Dehydration: Overview and Hydration Recommendations

Nationwide Children’s Hospital

Dehydration means that your child has lost too much fluid and does not have enough electrolytes (salts) in their body for it to work the right way. There are many ways a child can get dehydrated.

• Diarrhea, vomiting, and fever are the main causes in babies.
• Refusing to drink enough due to mouth sores or a bellyache.
• Not drinking enough in hot weather or when exercising.

Babies and younger children are at greater risk of getting dehydrated. It can be very dangerous for them. Your child will need extra liquids given in smaller amounts and more often at home until they are well.

If the liquids are not replaced, they may need to have fluid given directly through a plastic tube into the vein or intravenously (IV) to rehydrate them. Your child does not need that right now.

Kinds of Liquids to Give

• Your child may need to drink an oral rehydration solution (ORS) like Pedialyte^®. An
  ORS helps replace the electrolytes and fluids that your child needs.
  • You can buy ORSs in liquid or powder form or as popsicles at most pharmacies without a prescription. Store brand ORSs work the same as name brands.
  • Do not water down (dilute) or mix an ORS with formula.
  • Offer your child other things to drink. The ORS should not be the only fluid given to them for more than 6 hours.
  • Do not use sports drinks and home remedies instead of an ORS.
• If your child has diarrhea or vomiting, you may hold back food and milk for 1 or 2
  days until they begin to improve. Breastfeeding should not be stopped.

Liquids for Different Ages

• If your child is younger than 1 year of age, give them:
  • An ORS
  • Breast milk or formula mixed the correct way (see instruction on the box) if they can drink it.
  • Do not give these. They could make your child feel worse.
  • Water – unless it’s used to make formula
  • Teas or broths
  • Fruit juices or drinks that are high in sugar, such as Hawaiian Punch^®, Hi-C^®, Kool-Aid^®, sodas, or syrups
• If your child is older than 1 year of age, give them the same as above, and:
  • Water
  • Jello®
  • Popsicles made from an ORS
  • Milk, if it doesn’t make them sick
  • Clear juices like apple, cranberry, or cranapple

Amount of Liquids

• Start slow. Give small amounts of liquid often.
  • For children under 1 year of age: use a spoon or syringe to give 1 to 2 teaspoons (5 to 10 mL) of an ORS, breastmilk, or formula every 5 to 10 minutes.
  • For older than 1 year of age: give ½ to 1 ounce (1 to 2 tablespoons or 15 to 30 mL) every 20 minutes for a few hours. Gradually work up to drinking more.
• Measure the amount of liquid your child needs based on their weight. If your child cannot sip from a cup, try to use a teaspoon or a syringe (Picture 1).

* Minimum fluid goals per hour may increase if vomiting, diarrhea, or fever are present.

• If your child vomits some, most of the liquid is kept down. Wait for 30 to 60 minutes and try to give small amounts of liquids again.
• Do not force your child to drink or wake them up to drink if they are sleeping.

When to Call the Doctor

Call your child’s doctor or health care provider if they are getting worse, do not get any better in 24 hours, will not breastfeed, or show the following: 

• Does not pee.
• Urine is very dark.
  • Newborn (0 to 4 months of age) has less than 6 wet diapers in a day.
  • Child (4 months or older) has less than 3 wet diapers in a day or pees less than 3 times in a day.
• Dry or sticky mouth.
• Hard or fast breathing.
• No tears when crying.
• Sunken-looking eyes.
• Soft spot on baby’s head is flat, sunken, or pulls in.
• Bellyache (abdominal pain) that will not go away.
• Hard to wake up (lethargic), acts confused, or does not know what they’re doing.
• Vomit has blood, dark brown specks that look like coffee grounds, or is bright green.
• Vomiting or diarrhea is more severe or happens more often. 
• A high fever. Use a digital thermometer and wash it thoroughly after each use.
  • Is younger than 3 months of age and has a temperature of 100.4º Fahrenheit (F) or 38º Celsius (C) or higher.
  • Is older than 3 months and has a temperature:
    • Of 104ºF (40ºC) or above.
    • Above 102ºF (38.9ºC) for more than 2 days or keeps coming back.
    • That has been treated to bring it down, but it has not worked.
  • At any age, has a fever and:
    • Looks very ill, is very fussy, or very drowsy.
    • Has a stiff neck, a bad headache, or very sore throat.
    • Has an unusual rash.
    • Has immune system problems that make them more likely to get sick, such as sickle cell disease, cancer, or take medicine that weakens the immune system.  

Dehydration: Giving Liquids at Home (PDF), Spanish (PDF), Somali (PDF)

HH-I-207 ©2005, revised 9/2022, Nationwide Children’s Hospital

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Continuing Education Activity

The World Health Organization defines dehydration as a condition that results from excessive loss of body water. The most common causes of dehydration in children are vomiting and diarrhea. This activity describes the causes and pathophysiology of pediatric dehydration and highlights the role of the interprofessional team in its management.

Objectives:

• Identify the etiology pediatric dehydration.

• Recall the presentation of pediatric drhydration.

• List the treatment and management options available for pediatric dehydration.

• Explain interprofessional team strategies for improving care coordination and communication to advance the management of pediatric dehydration and improve outcomes.

Access free multiple choice questions on this topic.

Introduction

The World Health Organization defines dehydration as a condition that results from excessive loss of body water. The most common causes of dehydration in children are vomiting and diarrhea. 

