Dehydration in kids

Dehydration might happen if your child has lots of diarrhea and vomiting, doesn’t drink enough liquids, exercises a lot or sweats a lot. You should see your doctor if you’re concerned your child is dehydrated. Dehydration can be treated by increasing your child’s fluids. In severe cases, your child might need to go to hospital to get more fluids.

Dehydration can happen slowly or quickly, depending on how the fluid is lost and the age of the child. Younger children and babies are more likely to become dehydrated. This is because their bodies are smaller and they have smaller fluid reserves. Older children and teens can more easily handle minor fluid imbalances.​

Gastroenteritis is the most common cause of dehydration. This is because it can make your child lose a lot of body fluids quickly. Any illness with persistent diarrhea, vomiting or reduced fluid intake can result in dehydration.

Lots of sweating can also result in dehydration, particularly in babies in very hot weather, or in adolescent children who are doing vigorous activity.

It’s important to know the early signs of dehydration and to respond quickly if your child has them. The goal in treating dehydration is to replace fluids and restore body fluids to normal levels.

Kids who are mildly dehydrated from lots of activity will probably be thirsty and should drink as much as they want. Plain water is the best option. They should rest in a cool, shaded spot until the lost fluid has been replaced.

Rehydration

Kids with mild to moderate dehydration due to diarrhea from an illness (like gastroenteritis) should have their lost fluids replaced. This is known as rehydration. It’s done by giving a special liquid called an oral rehydration solution (ORS, a solution that restores lost fluids and minerals) over the course of 3 to 4 hours. Minerals in the body, such as sodium, potassium and chloride, help to keep a healthy fluid balance.

ORS (oral rehydration solution) is available in many grocery stores and drugstores without a prescription. It has the right combination of sugar and salts that dehydrated kids need.

Start the rehydration process by giving your child 1 or 2 teaspoons (5 or 10 milliliters) of an ORS every few minutes. You can use a spoon or an oral syringe. This may not seem like enough fluids to rehydrate your child, but these small amounts can add up to more than a cup (237 milliliters) an hour. If your child does well, you can gradually give bigger sips a little less often.

Even kids who are vomiting can usually be rehydrated this way because the small frequent sips get absorbed in between the vomiting episodes.

A breastfed infant should continue to be nursed, even during rehydration, unless vomiting repeatedly. Give the ORS in between feedings. Stop giving formula to a formula-fed baby during rehydration, and restart as soon as your baby can keep fluids down and isn’t showing signs of dehydration.

Do not give a dehydrated child water, soda, ginger ale, tea, fruit juice, gelatin desserts, or chicken broth. These don’t have the right mix of sugar and salts and can make diarrhea worse. Older kids who are dehydrated can have sports drinks, but oral rehydration solution is best for young children and infants.

When your child is rehydrated, you can serve a normal diet, including breast milk, formula, or milk.

Some dehydrated kids do not improve when given an ORS, especially if they have explosive diarrhea (very frequent BMs that are forceful and very loud) or are vomiting often. When fluid losses can’t be replaced for these or other reasons, a child might need to get intravenous (IV) fluids in the hospital.

If you’re treating your child for dehydration at home and feel that there’s no improvement or that the dehydration is getting worse, call your doctor right away or take your child to the nearest emergency room (ER).

Dehydration in kids key points:

• Babies and younger children are at greater risk of dehydration.
• Early, appropriate treatment can prevent dehydration.
• Children with mild dehydration can be managed at home.
• Children with moderate to severe dehydration should be seen by a doctor.

Causes of dehydration in kids

Dehydration happens when more fluid leaves the body than enters it. This can happen when a child does not drink enough fluid or when they lose more body fluid than normal. When a child is sick, fluid is lost through vomiting, diarrhea and fever. The imbalance of losing fluid without replacing it results in dehydration.

The most common causes of dehydration are:

• poor fluid intake during an illness
• fluid losses from diarrhea and/or vomiting.

Healthy children can vomit or have loose stools once in a while without becoming dehydrated. When a child is sick, dehydration can happen quickly and be very dangerous, especially for babies and young children. If children are vomiting, have diarrhea and are not able to drink, they can lose fluids quickly and become very sick.

