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Dehydration in Children

By Christopher P. Raab, MD, Associate Professor of Pediatrics;Attending Physician, Diagnostic Referral Division, Sidney Kimmel Medical College at Thomas Jefferson University;Nemours/Alfred I. duPont Hospital for Children

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

  • Dehydration occurs when there is significant loss of body water and, to varying amounts, electrolytes.

  • 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 occurs when the body loses more water than it takes in. Substances called electrolytes are lost also. Electrolytes are minerals in the bloodstream and within cells that are essential to life. Sodium, potassium, chloride, and bicarbonate are examples of electrolytes.

Causes

Dehydration is usually caused by

A less common cause of dehydration is

  • Not drinking enough fluid, such as during common childhood illnesses, or when a newborn has trouble breastfeeding.

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

Symptoms

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, increased thirst, and 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.

Severely dehydration causes children to become sleepy or lethargic, which is a sign they must be evaluated by a doctor or taken to the emergency department right away. They have no tears. They may develop a bluish discoloration to the skin (cyanosis) and breathe rapidly. Sometimes dehydration causes the concentration of salt in the blood to fall or rise abnormally. Changes in salt concentration make the symptoms of dehydration worse and can worsen lethargy. In severe cases, the child can have seizures or coma or suffer brain damage and die.

Diagnosis

  • Examination by a doctor

  • Sometimes blood and urine tests

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.

Treatment

  • Replacement of lost fluids

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 (ORS) 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 children are 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.

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 by vein (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.

Infants

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 solutions (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.

Older children

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.