Etiology

Infants and young children are particularly susceptible to diarrheal disease and dehydration. Reason include higher metabolic rate, inability to communicate their needs or hydrate themselves, and increased insensible losses. Other causes of dehydration may be the result of other disease processes resulting in fluid loss which includes: diabetic ketoacidosis (DKA), diabetes insipidus, burns, excessive sweating, and third spacing. Dehydration may also be the result of decreased intake along with ongoing losses. In addition to total body water losses, electrolyte abnormalities may exist. Infants and children have higher metabolic needs and that make them more susceptible to dehydration.[1]

Epidemiology

Dehydration is a major cause of morbidity and mortality in infants and young children worldwide.  Each year approximately 760,000 children of diarrheal disease worldwide. Most cases of dehydration in children are the consequence of acute gastroenteritis.

Acute gastroenteritis in the United States is usually infectious in etiology. Viral infections, including rotavirus, norovirus, and enteroviruses cause 75 to 90 percent of infectious diarrhea cases. Bacterial pathogens cause less than 20 percent of cases. Common bacterial causes include Salmonella, Shigella, and Escherichia coli. Approximately 10 percent of bacterial disease occurs secondary to diarrheagenic Escherichia coli. Parasites such as Giardia and Cryptosporidium account for less than 5 percent of cases.

Pathophysiology

[1]Dehydration causes a decrease in total body water in both the intracellular and extracellular fluid volumes. Volume depletion closely correlates with the signs and symptoms of dehydration. The total body water (TBW) in humans is distributed in two major compartments. 2/3rd the of TBW is in the intracellular compartment and the other 1/3rd is distributed between interstitial space (75%) and plasma (25%). The total body water is higher in infants and children as compared to the adults. In infants, it is 70% of the total weight, whereas it is 65% and 60% respectively in children and adults. As indicated earlier dehydration is total water depletion with respect to the sodium and volume depletion is the decrease in the circulation volume. Volume depletion is seen in acute blood loss and burns, whereas distributive volume depletion is seen in sepsis and anaphylaxis. In much of the literature, the distinction between dehydration and volume depletion is a blur.

Metabolic acidosis is seen in infants and children with dehydration, the pathophysiology of which is multifactorial.

1. excess bicarbonate loss in the diarrhea stool or in the Urine is certain types of renal tubular acidosis

2. Ketosis secondary to the glycogen depletion seen in starvation which sets in infants and children much earlier when compared to adults.

3. Lactic acid production secondary to poor tissue perfusion

4. Hydrogen ion retention by the kidney from decreased renal perfusion and decreased glomerular filtration rate.

In children with pyloric stenosis have very unique electrolyte abnormalities from the excessive emesis of gastric contents. This is seen mostly in the older children. They loose chloride, sodium, potassium in addition to volume resulting in hypochloremic, hypokalemic metabolic alkalosis. Kidney excretes base in the form of Hco3 ion to maintain acid-base balance of loss of Hydrogen ion in the emesis in the form of hydrogen chloride. It is interesting to note that kidney also excretes hydrogen ion to save sodium and water, which could be the reason for aciduria. Recently published article has shown that many children with pyloric stenosis may not have metabolic alkalosis.

History and Physical

Various sign and symptoms can be present depending on the patient’s degree of dehydration. Dehydration is categorized as mild (3% to 5%), moderate (6% to 10%), and severe ( more than 10%). The table below can assist with categorizing the patient’s degree of dehydration. The degree of dehydration between an older child and infant are slightly different as the infant could have total body water (TBW) content of 70%-80% of the body weight and older children have TBW of 60% of the body weight. An infant has to lose more body weight than the older child to get to the same level of dehydration. [2]

Dehydration%   Mild 3% to 5%  Moderate 6% to 10%  Severe >10%

Mental status         Normal         Listless, irritable     Altered mental

Heart rate              Normal         Increased              Increased

Pulses                    Normal        Decreased              Thready

Capillary refill         Normal        Prolonged               Prolonged

Blood pressure       Normal         Normal                  Decreased

Respirations           Normal        Tachypnea             Tachypnea

Eyes                      Normal        Slightly sunken       Fewer tears

Fontanelle              Normal        Sunken                  Sunken

Urine output           Normal        Decreased              Oliguric

(see image below)

Evaluation

Dehydration could be associated with hypo or hyper or isonatremia. Most cases of dehydration are hyponatremic. In selected cases, electrolyte abnormalities may exist. This includes derangements in sodium levels, acidosis characterized by low bicarbonate levels or elevated lactate levels. For patients with vomiting, who have not been able to tolerate oral fluids hypoglycemia may be present. Evaluation of urine specific gravity and the presence of ketones can assist in the evaluation of dehydration.[3]

Children who were given free water when they have ongoing diarrhea disease can present with hyponatremic dehydration, the excess of free water concurrent to excess sodium and bicarbonate loss in diarrhea. This is also seen in the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In these cases, the children appear to be more dehydrated and could also present with hyponatremic seizure activity.

Similarly, infants who are fed oral rehydration solution prepared from excess salt or who lost excess free water as in diabetes incipidus could have hypernatraemic dehydration

End-tidal carbon dioxide measurements have been studied in an attempt to assess degrees of dehydration greater than five percent in children. This non-invasive approach has promise, but as of now has not proven to be an effective tool in determining the degree of dehydration in children.  [4]

Treatment / Management

Priorities in the management of dehydration include early recognition of symptoms, identifying the degree of dehydration, stabilization, and rehydration strategies. [2][5][3]

Symptoms include vomiting, diarrhea, fever, decreased oral intake, inability to keep up with ongoing losses, decreased urine output, progressing to lethargy, and hypovolemic shock.

Mild Dehydration

The American Academy of Pediatrics recommends oral rehydration for patients with mild dehydration. Breastfed infants should continue to nurse. Fluids with high sugar content may worsen diarrhea and should be avoided. Children can be fed age-appropriate foods frequently but in small amounts.

Moderate Dehydration

The Morbidity and Mortality Weekly Report recommends administering 50 mL to 100 mL of oral rehydration solutions per kilogram per body weight during two to four hours to replace the estimated fluid deficit, with additional oral rehydration solution, administered to replace ongoing losses.

