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Dehydration means not enough fluid in a child's body. This can result from not drinking, vomiting, diarrhea, or any combination of the 3. Rarely, sweating too much or urinating too much can cause dehydration. Infants and small children are much more likely to become dehydrated than older children or adults .
Causes of Dehydration in Children
Dehydration is most often caused by a viral infection that causes fever, diarrhea, vomiting, and a decreased ability to drink or eat.
Common viral infections causing vomiting and diarrhea include rotavirus, Norwalk virus, and adenovirus.
Sometimes sores in a child's mouth caused by a virus make it painful to eat or drink, helping cause or worsen dehydration.
More serious bacterial infections may make a child less likely to eat and may cause vomiting and diarrhea.
Common bacterial infections include Salmonella, Escherichia coli, Campylobacter, and Clostridium difficile.
Parasitic infections such as Giardia lamblia cause the condition known as giardiasis .
Increased sweating from a very hot environment can cause dehydration.
Excessive urination caused by unrecognized or poorly treated diabetes (not taking insulin) is another cause.
Conditions such as cystic fibrosis or sprue do not allow food to be absorbed and cause dehydration.
Symptoms of Dehydration in Children
Be concerned if your child has an excessive loss of fluid by vomiting or diarrhea, or if the child refuses to eat or drink.
Signs of dehydration
Sunken eyes
Decreased frequency of urination or dry diapers
Sunken soft spot on the front of the head in babies (called the fontanel)
No tears when the child cries
Dry or sticky mucous membranes (the lining of the mouth or tongue)
Lethargy (less than normal activity)
Irritability (more crying, fussiness)
When to Seek Medical Care
Infants and small children can become dehydrated quickly.
Contact your doctor if your child has any of the following:
Dry mouth
Crying without tears
No urine output in 4-6 hours
Sunken eyes
Blood in the stool
Abdominal pain
Vomiting for more than 24 hours, or vomiting that is consistently green in color
Fever higher than 103°F
Less activity than usual
Urination much more than usual
Go to a hospital's Emergency Department in these situations:
If your child is lethargic (difficult to awaken)
If you cannot reach your doctor
If your child is complaining of severe abdominal pain
If your child's mouth looks dry
Exams and Tests
The doctor will perform a thorough history and physical exam in an effort to determine the cause of dehydration as well as how severe the dehydration is. The doctor will look for evidence of dehydration, as well as signs of illnesses that may cause dehydration.
Certain lab tests may be ordered.
A complete blood count may identify seriousness or type of infection.
Blood cultures may identify the type of bacterial infection.
Blood chemistry may identify any electrolyte abnormality caused by vomiting and diarrhea and may identify serious imbalances in body chemistry caused by illness.
Urinalysis may identify bladder infection, may give evidence of severity of dehydration, and may identify sugar and ketones in urine (evidence of uncontrolled diabetes).
In some cases, the doctor may order other tests, such as a chest x-ray, a test to check for rotavirus, stool cultures, or lumbar puncture (a spinal tap ).
Dehydration in Children Treatment
Self-Care at Home
Most children become dehydrated because of diarrhea or vomiting caused by a viral infection. The way to help a dehydrated child is to give plenty of fluids while the child is ill. This is called fluid replacement.
The best fluid replacement for children younger than 2 years is Pedialyte, Rehydralyte, Pedialyte freezer pops, or any similar product designed to replace fluids, sugar, and electrolytes (dissolved minerals such as sodium, potassium, and chloride). You can buy these products at most large grocery and drug stores.
You can make your own oral rehydration fluid by following this recipe:
one-half teaspoon table salt
one-half teaspoon potassium chloride (lite salt)
one-half teaspoon baking soda
4 tablespoons sugar
dissolved in 1 liter (a little over a quart) of water
Children older than 2 years may be given flat soda (soft drinks that are opened and allowed to lose their fizz), Gatorade, or water-based soups.
Give a few sips every few minutes.
Although it may seem that your child is vomiting all that is given, most often an adequate amount of fluid is kept down.
Within 4 hours after vomiting stops, a BRAT diet (bananas, rice, apples, toast, and other simple starches, such as noodles or potatoes) may be started in children who are weaned from formula or breast milk.
Change slowly to a normal diet after 1-2 days on the BRAT diet. If you are breastfeeding, you may continue to breastfeed throughout the illness.
If you are bottle-feeding, restart half-strength formula feedings after 1-2 days of Pedialyte, and then return to full-strength formula feedings within another day.
Medical Treatment
If the dehydration is mild (3-5% total body weight loss), the doctor may ask you to give the child small sips of Pedialyte or other oral rehydration fluids. If your child is able to drink fluids, and no dangerous underlying illness or infection is present, you will be sent home with instructions on oral rehydration, information about things to be concerned with and reasons to return or call back.
If the child is moderately dehydrated (5-10% total body weight loss), the doctor may place an IV into a vein and give the child fluids in this manner. If your child is able to take fluid by mouth after IV fluid replacement, looks better after IV fluid replacement, and has no apparent dangerous underlying illness or infection, you may be sent home with instructions on oral rehydration, instructions for close follow-up with your family doctor (most likely to be seen in the office the next day), and instructions on things to be concerned about and reasons to return or call back.
If the child is severely dehydrated (more than 10-15% weight loss), the child will most likely be admitted to the hospital for continued IV fluid replacement, observation, and often further tests to determine what is causing nausea, vomiting, and dehydration. Children with bacterial infections will receive antibiotics. In children, vomiting and diarrhea are almost never treated with drugs to stop vomiting (called antiemetics) or antidiarrheals.
Prevention
It is almost impossible to prevent your child from getting the viral infections that cause most cases of dehydration. The key is to recognize the danger signs early and to begin proper fluid replacement quickly.
If your child has vomiting or diarrhea more than 4-5 times, start fluid replacement with Pedialyte or a similar fluid to prevent dehydration. Consider keeping replacement fluid in your home for this type of situation.
Call your doctor any time you have concerns about your child's ability to get enough fluid.
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