DEHYDRATION in Children

By: Jonas Marvin Anaque RM, RN

Dehydration is a condition that can occur with excess loss of water and other body fluids. Dehydration results from
decreased intake, increased output (renal, gastrointestinal or insensible losses), a shift of fluid (eg, ascites,
effusions), or capillary leak of fluid (eg, burns and sepsis). Children are particularly susceptible to dehydration
The body water constitutes as much as 75% of the body weight of a newborn infant
If dehydration and the cause of dehydration are not adequately corrected, complications such as lethargy,
weakness, electrolyte and acid-base disturbances, and ultimately hypovolaemic shock resulting in end organ failure
and death may occur.
Causes of dehydration
Gastroenteritis- diarrhea also
Gastrointestinal obstruction - eg, pyloric stenosis: often associated with poor intake, vomiting.
Febrile illness: fever causes increased insensible fluid losses.
Burns: fluid losses may be extreme and require aggressive fluid management.
The most useful individual signs for predicting 5% dehydration in children are an abnormal capillary refill time,
abnormal skin turgor and abnormal respiratory pattern.[3]
Combining examination signs (eg, using general appearance, eyes, mucous membranes, and tears) provides a
much better method than any individual signs in assessing the degree of dehydration. Of the clinical indicators
used, the pinch test (skin turgor) has been shown to be the most reliable in several studies but is still not a reliable
test when used without other clinical indicators.
Assess on clinical signs and documented recent loss of weight (NB: Bare weight on same scales is most accurate).
Weigh bare child and compare with any recent (within 2 weeks) weight recordings. Precise calculation of water
deficit due to dehydration using clinical signs is usually inaccurate. The best method relies on the difference
between the current body weight and the immediate pre-morbid weight.
Clinical assessment therefore comprises some of the following indicators of dehydration:

Loss of body weight:

Mild dehydration: 1-5% weight loss.

Mild-to-moderate dehydration: 6-10% loss of body weight.

Severe: over 10% loss of body weight.

Clinical features of mild-to-moderate dehydration; two or more of:

Restlessness or irritability.

Sunken eyes (also ask the parent).

Thirsty and drinks eagerly.

Clinical features of severe dehydration; two or more of:

Abnormally sleepy or lethargic.

Sunken eyes.

Drinking poorly or not at all.

Pinch test (skin turgor):

Skin turgor is assessed by pinching the skin of the abdomen or thigh longitudinally between the thumb
and the bent forefinger. The sign is unreliable in obese or severely malnourished children:

Normal: skin fold retracts immediately.

Mild or moderate dehydration: slow; skin fold visible for less than two seconds.

Severe dehydration: very slow; skin fold visible for longer than two seconds.

Other features of dehydration include dry mucous membranes, reduced tears and decreased urine output.

Additional signs of severe dehydration include circulatory collapse (eg, weak rapid pulse, cool or blue
extremities, hypotension), rapid breathing, sunken anterior fontanelle.
Danger Signs

Appears to be unwell or deteriorating.

Altered responsiveness (eg, irritable, lethargic).

Sunken eyes.

Tachycardia.

Tachypnoea.

Reduced skin turgor.

DEHYDRATION in Children
By: Jonas Marvin Anaque RM, RN

Shock

Arrange emergency transfer to secondary care:

Pale or mottled skin.

Cold extremities.

Decreased level of consciousness.

Tachycardia.

Tachypnoea.

Weak peripheral pulses.

Prolonged capillary refill time.

Hypotension.
Management - The treatment of mild-to-moderate dehydration does not require intravenous therapy as long as
oral fluids are tolerated. Oral rehydration solutions such as Dioralyte may be used. Breast milk should be
continued if possible.

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

dry or sticky mouth

few or no tears when crying
eyes that look sunken into the head
soft spot (fontanelle) on top of baby's head that looks sunken
lack of urine or wet diapers for 6 to 8 hours in an infant (or only a very small amount of dark yellow
urine)

lack of urine for 12 hours in an older child (or only a very small amount of dark yellow urine)

dry, cool skin

lethargy or irritability

fatigue or dizziness in an older child

Preventing Dehydration
The best way to prevent dehydration is to make sure kids get plenty of fluids when they're sick or
physically active they should consume more fluids than they lose (from vomiting, diarrhea, or
sweating).
Fever due to various infections can be a factor in dehydration.
It's important that kids drink often during hot weather. Those who participate in sports or strenuous
activities should drink some extra fluid before the activity begins. They should also drink at regular
intervals (about every 20 minutes) during the course of the activity and after it ends.
Thirst is not a good early sign of dehydration. By the time a child feels thirsty, he or she may already be
dehydrated. And thirst can be quenched before the necessary body fluids have been replaced. That's why
kids should start drinking before thirst develops and consume additional fluids even after thirst is
quenched.

DEHYDRATION in Children
By: Jonas Marvin Anaque RM, RN
Other "clear liquids" often used by parents or recommended by doctors in the past are no longer

considered appropriate for use in dehydrated kids. Drinks to avoid include: water, soda, ginger ale, tea,
fruit juice, gelatin desserts, chicken broth, or sports drinks. These don't have the right mix of sugar and
salts and can even make diarrhea worse.