Signs of Dehydration in Infants & Children
Be alert for the following warning signs of dehydration, and notify the doctor immediately if any of them develop.
Mild to Moderate Dehydration:
- Plays less than usual
- Urinates less frequently (for infants, fewer than six wet diapers per day)
- Parched, dry mouth
- Fewer tears when crying
- Sunken soft spot of the head in an infant or toddler
- Stools will be loose if dehydration is caused by diarrhea; if dehydration is due to other fluid loss (vomiting, lack of fluid intake), there will be decreased bowel movements.
Severe Dehydration (in addition to the symptoms and signals already listed):
- Very fussy
- Excessively sleepy
- Sunken eyes
- Cool, discolored hands and feet
- Wrinkled skin
- Urinates only one to two times per day
Children who are mildly dehydrated do not need immediate medical attention but should be monitored for signs of worsening dehydration.
Dietary recommendations — Children who are vomiting but are not dehydrated can continue to eat a regular diet as tolerated. Dehydrated children require rehydration (replacement of lost fluid). (See ‘Oral rehydration therapy’below.)
Infants — If a breastfeeding infant vomits, he or she should continue to breastfeed unless your doctor or nurse tells you otherwise. Oral rehydration solutions (eg, Pedialyte) are not usually needed for infants who exclusively breastfeed because breastmilk is more easily digested.
If your infant vomits immediately after nursing, you can try to breastfeed more frequently and for a shorter time. For example, breastfeed every 30 minutes for five to 10 minutes. If vomiting improves after two to three hours, resume the usual feeding schedule. If vomiting worsens or does not improve within 24 hours, call your child’s doctor or nurse.
If your infant drinks formula, initially offer one-half to one ounce of an oral rehydration solution (eg, Pedialyte) every 15 minutes for two to three hours. If vomiting occurs after drinking, wait 30 minutes and try again. If vomiting improves, resume feeding with full strength infant formula. If vomiting worsens or does not improve within 24 hours, call your child’s doctor or nurse.
Older infants and children — Older infants and children who vomit can continue to eat, if desired. However, it is common for children to have little or no appetite during a vomiting illness.
●Monitor for signs of dehydration, and do not force the child to eat, especially during the first 24 hours. Encourage the child to drink fluids. The best fluids are the commercially prepared oral rehydration solutions (eg, Pedialyte). Other fluids, including water, diluted juice, or soda can be given in small quantities.
●Apple, pear, and cherry juice, and other beverages with high sugar content, should be avoided. Sports drinks (eg, Gatorade) should also be avoided since they have too much sugar and have inappropriate electrolyte levels.
●Recommended foods include a combination of complex carbohydrates (rice, wheat, potatoes, bread), lean meats, yogurt, fruits, and vegetables. High fat foods are more difficult to digest, and should be avoided.
●It is not necessary to restrict a child’s diet to clear liquids or the BRAT diet (bananas, rice, applesauce, toast). Although these and similar foods might be recommended to decrease diarrhea, these foods do not contain enough nutrients for a child.
Oral rehydration therapy — Oral rehydration therapy (ORT) was developed as a safer, less-expensive, and easier alternative to intravenous (IV) fluids. Oral rehydration solution (ORS) is a liquid solution that contains glucose (a sugar) and electrolytes (sodium, potassium, chloride), which are lost during vomiting and diarrhea.
ORS does not cure vomiting, but it does help to prevent and treat the dehydration that can develop because of a vomiting illness. You can buy ORS at most grocery stores and pharmacies in the United States without a prescription. A few widely available brands include Pedialyte, Infalyte, and ReVital, although generic brands work equally well. Gelatin, tea, fruit juice, rice water, and other beverages are not recommended in children who are dehydrated. Do not try to prepare ORS recipes at home because the formulas must be exact.
You can give ORS at home if your child is mildly dehydrated, refusing to eat a normal diet, or has vomiting, diarrhea, or both. If needed, you can give ORS in frequent, small sips or small amounts by spoon, bottle, or cup over three to four hours. Your child’s doctor or nurse might provide specific instructions for giving oral rehydration. One method is described below:
●The recommended amount is 5 teaspoons of ORS for every pound of body weight (or 50 milliliters per kilogram). For a 20-pound (9 kg) child, this would equal 100 teaspoons (450 milliliters) of ORS. This amount should be given gradually, spread out over about four hours.
●Measure the solution with a standardized medicine syringe or measuring cup or spoon, rather than a regular cup or spoon.
●Give the fluid by teaspoonfuls (5 milliliters each) every one to two minutes or as tolerated.
●After you give the whole amount, the child can eat a normal diet.
Children who refuse to drink or who vomit immediately after drinking ORS should be monitored closely for worsening dehydration. Children who are not dehydrated can continue to drink ORS between episodes of vomiting to prevent dehydration.