Signs of Dehydration in Children

Signs of Dehydration in Children

1. Skin is dry.

2. Mouth is often dry.

3. Minimum amount of urine passed during the day or night if bedwetting continues after 6 years of age.

4. Child remains restless for no reason and refuses to drink fluids even when thirsty.

5. Thirsty while playing/exercising in hot weather or while vomiting/diarrhea or while suffering from fever etc,

6. Grumpy but will not drink fluids despite thirstiness.

7. Weakness/drowsiness accompanied by excessive sweating even in a cool environment. (in very severe cases it can lead to loss of consciousness)

8 Children are too weak to get up easily after falling, that’s why they need protection from bumping with furniture and other children.

9. Pale/blue-colored face after vomiting, or diarrhea or during fever, etc,

10. Decrease in urine output with the presence of swollen gland around the neck (not all might show such symptoms).

11. Consistently decreased volume of urine passed per day accompanied by frequent urination.

12. Red rashes on the skin due to external stimuli like heat, cold, touch, and pain. (ex: prick by a needle) (this is common in children with immature immune systems and whose bodies are unable to maintain normal temperature levels which leads to sweating excessively even in the cool environment )

13. Unconsciousness followed by convulsion in case of severe dehydration.

14. Comatose state due to severe dehydration with lack of skin turgor i.e, skin is not easily convexed on pressing the abdomen . (will be visible only if the child is suffering from very severe dehydration).

15. Blood pressure drops significantly after standing for some time. (in case of coma)

16.. Loss of consciousness caused by hypovolemia (when there is an insufficient blood supply to the brain) can lead to death. (this might happen in cases where children are suffering from a reduced level of food intake and drinking water simultaneously.)

Mild-moderate and severe dehydration in pediatrics:

Mild dehydration is defined as a weight loss of 3% to 5%, representing an acute fluid deficit of approximately 500 ml. Moderate dehydration is defined by a weight loss of 6% to 9% or an acute fluid deficit of approximately 1,000 ml.

Severe dehydration is >10% weight loss, or an acute fluid deficit greater than 2,000 ml. Most studies define the volume deficit in children with diarrhea and vomiting based on stool weight rather than volume

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The average volume of urine output per day is about 0.5 quarts (500 mL). Some children may have a large amount of urine (>1 quart per day) while others may produce it less frequently (<0.3 quarts per hour). The following table gives examples of urine output for various age groups.

How to treat dehydration in infants:

There are few guidelines for the management of dehydration in infants. The following is based on expert opinion and experience, and may vary with different health care providers: For mild-moderate dehydration, fluid replacement oral rehydration therapy (ORT) or intravenous fluids might be started. Fluid volume of 15 ml/kg/hour for 6 hours is recommended to replace the fluid loss of 5% body weight.

For severe dehydration, intravenous fluids should be used initially together with electrolyte supplementation immediately after initial assessment until oral intake resumes. IV access should be obtained urgently if not already present; peripheral line insertion should only occur if central lines cannot be established rapidly;

children requiring emergency surgery or transfer for surgery or intensive care require immediate cannulation of large veins (e.g., central line, jugular). If peripheral vein cannulation is unsuccessful, surgical cut down should be performed under sterile conditions without delay.

Intraosseous lines can be used if there is no response to attempts at venous access within 30-60 min; intravenous fluid (0.9% saline or Ringer’s lactate) should be administered through the intraosseous device to replace volume deficits and ongoing losses until venous access is obtained after appropriate training in the technique of intraosseous insertion has been successful. Parenteral nutrition may be needed for some children who are unable to tolerate oral intake while awaiting resolution of their illness.

pediatric dehydration guidelines:

The following are guidelines for the management of dehydration in children. It should be noted that these are guidelines only; any child who is significantly ill enough to need fluid resuscitation will require critical care evaluation, which may include invasive procedures and other supportive measures not previously mentioned.

signs of dehydration in adults:

