Dehydration in children

Dehydration means not enough fluid in a child's body. This can result from vomiting, diarrhea, not drinking or any combination of these three. Sweating or urinating too much can also cause dehydration, although this is far less common. 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 or winter vomiting disease (norovirus).

•      Sometimes sores in a child's mouth caused by a virus make it painful to eat or drink, helping to cause or worsen dehydration.
 

•      More serious bacterial infections can make a child less likely to eat and may cause vomiting and diarrhea.

•    Common bacterial infections include Salmonella, E coli, Campylobacter and C.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 unrecognised or poorly treated diabetes (not taking insulin) is another cause.

Symptoms of dehydration in children

You should be concerned if your child has an excessive loss of fluid from vomiting or diarrhea, or if the child refuses to eat or drink.

Signs of dehydration:

•      Sunken eyes

•      Decreased frequency of urination or dry nappies

•      Sunken soft spot on the top of the head in babies (called the fontanelle)

•      No tears when the child cries

•      Dry or sticky mucous membranes (the lining of the mouth or tongue)

•      Lethargy (less activity than normal)

•      Irritability (more crying, fussiness)

When to seek medical care:

Infants and small children can become dehydrated quickly.

Contact your doctor or NHS Direct (NHS 24 in Scotland) 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 colour

•      Fever higher than 39 Celsius (103°F)

•      Less activity than usual

•      Urination much more than usual

Call the emergency number or go to a hospital’s Accident and Emergency Department in these situations:

•      If your child is lethargic (difficult to awaken)

•      If your child is complaining of severe abdominal pain

•      If your child's mouth looks dry

Examinations and tests

The doctor will perform a thorough history and physical examination in an effort to determine the cause of dehydration, as well as to find out how severe the dehydration is. He or she will look for evidence of dehydration, as well as signs of illnesses that may cause dehydration.

Certain tests may be performed.

•      A full 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, 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).

Self-care at home  

Most children become dehydrated because of diarrhea or vomiting caused by a viral infection. The goal is to prevent dehydration in the first place or replace lost fluid by giving plenty of fluids while the child is ill. This is called fluid replacement.

•   Oral re-hydration solutions (ORS) are often recommended as the body will have lost sugar, salts and minerals as well as water. GPs or pharmacists can advise a parent about suitable products. Check the dosage instructions.

•       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.  

The aim is to try and maintain normal eating habits.

•    For children on solid food, within four hours after vomiting stops, simple foods that are high in carbohydrates are recommended, like rice, pasta or potatoes. 

•   If you are breastfeeding you may continue to breastfeed throughout the illness. 

•      If you are bottle-feeding continue with normal strength feeds. 

Medical treatment

In cases of severe dehydration, admission to hospital may be required. Fluid may be given through a tube through the nose or saline drip intravenously.

Next steps - follow-up

After leaving hospital, the child will be sent home and parents given instructions for care, monitoring and further fluid replacement.

Prevention

•      It is almost impossible to prevent your child from getting the viral infections that cause most cases of dehydration. The key is to recognise the danger signs early and to begin proper fluid replacement quickly.

•     If your child has vomiting or diarrhoea more than four to five times, seek medical advice. You may be advised to oral rehydration solutions to prevent dehydration. Consider keeping these in your home for this type of situation.

•     Seek medical advice at any time if you have concerns about your child's ability to get enough fluid.

Outlook

•      Most dehydration is caused by viral infections that naturally run their course. The most dangerous problem with viruses is dehydration, which can kill infants and children.

•      In most cases, providing adequate fluid, either by mouth or via a drip, is all that is necessary to assure your child's complete recovery.

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