Severe Dehydration

For patients who are severely dehydrated, rapid restorations of fluids are required.

Patients who are severely dehydrated can present with altered mental status, lethargy, tachycardia, hypotension, signs of poor perfusion, weak thread pulses, and delayed capillary refill.

Intravenous fluids, starting with 20 ml/kg boluses of normal saline are required. Multiple boluses may be needed for children in hypovolemic shock. Additional priorities include obtaining a point of care glucose test, electrolytes, and urinalysis assessing for elevated specific gravity and ketones. [6]

Hypoglycemia should be assessed at the point of care testing via glucometer, and venous blood gas with electrolytes or serum chemistries. It should be treated with intravenous glucose. The dose is 0.5 gm/km to 1 gm/km. This translates to 5 ml/kg to 10 ml/kg of D10, 2ml/kg to  4 ml/kg of D25, or 1 ml/kg to- 2 ml/kg of D50. The use of D50 is usually reserved for an adolescent or adult-sized patients using a large bore intravenous line. [7]

Replacement of Fluids

An assessment of the degree of dehydration will determine the fluid replacement. Using tables that can predict the degree of dehydration is helpful. If a previous “well weight” is available, that can be subtracted from the patient’s “sick weight” to calculate total weight loss. One kilogram weight loss equates to one liter of fluid lost.

The rate of replacement is based on the severity of the dehydration. Patients with hypovolemic shock need rapid boluses of isotonic fluid either normal saline or ringer lactate at 20ml/kg body weight. This could be repeated 3 times with reassessment in-between the boluses. Ringer lactate is superior to normal saline in hemorrhagic shock requiring rapid resuscitation with isotonic fluids.[8] This difference is not found in the children with severe dehydration from acute diarrheal disease. In these children, the replacement with normal saline and ringer lactate did show similar clinical improvement.[9]

Rapid infusion can cause cardiac insufficiency, congestive heart failure, and pulmonary edema. Rapid correction in patients with diabetic ketoacidosis can cause cerebral edema in adolescent and children.

The rate of replacement fluids is calculated after taking into account for the maintenance, replacement and deficit requirement of the patient. Sodium requirements of the children in the hospital are higher than that of the adults. The children have high metabolic needs, has higher insensible lose as they have a higher body surface area. They also have higher respiratory and heart rates, requiring the use of an intravenous solution containing high sodium like D5NS. The deficit is determined by the degree of dehydration as outlined earlier. The second phase of fluid replacement therapy lasts for 8 hours, during which the child requires 1/2 of the remaining deficit in addition 1/3rd of the maintenance fluid. The remaining half of the deficit and the 2/3rd of the daily maintenance therapy is given during the third phase of the therapy which spans the following 16 hours.

Holliday-Segar calculation is used for calculation of maintenance fluid in children, which is 100ml/kg/day for first 10 kg body weight (BW), then 50 ml/kg/day for the next 10 kg BW and then 20 ml/kg /day for any BW over and above. [10]

For patients where intravenous access can not be achieved or maintained, other methods can be employed. They include continuous nasogastric hydration and subcutaneous hydration.[11]]

Hypodermoclysis refers to hydrating the subcutaneous space with fluid which can be absorbed systemically. Hypodermoclysis is best reserved for the stable child or infant with mild to moderate dehydration who either fails a trial of fluids by mouth or who needs some degree of rehydration to facilitate gaining intravenous access after a slow subcutaneous fluid bolus has been given.

The process begins with:

The placement of topical anesthetic cream, such as EMLA, cover with an occlusive dressing, wait for 15 to 20 minutes.“Pinch an inch” of skin anywhere, but the most practical site for young children is between the scapulae.Insert a 25-gauge butterfly needle or 24-gauge angiocatheterInject 150 units hyaluronidase SC (if available).Infuse 20 mL/kg isotonic solution over one hour, repeat as needed or use this technique as a bridge to intravenous access.

Differential Diagnosis

• Hypovolemic shock 

Pearls and Other Issues

Once the patient’s condition has stabilized, hydration therapy continues to replace existing and ongoing losses. Fluid therapy should include maintenance fluids plus replacement of the existing fluid deficit.

Deficit calculation can be determined in several ways. If the patient’s weight before the illness is known, it can be subtracted from the current weight. Each kilogram lost would be equivalent to one liter of fluid lost. If the prior weight is not known, multiply the weight in kilograms by the dehydration percent.

For a 10 kg patient who is 10% dehydrated, 0.1 represents 10%

Maintenance fluids can be calculated as follows:

For a patient weighing less than 10 kg, they should receive 100 mL/kg/day.

If the patient weighs less than 20 kg, fluids will include the 1000 mL/day plus 50 mL/kg/day for each kilogram between 10 kg and 20 kg.

For patients weighing more than 20 kg, give 1500 mL/day, plus 20 mL/kg/day for each kilogram over 20 kg. Divide the total by 24 to determine the hourly rate.

In hyponatremic dehydration, half of the deficit can be replaced over eight hours with the remaining half the following sixteen hours. Severe hyponatremia (< 130 mEq/L) or hypernatremic dehydration (> 150 mEq/L) is corrected over 24 to 48 hours. Symptomatic hyponatremia (seizures, lethargy) can be acutely managed with hypertonic saline (3% sodium chloride). The deficit may be calculated to restore the sodium to 130 mEq/L and administered over 48 hours, as follows:

Sodium deficit = (sodium desired – sodium actual) x volume of distribution x weight (kg))

Example: Sodium = 123, weight = 10 kg, assumed volume of distribution of 0.6; Sodium deficit = (130-123) X 0.6 X 10 kg = 42 mEq sodium. Hypertonic saline (3%) which contains 0.5 mEq/mL may be used for rapid partial correction of symptomatic hyponatremia. A bolus dose of 4 mL/kg raises the serum sodium by 3 mEq/L to 4 mEq/L.

