Clinical Reference Systems: Pediatric Advisor 10.0

Description

Dehydration is a condition in which the body doesn't have enough water to function properly. Your child's body can lose a lot of water if he or she has diarrhea, is vomiting, or has been exercising for a long time without having anything to drink. If water is not adequately replaced in the body, complications can include decreased activity, weakness, electrolyte imbalances, and, in cases of extreme dehydration, death.

Infants and young children are at greatest risk for dehydration. Sick children may become more dehydrated if they do not want to drink because their stomach hurts or if they are very weak.

With mild dehydration, children may:

• have sticky or dry mouths
• urinate less
• be more thirsty than usual.

With more severe dehydration, children often:

• have decreased alertness
• have sunken eyes
• urinate much less if at all
• lose weight.

Dehydration can be a medical emergency. Call your doctor IMMEDIATELY because your child may need intravenous (IV) fluids at the hospital if:

• Your child's activity level is greatly decreased.
• Your child is difficult to arouse.
• Your child appears limp and weak.
• Your child doesn't seem to recognize you.

Home Care

Encourage your child to drink. Since dehydration, no matter what the cause, involves high loss of body water, the goal is to replace it. Often the specific approach to treatment will vary with the type of illness causing the dehydration. For instance, the type and rate of fluid replacement in a child with vomiting and diarrhea is different from fluid replacement in a child dehydrated due to sports activity.

1. Mild dehydration due to illness in infants under 1 year old

   Encourage, but do not force, your child to drink. If you are not breast-feeding your child, give him or her special clear liquids with electrolytes, such as Pedialyte or Kao Lectrolyte, instead of formula for the first 12 to 24 hours. These oral electrolyte solutions are available without prescription at supermarkets and drugstores. If you are breast-feeding and your baby is urinating less frequently than normal, offer an electrolyte solution between breast-feedings for the first 6 to 24 hours.

   If your child is vomiting, give small, frequent amounts of breast milk or the electrolyte fluids rather than less frequent large amounts. For example, if your child normally takes 8 ounces every 4 hours, give instead 1 ounce every 1/2 hour. The child will be better able to keep the liquid down and still get the same amount of fluid.

   If your child is not vomiting or having diarrhea, you may give age-appropriate foods along with the breast milk or electrolyte liquids.

   For most illnesses, start giving a bottle-fed baby full- strength formula again after 12 to 24 hours of the clear liquids.

2. Mild dehydration due to illness in children over 1 year old

   Encourage but do not force your child to drink. Kool- Aid and half-strength lemon-lime soft drinks (half water, half soft drink) may be given to start. Clear soups, half-strength sports drinks, Popsicles, and half- strength Jell-O water are also good choices. Avoid all fruit juices.

   If your child is vomiting, he or she should drink small, frequent amounts of liquid rather than large infrequent amounts.

   If your child is not vomiting or having diarrhea, water alone works well for rehydration in the first few hours, although your child may eat regular food if he or she is hungry.

   After a few hours of clear liquids, start giving your child liquids and foods with energy sources (sugar) and nutritional value.

3. Mild dehydration due to exertion in older children

   Follow the instructions given above for mild dehydration in children over 1 year old. Your child will probably be quite thirsty and should be allowed to drink as much as she or he wants. Pure water is acceptable for the first hour or two, but after this, drinks containing sugar or regular food is necessary. Also, your child should rest from the activity in a cool, shaded environment until he or she is rehydrated.

Mistakes to Avoid

1. Clear liquids should not be used alone for longer than 12 to 24 hours because they lack adequate calories. Your child needs normal, healthy foods to regain strength.

2. Avoid highly concentrated solutions, such as boiled milk, and drinks with a lot of sugar such as colas and apple juice (unless diluted with water).

Prevention

• Make sure your child drinks often during strenuous activities, such as prolonged sports, or during exposure to hot, dry, or windy environments.
• Remember that children frequently become mildly dehydrated during travel or when fluids aren't readily available. Encourage drinking during travel and carry water with you whenever possible.
• At the first sign of vomiting or diarrhea, encourage fluids as advised in the home care instructions for these illnesses.

Call Your Child's Physician IMMEDIATELY If:

• Your child does not make tears while crying.
• Your child has a dry or sticky mouth.
• Your child has no urine in over 8 hours.
• Your child is dizzy or unsteady while standing or walking.
• Your child appears less alert than usual.
• Your child refuses to drink fluids despite your encouragement.
• Your child starts to act very sick.
• Your child's vomiting is worsening or lasting longer than 6 to 8 hours.