Dehydration Health Article

When to call the doctor

A doctor should be notified whenever an infant or child exhibits signs of dehydration or a parent is concerned that a stomach virus or other acute illness may lead to dehydration.

A doctor should also be notified if any of the following is the case:

• Symptoms of dehydration worsen.
• A breast-fed or bottle-fed infant is unable to feed or feeds poorly.
• An infant or child urinates very sparingly or does not urinate at all during a eight-hour period.
• An infant younger than two months of age has diarrhea or is vomiting.
• Dizziness, listlessness, or excessive thirst occurs.
• The child's heart is beating fast.
• The child has dry eyes, sunken eyes, a dry mouth, or is not producing tears.
• There is blood in the stool or vomit.

An infant can become dehydrated within hours after the onset of illness. In general, the smaller the child, the lower the threshold should be for healthcare intervention if dehydration is suspected.

Diagnosis

A child's symptoms and medical history alone usually suggest dehydration. Physical symptoms are usually all that is necessary for diagnosing dehydration, although laboratory tests may be ordered by the physician. Physical examination may reveal shock, rapid heart rate, and/or low blood pressure. Laboratory tests, including blood tests (to check electrolyte levels) and urine tests (e.g. urine specific gravity and creatinine), may be used to evaluate the severity of the problem.

Treatment

Increased fluid intake and replacement of lost electrolytes are extremely important for restoring fluid balances in infants and children who are dehydrated. Treatment is given based on severity of dehydration. Treatment should include two phases: a rehydration phase and a maintenance phase. In the rehydration phase, fluid losses are replaced quickly, within three to four hours until normal hydration is achieved. In the maintenance phase, calories and fluids are given. Rapid refeeding should follow rapid rehydration with the goal of returning the child to an unrestricted, age-appropriate diet including solids. Withholding foods to rest the gut is not recommended. Breastfeeding should be continued at all times through both stages of treatment. Full-strength formula is usually tolerated. Changing formula or diluting to half strength are common practices but are usually unnecessary and may even prolong symptoms and delay nutritional recovery.

To replace calories quickly during acute illness, food should be given as soon as the child will tolerate it. During both rehydration and maintenance phases, fluid losses from vomiting and diarrhea should be replaced continuously. Restricting lactose (milk and milk products) is usually not necessary but may be helpful in a child with a severe intestinal disease or diarrhea in a malnourished child.

Children with minimal dehydration weighing less than 10 kilograms (22 pounds) should be given 60 to 120 mL (2–4 ounces) of an oral rehydration solution (ORS) for each episode of vomiting or diarrheal stool. Those weighing more than 10 kg (22 lbs) should be given 120 to 240 mL (4–8 ounces). Food should not be restricted. Children with mild to moderate dehydration should be given 50 to 100 mL (roughly 2–3.5 ounces) of an ORS per kilogram body weight during two to four hours to replace fluid losses. Additional ORS should be administered to replace ongoing losses from vomiting and diarrhea. In a sick child, a teaspoon, syringe, or medicine dropper can be used to offer a small amount at first with amounts increasing as tolerated. If the child appears to want more, more can be given. Severe dehydration is a medical emergency requiring intravenous fluids immediately.

For moderate or severe dehydration, a child should be treated in a medical facility. Moderate dehydration can be treated orally, but severe dehydration requires the child to take fluids intravenously (IV). When treating dehydration, the underlying cause must also be addressed. For example, if dehydration is caused by vomiting, medications may be prescribed to resolve these symptoms. However, anti-diarrheal medications are not recommended in children. A child who is dehydrated due to diabetes, kidney disease, or adrenal gland disorders must receive treatment for these conditions as well as for the resulting dehydration.

For older children who are mildly dehydrated, just drinking plain water may be all the treatment that is needed. For infants and younger children, especially when ill, drinking a commercial ORS should be encouraged. Parents should follow label instructions when giving children Pedialyte or other commercial products recommended for relieving dehydration. Sports drinks are not recommended as they contain a lot of sugar and may worsen diarrhea.

In order to accurately calculate fluid loss, it is important to chart weight changes every day and keep a record of how many times a child vomits or has diarrhea. Parents should note how many times a baby's diaper must be changed.