By Tracy Bennett
Busy children often don’t take time to get the right amount of fluids. If they wait until they are thirsty, they may already be dehydrated. Parents usually know to be on the lookout for dehydration when their children have been ill—vomiting, diarrhea, and fever. But the task is more elusive in children with specialized diets, such as ketogenic diets, or who have health conditions such as diabetes, kidney disease, or metabolic disorder. Dehydration is also often a concern for parents when children are transitioning from being tube fed to orally fed.
Signs of Dehydration
According to HealthyChildren.org, mild to moderate dehydration in infants and children is exhibited by less active play, less frequent urination, loose stools if dehydration is caused by diarrhea or decreased bowel movements if caused by vomiting or lack of fluid intake. For infants or children in diapers, it’s possible to measure the amount of urination by the number of wet diapers and the weight of the diaper. Ask your healthcare provider for guidance. More severe symptoms include being excessively sleepy, sunken eyes, cool and discolored hands and feet, and wrinkled skin. Always consult a health care provider if you are concerned that child is or may become dehydrated. “Doctors look at other signs such as capillary refill, mucous membranes, skin turgor, alertness, weight, and heart rate,” adds Dr. Emily Goodwin, of Children’s Mercy, Kansas City, Mo. Chronic dehydration can also be a problem and would not have the exact same signs and symptoms as acute dehydration.
Prevention and Treatment
Keeping kids hydrated depends on the situation, but a good tip for kids and adults alike, is to drink at regular intervals throughout the day. The daily amount needed depends on age, weight, sex, and activity level. Other factors, such as illness with fever, fast breathing or other insensible losses can impact the amount needed. The Academy of Nutrition and Dietetics says that generally kids should drink six to eight cups of water per day. EatRight.org provides the following chart.
|Age Range||Gender||Total Water (Cups/Day)|
|4 to 8 years||Girls and Boys||5|
|9 to 13 years||Girls||7|
|14 to 18 years||Girls||8|
According to KidswithTubes.org, when children reach the age of 10 to 12 years, their water needs approach that of adults. They need the number of ounces equivalent to half of their body weight. Remember, juice, tea, and soda are not good choices for meeting regular fluid needs or in times of dehydration. Water and milk, because it contains electrolytes, are good choices. Once a child becomes dehydrated, oral rehydration solutions, such as Pedialyte® or Powerade®, may be necessary instead of just water. These solutions should be given over the course of several hours. Dr. Goodwin recommends kids on ketogenic diets check with their Neurology team to determine the best rehydration solution.
Generally, it’s better to rehydrate orally or through a tube, rather than by IV, says Dr. Goodwin. KidsHealth.org recommends starting with small frequent volumes, and ask your healthcare provider for advice. In addition, the World Gastroenterology Organization has guidelines on rehydration. (See document link below.) Dr. Goodwin adds: “Sometimes avoiding dehydration in a child with a feeding tube is easier than in those without and who refuse things by mouth. Generally, boluses or slow continuous rehydration fluid can be given by tube, depending on tolerance and condition of the child.”
Is there such a thing as too much water? While, technically it is possible to overhydrate, that’s usually not a concern if the child’s heart and kidneys are working well and healthy. Any extra fluids would be urinated, explains Dr. Goodwin. However, “Kids that are fed by G-tube often have other factors to consider such as calorie needs and hormone, kidney, heart, or nervous system disorders.” she says.
There are so many factors affecting the increased chance of dehydration that it’s very difficult to offer blanket strategies for parents. You must consider the age and health of your child, their activity level, body temperature, the outdoor temperature, and other losses such as vomiting and diarrhea when they are sick. For all kids, it’s a good idea to talk with your health care provider about hydration strategies specific to your child.
2003 Newsletter from Kids with Tubes includes articles on Fluid Requirements and Water Intake for Health and Well Being.
Dehydration Overview from KidsHealth.org
World Gastroenterology Organization Global Guidelines. See page 12 for rehydration tips.