Rapid correction of hypernatremia may result in cerebral edema, as a result of intracellular swelling occurs. Osmotic demyelination syndrome, also known as central pontine myelinolytic, can occur as a result of rapid correction of hyponatremia. Symptoms include a headache, confusion, altered consciousness, gait disturbance, and may lead to respiratory arrest.

Enhancing Healthcare Team Outcomes

Diarrheal diseases and resulting severe dehydration are the leading cause of infant mortality worldwide especially in children < 5years of age.[12]. This burden is even higher among children in developing countries. To improve the outcome and decrease the morbidity and mortality from the diarrhea diseases especially Rotaviral disease which is the leading cause of death in children we need cooperation between various different agencies and countries.

World health organization while working with member countries and other agencies promotes national policies and investments to have access to safe drinking water, to improve sanitation, to research in diarrhea prevention like vaccination, to implement preventive measures like  source water treatments, safe storage and to help train the health care workers who could go into communities to bring the change at local level.  

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Dehydration Scale. Contributed by Roy M. Vega MD

References

1.

Tutay GJ, Capraro G, Spirko B, Garb J, Smithline H. Electrolyte profile of pediatric patients with hypertrophic pyloric stenosis. Pediatr Emerg Care. 2013 Apr;29(4):465-8. [PubMed: 23528507]

2.

Falszewska A, Szajewska H, Dziechciarz P. Diagnostic accuracy of three clinical dehydration scales: a systematic review. Arch Dis Child. 2018 Apr;103(4):383-388. [PubMed: 29089317]

3.

Vega RM, Avner JR. A prospective study of the usefulness of clinical and laboratory parameters for predicting percentage of dehydration in children. Pediatr Emerg Care. 1997 Jun;13(3):179-82. [PubMed: 9220501]

4.

Freedman SB, Johnson DW, Nettel-Aguirre A, Mikrogianakis A, Williamson-Urquhart S, Monfries N, Cheng A. Assessing Dehydration Employing End-Tidal Carbon Dioxide in Children With Vomiting and Diarrhea. Pediatr Emerg Care. 2018 Aug;34(8):564-569. [PubMed: 28538608]

5.

Yang HW, Jeon W, Min YG, Lee JS. Usefulness of end-tidal carbon dioxide as an indicator of dehydration in pediatric emergency departments: A retrospective observational study. Medicine (Baltimore). 2017 Sep;96(35):e7881. [PMC free article: PMC5585495] [PubMed: 28858101]

6.

Geurts D, Steyerberg EW, Moll H, Oostenbrink R. How to Predict Oral Rehydration Failure in Children With Gastroenteritis. J Pediatr Gastroenterol Nutr. 2017 Nov;65(5):503-508. [PubMed: 28248796]

7.

Sendarrubias M, Carrón M, Molina JC, Pérez MÁ, Marañón R, Mora A. Clinical Impact of Rapid Intravenous Rehydration With Dextrose Serum in Children With Acute Gastroenteritis. Pediatr Emerg Care. 2018 Dec;34(12):832-836. [PubMed: 28463940]

8.

Martini WZ, Cortez DS, Dubick MA. Comparisons of normal saline and lactated Ringer’s resuscitation on hemodynamics, metabolic responses, and coagulation in pigs after severe hemorrhagic shock. Scand J Trauma Resusc Emerg Med. 2013 Dec 11;21:86. [PMC free article: PMC4029282] [PubMed: 24330733]

9.

Kartha GB, Rameshkumar R, Mahadevan S. Randomized Double-blind Trial of Ringer Lactate Versus Normal Saline in Pediatric Acute Severe Diarrheal Dehydration. J Pediatr Gastroenterol Nutr. 2017 Dec;65(6):621-626. [PubMed: 28422812]

10.

Meyers RS. Pediatric fluid and electrolyte therapy. J Pediatr Pharmacol Ther. 2009 Oct;14(4):204-11. [PMC free article: PMC3460795] [PubMed: 23055905]

11.

Rébeillé-Borgella B, Barbier C, Moussaoui R, Faisant A, Michard-Lenoir AP, Rubio A. [Nasogastric rehydration for treating children with gastroenteritis]. Arch Pediatr. 2017 Jun;24(6):527-533. [PubMed: 28416428]

12.

GBD Diarrhoeal Diseases Collaborators. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017 Sep;17(9):909-948. [PMC free article: PMC5589208] [PubMed: 28579426]

Disclosure: Roy Vega declares no relevant financial relationships with ineligible companies.

Disclosure: Usha Avva declares no relevant financial relationships with ineligible companies.

Dehydration in children. What is Dehydration in Children?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Dehydration in children occurs when increased excretion of fluid from the body (vomiting, diarrhea, polyuria, excessive sweating), its reduced intake, or a combination of these two causes. The condition is manifested by increased thirst or complete refusal to drink, dry skin and mucous membranes, increased heart rate and a drop in blood pressure. In severe cases, depression of consciousness, convulsive syndrome, critical hemodynamic disorders are observed. Diagnostic search includes physical examination, determination of CVP, laboratory analysis of blood and urine. Treatment consists of rapid oral or parenteral rehydration, the use of symptomatic agents.

ICD-10

E86 Dehydration. Decreased plasma or extracellular fluid volume

• Causes
• Pathogenesis
• Classification
• Symptoms
• Complications
• Diagnostics
• Treatment
  • Conservative therapy
• Prognosis and prevention
• Prices for treatment

General

Dehydration (exicosis) is one of the leading causes of death among young children, especially in countries with underdeveloped medicine. Although correct treatment regimens have been developed, due to the characteristics of the child’s body, the problem continues to occupy an important place in modern pediatrics. This is not an independent nosological unit, but a sign or complication of other diseases. The syndrome is more common in those suffering from acute intestinal infections – up to 40% of all children admitted to the hospital.