Dehydration in kids prevention

Making sure kids get plenty of fluids when they’re sick or physically active can help protect them from getting dehydrated. The best way to avoid significant dehydration is to see your doctor if your child has an illness that’s causing her to lose lots of fluid or stop drinking.

On hot days or when your child is exercising, he needs to stay hydrated. Make sure there’s plenty of water handy so your child can drink if he’s thirsty. You might need to remind some children to have regular drink breaks.

How to keep your child hydrated can depend. For example, a child with a sore throat may become dehydrated because drinking or eating is too painful. Easing the pain with acetaminophen or ibuprofen may help, and cold drinks or popsicles can soothe a burning throat while also giving fluids.

Not all fevers need to be treated, but if your child is uncomfortable and not getting enough fluids, you can give acetaminophen or ibuprofen to help control the fever.

It’s important that kids drink often during hot weather. Those who play sports or are very physically active should drink extra fluids beforehand, and then take regular drink breaks (about every 20 minutes) during the activity. Ideally, sports practices and competitions should be held in the early morning or late afternoon to avoid the hottest part of the day.

Thirst is not a good early sign of dehydration. By the time they feel thirsty, kids might already be dehydrated. That’s why they should start drinking before they feel thirsty and have more fluids even after thirst is quenched.

Dehydration and gastroenteritis

Kids with mild gastroenteritis also called the “stomach flu”, who aren’t dehydrated should still drink extra fluids to replace those lost from vomiting and diarrhea. Most kids can safely eat their regular diet while they’re sick.

Infants with mild gastroenteritis who aren’t dehydrated should continue getting breast milk or regular-strength formula. Older kids may continue to drink full-strength milk and other fluids.

Foods that are usually well tolerated by kids with gastroenteritis who aren’t dehydrated include: complex carbohydrates (such as rice, wheat, potatoes, bread, and cereals), lean meats, yogurt, fruits, and vegetables. Avoid fatty foods or foods high in sugars (including juices and soft drinks).

If your child is vomiting and isn’t dehydrated, give fluids often, but in small amounts.

Signs and symptoms of dehydration in kids

If your child has a fever, diarrhea, or vomiting, or is sweating a lot on a hot day or during intense physical activity, watch for signs of dehydration. These include:

• a dry or sticky mouth
• few or no tears when crying
• eyes that look sunken
• in babies, the soft spot (fontanelle) on top of the head looks sunken
• peeing less or fewer wet diapers than usual
• dry, cool skin
• irritability
• drowsiness or dizziness

Mild to moderate dehydration:

• a dry tongue
• few or no tears when crying
• fussiness in an infant
• no wet diapers for 6 hours in an infant
• no urination (peeing) for 8 hours in children

Severe dehydration:

• very dry mouth (looks “sticky” inside)
• dry or wrinkly skin (especially on the belly and upper arms and legs)
• inactivity or decreased alertness and excessive sleepiness
• sunken eyes
• sunken soft spot on top of an infant’s head
• no peeing for 8 or more hours in an infant
• no peeing for 10 or more hours in a child
• deep, rapid breathing
• fast or weakened pulse

Dehydration diagnosis

The Clinical Dehydration Scale is used by health-care professionals to determine the severity of dehydration. Parents and caregivers can use it at as well. Using this scale can help to guide you as to whether your child is getting better, staying the same or getting worse. A doctor may use more findings to assess dehydration, but this scale is a good place to start. If you have any concerns, see a doctor to get your child checked.

The chart assigns points for certain signs or symptoms you observe in your child. The higher the point total, the worse the dehydration.

To calculate your child’s dehydration status:

• mark down your child’s symptoms
• for each symptom, find the point value in the chart
• add up the points to get a score for your child’s level of dehydration.

For example, if your child has dry mucous membranes* (2 points), decreased tears (1 point), and a sweaty appearance (2 points), the total point value is 5 points. A score of 5 points means your child has moderate to severe dehydration.

Table 1. Clinical Dehydration Scale

Footnotes: *Mucous membranes include the moist lining of the mouth and the eyes.

