Dehydration

What is dehydration?

Every day, we lose body fluids (water and other liquids) in our urine, stool, sweat and tears. We replace the lost fluids by eating and drinking. Normally, the body balances these processes carefully, so we replace as much water as we lose. Minerals in the body, such as sodium, potassium and chloride, help to keep a healthy fluid balance.

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.

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.​

Common signs and symptoms of dehydration

Your child may show one or more of the following symptoms of dehydration:

• dry, cracked lips and a dry mouth
• increased thirst
• less urine than normal, no urine for six hours (babies) to 12 hours (children), or dark-coloured urine
• drowsiness or irritability
• cold or dry skin
• low energy levels, seeming very weak or limp
• no tears when crying
• sunken eyes or sunken soft spot (fontanelle) on baby's head

Causes of 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.

Measuring dehydration

The Clinical Dehydration Scale is used by health-care providers 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 health-care provider may use more findings to assess dehydration, but this scale is a good place to start. If you have any concerns, see a health-care provider 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:

1. mark down your child's symptoms
2. for each symptom, find the point value in the chart
3. 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.

Clinical Dehydration Scale

*Mucous membranes include the inside lining of the mouth and eyes.

Score of 0 = no dehydration

Score of 1 to 4 = some dehydration

Score of 5 to 8 = moderate to severe dehydration

(Goldman, 2008)

Treatment of dehydration

The treatment of dehydration is based on how dehydrated your child is. Over-the-counter medications to treat vomiting and diarrhea are not recommended for children.

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

Take your child to see a health-care provider or go to the nearest hospital for assessment and treatment right away.

Mild dehydration (score of 1 to 4 on the Clinical Dehydration Scale)

Offer your child diluted apple juice, followed by their preferred drink or oral rehydration solutions to replace the water and salts your child has lost. Oral rehydration solutions 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 your child 5 to 10 mL (1 to 2 teaspoons) every five minutes. Slowly increase this amount to reach the amount your child will tolerate.

If your baby is breastfeeding or formula feeding, continue to breastfeed or offer formula. If your baby refuses to breastfeed or take their regular bottle, you can try to offer small amounts of oral rehydration solution, breastmilk or formula in a syringe.

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 to 120 mL (1/4 to 1/2 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 to 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.

When to see a health-care provider

Go to the nearest Emergency Department if:

• your child does not appear to be recovering or is becoming more dehydrated
• there is blood in the diarrhea or vomit, or the vomit turns green in colour
• your child has pain that you cannot manage easily or that is making them unable to take in enough fluids
• your child refuses to take oral rehydration solution or preferred drink, even with a syringe
• your child has persistent vomiting or diarrhea and is unable to drink enough fluids to keep up with the losses
• your child does not make urine for more than 6 hours (if a baby) or 12 hours (if a child)
• your child is very sleepy or very irritable

Your child may show physical changes when their condition is serious or when their condition gets worse. Parents and caregivers can learn how to spot these signs in order to seek help from a health-care provider.