Dehydration in children

Causes

The most common etiological factors for dehydration in children are vomiting and diarrhea. Pathological fluid losses through the intestines can reach several liters per day, which, without replenishing the water and electrolyte balance, is fraught with serious complications. As a rule, symptoms occur against the background of intestinal infections (viral, bacterial, protozoal), toxic or medicinal gastroenteritis. There are other causes of dehydration:

• Increased urination. Pathology occurs in chronic renal failure, tubulopathies, pyelonephritis. Active excretion of urine occurs with diabetic ketoacidosis, homeostasis disorders, accompanied by blood hyperosmolarity. A rare cause of dehydration in children is diabetes insipidus.
• Increased sweating. The symptom develops in response to fever in ARVI and acute inflammatory diseases of the respiratory system, allergic reactions, endocrine diseases, and severe metabolic disorders. The physiological factors of sweating include staying in hot and stuffy rooms.
• Burns. Moderate thermal damage to the skin is accompanied by an active release of exudate and its accumulation in numerous blisters. Dehydration begins with damage to more than 10% of the surface of the skin and burns of at least 2 degrees.
• Insufficient fluid supply. Physiologically, the child loses fluid every day with breath, sweat, urine. If he doesn’t get enough to drink, dehydration occurs. A severe degree of exsicosis is observed if the liquid is not only supplied in small quantities, but is also strongly excreted.

In children, dehydration is more severe than in adults, due to a number of predisposing factors. At an early age, the ratio of body surface area to its volume is higher, so moisture evaporates faster. Young children cannot accurately describe the feeling of thirst and ask for water. As a result, the initial stages of dehydration may go unnoticed. In addition, increased metabolism in the child’s body requires more fluid.

Pathogenesis

With exicosis, the amount of cellular and extracellular water decreases, blood filling of the vessels decreases. In children, blood circulation is disturbed: cardiac output is inhibited, microcirculation slows down, and ischemia of internal organs develops. Electrolyte imbalance causes arrhythmias, changes in kidney function, muscle spasms, and other disorders. The molecular and cellular mechanisms of dehydration depend on its form.

Classification

According to severity, three stages of exsicosis are distinguished, which are determined by the amount of fluid lost (as a percentage of the initial weight). With a mild degree, the deficit is 5% in children under 3 years of age and 3% in the rest, with an average – 10% and 6%, with a severe one – 15% and 9% respectively. For the rational selection of dehydration therapy, a systematization of the types of exicosis is proposed, according to which there are:

• Isotonic dehydration. There is a uniform loss of water and blood electrolytes, so the patient’s condition remains stable longer. Characterized by a sharp decrease in diuresis with normal or slightly reduced blood pressure.
• Hypertensive dehydration. Massive water losses are observed with the preservation of salts, due to which blood hyperosmolarity develops. Severe cellular dehydration occurs, leading to excruciating thirst. In addition to general symptoms, psychomotor agitation, convulsions are possible.
• Hypotonic dehydration. The excretion of minerals from the body prevails over the loss of fluid. The condition is extremely dangerous, because it quickly causes a decrease in blood pressure and circulatory failure. Children’s consciousness is disturbed.

Symptoms

With mild exicosis, the general condition remains satisfactory. Mucous membranes and tongue are moist, skin tone is not changed. In infants, the fontanel has a normal appearance. The amount of urine and the frequency of urination are slightly reduced. Older patients complain of thirst that does not go away even after drinking large volumes of liquid. Small children do not complain, but become lethargic, refuse to eat.

Moderate dehydration is characterized by a progressive deterioration in well-being. The skin turgor is reduced, it gathers into thin folds that take longer to straighten out than usual. The lips dry up and crack, the mucous membranes are dry. The child’s diuresis sharply decreases, the pulse quickens, and the heart sounds become muffled. Depending on the type of dehydration, there is an excruciating thirst or lack of desire to drink.

Severe dehydration in children is manifested by cyanosis and marble pattern of the skin, dryness and redness of the mucous membranes, in infants by the retraction of the fontanel. Arterial pressure is sharply reduced, and the pulse is quickened. The child is lethargic, drowsy, seizures and coma may occur. Hoarseness of voice or aphonia is noted, the patient refuses to drink. Severe water deficiency is accompanied by the absence of urine.

Complications

Acute fluid loss of more than 15% of body weight in young children causes irreversible tissue damage that is incompatible with life. In patients over 5 years of age, dehydration is much less likely to end fatally, since compensation mechanisms are better developed, but with untimely treatment and the presence of a severe underlying disease, there is a risk of death.

Circulatory pathologies during exicosis are accompanied by tissue hypoxia, brain neurons are most quickly affected. This is manifested by clouding of consciousness, psychomotor agitation and hallucinations, coma. Damage to the nerve centers leads to impaired breathing and thermoregulation, which increases the likelihood of death in children in the absence of medical care.

Diagnostics

Mild degrees of dehydration are detected by a pediatrician during a standard clinical examination of a child. Diagnosis of moderate and severe forms of exsicosis is usually carried out by emergency doctors, since the condition requires urgent medical measures. To diagnose and find out the causes of dehydration, the following research methods are prescribed:

• CVP measurement. Invasive diagnostics is carried out to clarify the degree of blood filling of the vascular bed and the selection of rational therapy. A decrease in indicators of less than 10 mm of water is considered pathological. Art. in infants and less than 60 mm of water. Art. in older children.
• Blood tests. The hemogram shows an increase in hematocrit of more than 40-45% (taking into account age), concomitant leukocytosis with an infectious cause of dehydration. In a biochemical analysis of blood, electrolyte imbalance draws attention, an increase in the level of acute-phase proteins or nitrogenous compounds is possible.
• Urinalysis. The analysis is characterized by increased or reduced density. With renal causes of dehydration in children, proteinuria, leukocyturia, erythrocyturia, or cylindruria are found. To assess the form of exsicosis, look at the level of sodium excretion in the urine.

