Is Your Child Dehydrated?

Risks Run from Fatigue and Irritability to Hospitalization

dehydrated girl in hammock outside
Dejan Ristovski/Stocksy United

It is not unusual for parents to worry about dehydration when their child is vomiting or has diarrhea. At other times, it can sneak up on parents even when a child appears to be functioning normally.

While dehydration tends to be easily remedied, it can sometimes lead to serious complications if left untreated. Recognizing the early signs is the first step to avoiding illness and hospitalization in children at risk of dehydration.

Identifying Dehydration in Children

Fortunately, kids don't get dehydrated very easily. When it does happen, it relates not so much to the loss of fluid but to losing more fluids than the child is taking in, either due to vomiting or frequent, watery diarrhea. It can also be caused by chronic conditions such as diabetes when high glucose levels can lead to increased urination and decreased hydration.

When either of these things happens, you will typically see signs of dehydration including a sudden loss of weight, a sunken look in the child's eyes, and change in urination patterns. We can also diagnose the condition with two simple tests:

  • the speed of capillary refill (tested by pressing on the child's nail bed and seeing how long it takes for the whitened nail to return to normal color)
  • the speed of skin turgor (tested by squeezing a fold of skin on the child's belly, holding it for a few seconds, and then seeing how long it takes for it to return to normal)

    These symptoms can not only tell you if your child is dehydrated but how dehydrated he or she might be.

    Treating Dehydration in Children

    Whatever the severity, immediate treatment is required to reverse the condition. If you are able to get your child to drink enough fluids, even a tiny amount a little at a time (the classic treatment for vomiting and diarrhea), you can largely avoid complications.

    The mistake parents will often make is to give the child too much at once, which can lead to vomiting and the worsening of symptoms.

    In severe cases, oral fluid may not be enough. Oftentimes, emergency care is needed to provide ​a more rapid intake of fluids using an intravenous (IV) drip.

    Symptoms of Mild Dehydration

    Most children who are sick will experience minimal or no dehydration, which we can confirm by the presence of the following characteristics:

    • normal thirst
    • a moist mouth and tongue
    • normal to slightly decreased urine output
    • less than three percent weight loss
    • normal heart rate and breathing
    • warm extremities
    • capillary refill in less than two seconds
    • instant recoil on skin turgor test
    • eyes that are not sunken

    Symptoms of Mild to Moderate Dehydration

    If mild dehydration worsens, the child may begin to feel tired, restless, and irritable (often making it difficult to give them fluids). Other signs can include:

    • increased thirst
    • a dry mouth and tongue
    • decreased urine output
    • three to nine percent weight loss
    • normal to increased heart rate and normal to fast breathing
    • cool extremities
    • capillary refill greater than two seconds
    • recoil on skin turgor test in less than two seconds
    • slightly sunken eyes

    This is the stage when you should consider calling your pediatrician.

    Symptoms of Severe Dehydration

    Severe dehydration is considered an emergency requiring immediate medical attention. By this stage, the child will appear lethargic, may be difficult to awaken, or even be unconscious. Other symptoms can include:

    • difficulty or inability to drink
    • a parched mouth and tongue
    • minimal or no urine output
    • greater than nine percent weight loss
    • increased heart rate, weak pulse, and deep breathing
    • cool, mottled extremities
    • capillary refill that is very prolonged or minimal
    • recoil on skin turgor test in more than two seconds
    • deeply sunken eyes

    Do not delay seeking emergency care if any of these symptoms appear.

    Sources:

    Centers for Disease Control and Prevention. "Managing Acute Gastroenteritis Among Children." MMWR. 2003; 52(RR16);1-16.

    Popkin, B.; D'Anci, K; and Rosenberg, I. "Water, Hydration, and Health." Nutritional Review. 2010; 68(8):439-458.

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