• Score of 0 = no dehydration
• Score of 1 to 4 = some dehydration
• Score of 5 to 8 = moderate to severe dehydration

Dehydration in kids treatment

The treatment of dehydration is based on how dehydrated your child is. You can treat mild cases of dehydration by giving your child more fluid. Over-the-counter medications to treat vomiting and diarrhea are not recommended for children.

One option is oral rehydration fluid like Gastrolyte®, Hydralyte™, Pedialyte® or Repalyte®. You can buy these fluids over the counter from a pharmacy.

Other options include water, diluted lemonade, cordial or fruit juice. If you’re using a sugary drink, it’s important to dilute it – use one part of lemonade, cordial or juice to four parts of water.

Your child might not be keen to drink. You can try to get her drinking more by giving her drinks via a syringe or spoon, or letting her suck icy poles. You can get Hydralyte™ icy poles from pharmacies.

If your child is vomiting, it’s usually better to offer small amounts, but frequently. For example, give your child a few mouthfuls every 15 minutes.

If you have a breastfed baby older than six months, keep breastfeeding but feed more often. You can give your child extra oral rehydration fluid between feeds.

If your baby is older than six months and is bottle fed, give him oral rehydration fluid for the first 24 hours only and then reintroduce full-strength formula in smaller, more frequent feeds. You can still offer extra oral rehydration fluids between feeds.

In more severe cases, your child might need to go to hospital to catch up on fluid loss.

In many cases, the safest and quickest way to do this is by via a small tube that goes into your child’s nose and then into his stomach. The rehydrating fluids go through this tube. Less often, your child will be given fluids intravenously (directly into the vein).

Moderate to severe dehydration (score of 5 to 8 on the Clinical Dehydration Scale)

Take your child to see a doctor or go to the nearest hospital for assessment and treatment right away.

Home remedy

Mild dehydration (score of 1 to 4 on the Clinical Dehydration Scale) often can be treated at home. If your child has diarrhea but no vomiting, continue feeding a normal diet. If your child is vomiting, stop milk products and solid foods, and:

• Give infants an oral electrolyte solution (a solution that restores lost fluids and minerals), about 1 tablespoon every 15–20 minutes. Oral rehydration solutions (ORS) such as Pedialyte, Gastrolyte, Enfalyte or other brands contain a properly balanced amount of water, sugars and salts to help the body absorb the fluid. Giving your child water on its own is not enough because water lacks sugars and salts, which are needed to treat dehydration.
• Give children over 1 year old sips of clear fluids such as an oral electrolyte solution (ORS) to replace the water and salts your child has lost, ice chips, clear broth, or ice pops. Give 5 to 10 mL (1 to 2 teaspoons) every 5 minutes. Slowly increase this amount to reach the amount your child will tolerate. If your baby is breastfeeding, continue to breastfeed. If your baby refuses to breastfeed, see a doctor immediately.

No dehydration (score of 0 on the Clinical Dehydration Scale)

Continue to offer your child fluids and an age-appropriate diet. If your child has vomiting or diarrhea, give diluted apple juice, their preferred drink or oral rehydration solution for each diarrhea or vomiting episode. Give 60 – 120 mL (1/4 to ½ a cup) for toddlers and 120 mL (1/2 a cup) for older kids. Continue to offer your child small frequent feedings.

Treatment after rehydration

Once your child is better hydrated, the next step is to work toward getting them back to what they normally eat. This can usually happen about four to six hours after the last episode of vomiting. Offer your child the usual foods and drinks they enjoy.

You do not need to give your child a restrictive diet such as BRAT (bananas, rice, apple sauce, toast). However, avoid offering your child foods that have a high sugar content, fried or high-fat foods, and spicy foods until they have recovered. These foods can be more difficult to digest.

Do not dilute your child’s formula or milk with water, oral rehydration solution or any other fluid.

If your child has ongoing diarrhea or vomiting, give diluted apple juice, your child’s preferred drink or oral rehydration solution for each stool or vomiting episode. Give 60 – 120 mL (1/4 to 1/2 a cup) for toddlers and 120 mL (1/2 a cup) kids. You can also offer them the usual foods and drinks they enjoy. Even if there is diarrhea, it is usually better to continue offering nutritious foods your child’s body needs to recover and to heal.