Treatment

Conservative therapy

The basis of the treatment of dehydration is rehydration of the body, which stabilizes the child’s condition and prevents serious consequences. Older children with mild exsicosis are treated at home, the rest are subject to immediate hospitalization in a pediatric hospital or intensive care unit. There are 2 ways to rehydrate:

• Oral fluid replacement. If the patient does not refuse to drink and does not suffer from indomitable vomiting, replenishment of the water balance is carried out with special pharmacy solutions or salted water, unsweetened compotes and tea. In the first 6 hours, an increased fluid load is recommended, after stabilization of hemodynamic parameters, they switch to a maintenance regimen.
• Parenteral rehydration. It is prescribed for 2-3 stages of dehydration in children. Glucose-salt solutions are used, with a decrease in oncotic pressure, colloidal mixtures are added. The elimination of hypovolemia takes 2-8 hours, depending on the severity of the condition, during this period about half of the volume of fluid calculated per day is injected.

With exicosis, the development of hypokalemia is possible, to eliminate which a solution of potassium chloride or panangin is used. Further therapy is selected in accordance with the root cause of dehydration, the severity of complications. For intestinal infections, children are shown enterosorbents and probiotics, for high fever – antipyretics from the group of non-steroidal anti-inflammatory drugs, for kidney damage – uroseptics, anti-inflammatory and antibacterial drugs.

Prognosis and prevention

With timely diagnosis of dehydration and adequate rehydration, the signs of pathology disappear within 12-48 hours. Severe degrees of dehydration in infants are of concern, often leading to complications. Prevention consists in observing the drinking regime, the use of home or pharmacy rehydrating solutions with increased sweating, diarrhea or vomiting.

You can share your medical history, what helped you in the treatment of dehydration in children.

Sources

1. Infusion therapy in children. Guidelines / V.P. Dairy, N.Yu. Miropolskaya. — 2018
2. Childhood diseases: A textbook for universities (volume 1). 8th ed. / N.P. Shabalov. — 2017
3. Factors affecting the development of severe dehydration in children. V.Sh. Abdurashidov, K.A. Khamzaev, D.P. Khakimov // Medicine and pharmacology. — 2016
4. Dehydration in children with acute diarrhea. S.V. Khaliullina, V.A. Anokhin, Yu.R. Urmancheeva // Children’s infections. — 2014
5. This article was prepared based on the materials of the site: https://www.krasotaimedicina.ru/

IMPORTANT
Information from this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

First aid for vomiting and diarrhea in a child: act immediately and correctly

Contents

• 1 What to do if your child has vomiting and diarrhea: first aid and advice
  • 1.1 Causes of vomiting and diarrhea in children
  • 1.2 How to determine if your child is in danger
  • 1.3 How to prevent dehydration in a child at Ponos and vomiting:
  • 1.4 Basic dietary dietary rules for vomiting and diarrhea in a child
    • 1.4.1 1. Drinking
    • 1.4.2 2. Food
    • 1.4.3 3. Mode
  • 1.5 Medicines for vomiting and diarrhea in children
    • 1.5.1 Antibiotics
    • 1.5.2 Antiemetics
    • 1.5.3 Medicines to stop diarrhea
    • 1.5.4 Probiotics

    900 15 1.5.5 Rehydration products

  • 1. 6 Folk remedies for vomiting and diarrhea in a child
  • 1.7 Effective ways to deal with symptoms of vomiting and diarrhea in a child
    • 1.7.1 Increase water intake
    • 1.7.2 Avoid hard foods
    • 1.7.3 Monitoring certain activities
    • 1.7.4 Consulting a doctor
  • 1.8 When to see a doctor if your child cannot stop vomiting and diarrhea
  • 1.10 Prevention of Vomiting and Diarrhea in a Child
  • 1.11 Important Tips for Parents in Treating Vomiting and Diarrhea in a Child
  • 1.12 Related Videos:
  • 1.13 Q&A:
    • • 1.13.0.1 What should not be given to a child with diarrhea and vomiting?
      • 1.13.0.2 What is the correct response to vomiting and diarrhea in an infant?
      • 1.13.0.3 What symptoms might indicate that a child needs emergency care?
      • 1.13.0.4 Can medication help a child with vomiting and diarrhea?
      • 1.13.0.5 What measures can be taken to prevent vomiting and diarrhea in a child?
      • 1. 13.0.6 What to do if the child does not have an appetite but does not vomit or have diarrhea?

Find out how to give first aid to a child with vomiting and diarrhea. Recommendations for dealing with symptoms, delivery to the doctor and home treatment. Be prepared for emergencies!

One of the most annoying problems young children face is vomiting and diarrhea. This can be very dangerous to health, especially if the child is dehydrated. The situation requires a quick and correct response. In this article, we will talk about how to provide first aid for vomiting and diarrhea in order to reduce the risk to the health of the child.

Although vomiting and diarrhea are very common conditions, not every adult knows how to give first aid properly. Incorrect treatment can only aggravate the situation. The correct behavior for vomiting and diarrhea in a child is not only to provide appropriate care, but also to take measures to prevent further dehydration, as well as various undesirable complications.

In this article, we will look at important issues related to vomiting and diarrhea in children and discuss in detail how to respond to these conditions. To begin with, we will talk about the causes of vomiting and diarrhea in children, as well as describe the symptoms in detail so that you can easily recognize this symptom and start taking action in time.