The following are signs of dehydration in adults. More than two or three of these symptoms may indicate a greater risk for fluid loss and, particularly in children, hospitalization should be considered for rehydration:

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A weight loss of 5% to 7% body mass or more is an indication for immediate medical attention. A healthy adult loses about 1 liter (about 4 cups) of water each day through the kidneys and skin even without significant physical exertion. (nephropathy mostly related to diabetes)

To prevent complications from chronic dehydration such as kidney stones, drink enough liquid throughout the day to produce at least one large urine void daily. Children with neurogenic bladder receiving intermittent catheterization may also benefit from increased fluid intake; however, it is important to maintain appropriate fluid levels in the child’s extracellular fluid compartments to avoid cerebral edema.

Dehydration in toddlers when to worry:

Rehydration of a child having mild or moderate dehydration by the oral route is relatively straightforward. The following steps may be taken:

For severe dehydration, however, intravenous fluids should be used initially together with electrolyte supplementation immediately after initial assessment until oral intake resumes. IV access should be obtained urgently if not already present; peripheral line insertion should only occur if central lines cannot be established rapidly;

children requiring emergency surgery or transfer for surgery or intensive care require immediate cannulation of large veins (e.g., central line, jugular). If peripheral vein cannulation is unsuccessful, surgical cut down should be performed under sterile conditions without delay. Intraosseous lines can be used if there is no response to attempts at venous access within 30-60 min.

intravenous fluid (0.9% saline or Ringer’s lactate) should be administered through the intraosseous device to replace volume deficits and ongoing losses until venous access is obtained after appropriate training in the technique of intraosseous insertion has been successful. Parenteral nutrition may be needed for some children who are unable to tolerate oral intake while awaiting resolution of their illness.

Dehydration in infants:

In infants, it is often easier to tell when a child is dehydrated than in older children because there are definite clinical signs – sunken fontanelle, state of shock, listlessness, lethargy, and failure to thrive. These signs occur late rather than early in dehydration because infants are unable to sense their body’s state of hydration.

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in children:

The following are guidelines for the management of dehydration in children. It should be noted that these are guidelines only; any child who is significantly ill enough to need fluid resuscitation will require critical care evaluation, which may include invasive procedures and other supportive measures not previously mentioned: rehydration with oral fluids (generally given as frequent small volumes) or intravenously (given as larger volumes more frequently);

electrolyte supplementation including potassium, sodium, and magnesium; use of colloid solutions such as human serum albumin, plasma protein fraction, and dextrans to correct hypovolemia and improve perfusion if necessary; use of antibiotics if infection is present or suspected; and possible use of parenteral nutrition to aid in the child’s recovery.

infant dehydration assessment:

Dehydration in infants can be assessed using the Clinical Signs for Assessment for Rehydration (CSAR) tool. It is based on eight signs: skin turgor, level of consciousness, heart rate/rhythm, capillary refill time, respiratory rate, weight loss in the last 24 hours, stool output over the last 24 hours, and urine output over the last 8-12 hours.

Each sign is assigned a score from 0 to 2 depending on severity. A higher score indicates more severe dehydration; a total score of 5 or above indicates that rehydration should be started urgently.

The best protection from dehydration:

The best way to prevent dehydration during hot weather is to drink sufficient liquids each day. Frequent small amounts of liquid are better than large amounts less frequently. A good rule of thumb is to drink when you are thirsty.

Infants and young children should not be given an unrestricted intake of fluids at any time because they can become severely dehydrated very quickly if their fluid requirements are not met (Toddlers, 2014). Children older than 6 months who participate in strenuous physical activity or play for extended periods in hot environments should also be supervised to ensure that they do not become overheated.

If they appear ill or disorientated due to the heat, rehydration is necessary (Toddlers, 2014). When playing outside on a hot day, wearing sunscreen with SPF 30+ is recommended; applying sunscreen 20-30 before going outdoors will allow it to be effective (NHS Choices, 2014a).

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