Causes of vomiting and diarrhea in children

Infections: Vomiting and diarrhea in children can be caused by infectious diseases such as gastroenteritis and viral infections. They can be transmitted through dirty hands, unclean surfaces, water and food.

Allergies: Some children may have an allergic reaction to certain foods, medicines, or other substances that can cause vomiting and diarrhea.

Overeating: Overeating or eating large amounts of sugary and fatty foods can cause vomiting and diarrhea in children.

Stress: Children may experience stress during travel, school changes, parental divorce or forced relocation, which can lead to vomiting and diarrhoea.

Inadequate Diet: Some children may have an unhealthy diet that can cause vomiting and diarrhoea.

How to determine the degree of danger to the health of the child

The first thing to do in case of vomiting and diarrhea in a child is to determine the degree of danger to his health. If the child cannot hold liquid and food inside, accompanied by other unpleasant symptoms, you should immediately seek help from a doctor or call an ambulance to prevent the development of dangerous symptoms.

If a child feels tired and is sick for more than two days, his symptoms should be carefully examined. Several types of stools per day, profuse sweating, severe dizziness, a temperature above 38 degrees indicate the need for immediate medical advice, as these may be the first signs of serious illness.

• If the child constantly vomits and cannot hold liquids,
• if he has a high temperature, severe pain in the abdomen or head, or other severe symptoms,
• if he faints, feels dizzy,

then it is recommended call an ambulance or go to the hospital. Never delay seeking medical attention when your child’s health is at risk.

How to prevent dehydration in a child with diarrhea and vomiting:

When a child has diarrhea and vomiting, it is very important to prevent dehydration, which can occur due to loss of fluid and electrolytes through feces and vomiting. To do this, you need:

1. Give your child plenty of fluids to drink. Fluid replenishes the loss of fluid and electrolytes in the body. It is recommended that you give your baby breast milk, infant formula, or special electrolyte solutions available from pharmacies.
2. Nutrition. In order for the child’s body to replace the loss of fluid and electrolytes through feces and vomiting, it is necessary to give him easily digestible foods. For example, broths, cereals on the water, mashed fruits and vegetables. Avoid heavy, fatty and spicy foods.
3. Pay attention to the amount of urine. Make sure your child is urinating at regular intervals and in sufficient quantities, this indicates that his body is getting enough fluid.
4. Reduce the aggressive effects of diarrhea and vomiting. Try to reduce the amount of vomiting and diarrhea in the child. To do this, you can give him anti-emetic drugs and excrement-eliminating agents.

If fluid is not replaced, dehydration can lead to serious health problems for the baby, so it is important not to delay fluid and electrolyte replacement until later. If you notice that the child has too little urine, or he has other signs of dehydration (dry skin, headache, unstable pressure), then immediately consult a doctor for further treatment.

Basic nutrition rules for vomiting and diarrhea in a child

1. Drinking

When vomiting and diarrhea in a child, it is very important to provide his body with enough liquid. It is recommended to give small portions, but often, water, weak tea, dried fruit compote or special electrolyte solutions. It is strictly forbidden to give carbonated drinks, coffee, alcohol, juices and milk, as they can worsen the condition of the baby.

2. Nutrition

On the first day of illness, it is better not to give the child food at all. On the following days, you can gradually introduce light foods such as white rice, biscuits, buttered toast. The menu should be easy to digest, not greasy or heavy.

It is worth refusing to use branded children’s products, as they may contain harmful hormonal additives, and purchase only fresh and high-quality products. You can not give fried, salty and spicy foods, as they cause irritation and impair the functioning of the gastrointestinal tract.

3. Regime

It is important to provide your child with the right diet. He should get food at about the same time each day. Care should be taken to ensure that the child does not eat before bed, as this can lead to bedwetting. After eating, the child should be given time to rest so that the food has time to be digested. During illness, it is better not to put the baby to sleep in the supine position, this can cause vomiting.

Medications to treat vomiting and diarrhea in a child

Antibiotics

If the cause of vomiting and diarrhea is a bacterial infection, antibiotics are recommended. However, the decision to prescribe antibiotics should only be made after consultation with a doctor.

Antiemetics

If vomiting is a symptom, antiemetics may be used. These medications can reduce the strong desire to vomit and keep the body hydrated.

Medicines to stop diarrhea

Special medicines can be used to stop diarrhea. However, such medicines should only be taken on the advice of a doctor. These drugs should not be abused as side effects such as constipation may occur.

Probiotics

Probiotics can improve the intestinal flora and reduce the risk of diarrhea. However, the use of probiotics should also be agreed with the doctor.

Rehydration agents

In case of vomiting and diarrhea, it is necessary to replenish the water balance in the body. To do this, you can use rehydration agents, such as Regidron or Oralit. However, before using any remedy, you should consult your doctor.

Folk remedies to combat vomiting and diarrhea in a child

Diseases of the gastrointestinal tract in children can be caused by many factors – from the usual reaction to new foods to serious infectious diseases. To speed up the healing process, you can use folk remedies.

• Rice water. This drink is one of the most effective in the fight against vomiting and diarrhea. For cooking, you need to pour rice with water in a ratio of 1: 5 and cook until a thick mushy state is obtained. It is worth taking a tablespoon several times a day.
• Ginger tea. Ginger is an excellent remedy for vomiting. To prepare ginger tea, you need to take fresh ginger root, finely chop it. Pour boiling water over and let steep. This remedy is best taken in a hot circle several times a day.
• St. John’s wort. If your child develops a gastrointestinal illness, St. John’s wort can be taken as an infusion. To do this, pour 1 tablespoon of herbs in a glass of boiling water, let it brew and consume after meals, usually three times a day.

If giving the child only folk remedies does not improve the condition, you should consult a doctor. Consultation with a specialist is necessary when the child requires attention and special treatment, especially if the symptoms are long-term, such as anorexia and malnutrition.

Effective ways to manage the symptoms of vomiting and diarrhea in a child

Increasing water intake

The child is very prone to dehydration due to diarrhea and vomiting, so at first it is necessary to ask him to drink small portions of water every few minutes. You can also increase your child’s fluid intake by pressuring juices or soups.

Avoid hard foods

It is important to provide soft foods to children to relieve symptoms of vomiting and diarrhea. It is recommended to add more porridge, low-fat cottage cheese, bananas and other soft foods to their daily diet. However, you can find a way to increase the potential benefits by squeezing a lemon on a little cereal to avoid unnecessary harshness.

Monitoring certain activities

The differential diagnosis helps to detect all diseases that may be associated with vomiting and diarrhea in a child. This will allow you to better monitor and detect when symptoms improve or worsen.

Consult your doctor

Careful adherence to these recommendations will most likely help prevent possible complications. However, the child’s conditions may worsen or change, and in such a situation it is necessary to consult a doctor for more specific medical advice.

When to see a doctor if your child does not stop vomiting and diarrhea

If your child does not stop vomiting and diarrhea for more than a day, you should see a doctor. It is also worth seeking medical attention if the child refuses to drink, eat, shows signs of dehydration, or has a fever.

The doctor will conduct an objective examination of the child, eliminate the cause of the disease and prescribe the necessary treatment. It is important to remember that improper treatment or self-medication can lead to serious complications, especially when it comes to children.

If the child has other chronic diseases, the doctor should be informed in order to rule out possible complications. You should also pay attention to the state of the environment where the child is, and take measures to prevent infection of other family members.

How to prepare to see a doctor for vomiting and diarrhea in a child

If a child has vomiting or diarrhea, the first step is to call a doctor. To make the most of the time before his arrival, you need to prepare for the reception.

The first step is to determine the cause of the vomiting and diarrhea. It could be an allergic reaction, infection or intoxication. To do this, you should pay attention to the symptoms, which include: high fever, sharp pain in the abdomen, blood in the stool. It should also be noted how long the child’s condition has lasted, whether there have been any changes in his behavior.

The second step is to complete a detailed medical history of the child. It includes all information about previous diseases, heredity, dental condition, etc. This will allow the doctor to quickly and accurately determine the diagnosis and prescribe treatment.

You should also find out where the nearest hospital or pharmacy is and what services are available at home. This will allow, in case of need, to quickly and timely take the necessary measures and provide assistance to the child.

And, of course, do not forget about your own psychological preparation. In this state of the child, your support and attention may be needed, so it is important to be mentally and emotionally prepared for this.

Prevention of vomiting and diarrhea in children

Vomiting and diarrhea are common problems in young children. They can be caused by infections, allergies, stress, or poor diet. To prevent these problems in a child, it is important to monitor his nutrition and hygiene.

Hygiene

• Wash hands before feeding or eating.
• Wash your baby’s hands after outdoor activities, playing with animals, or before feeding.

Nutrition

• Feed your child only what is appropriate for his age.
• Prepare food in a clean and hygienic way.
• Do not give your child expired or spoiled food.
• Maintain breastfeeding as needed.

Other measures

• Avoid places where there may be many people, especially in winter.
• Stimulate children’s immunity by letting them play outside.

Important advice for parents when treating vomiting and diarrhea in a child

Maintain hygiene

If a child shows signs of vomiting and diarrhea, first aid should be immediately applied, starting with maintaining hygiene. Parents’ hands should be thoroughly washed before handling the child, and gloves should be worn while caring for the child. It is also necessary to follow the principle of individual hygiene: use separate towels and detergents for the child.

Drink more fluids

Vomiting and diarrhea can lead to dehydration in a child. Therefore, it is very important that he drink enough fluids to fill the fluid loss. These can be hypotonic drinks, kissels, warm and cool, but always non-carbonated. Do not give your child juices, as they may be too strong for his stomach.

Listen for symptoms

If your child continues to vomit or have diarrhea, or if they have a fever or feel sick, see a doctor. Symptoms may indicate a more serious problem that needs to be addressed in the hospital.

Follow dietary restrictions

It is important to remember that when a child vomits and has diarrhea, the gastric emptying is much weaker than usual. Therefore, dietary restrictions should be observed. The child should not be given heavy and fatty meals, and also avoid the product of lactic acid and protein foods. The choice of dishes should be easy, simple and not burdening the stomach.

Calm your child

It is very important to calm a child who complains of vomiting and diarrhea. He may become frightened or frighten others with his behavior. Trust him that he will get through this and point him to a special routine of the day when he feels at his best. This will help the child feel good, as well as recover from illness faster.

Related videos:

Q&A:

What should not be given to a child with diarrhea and vomiting?

Milk and dairy products, sweets, fatty and spicy foods, alcohol and strong tea should not be given to the child.

How to respond to vomiting and diarrhea in an infant?

Breastfeed as often as possible to prevent dehydration. If a baby refuses to drink breast milk, you need to see a doctor.

What symptoms might indicate that a child needs emergency care?

If a child has a high temperature, cannot drink and does not tolerate fluid well, there are signs of dehydration (dry mucous membranes, ridges under the eyes, tears are lost), it is necessary to call an ambulance.

Can medicines help with vomiting and diarrhea in a child?

Only a doctor can prescribe medication to treat vomiting and diarrhea in a child. In some cases, it is necessary to take probiotics or drugs that reduce the secretion of gastric juice to reduce irritation of the stomach wall.

What measures can be taken to avoid vomiting and diarrhea in a child?

Cleanliness is a guarantee of health, you need to regularly ventilate and humidify the room, keep your hands and toys clean, nutrition should be balanced and healthy.