Saturday, 17 October 2015

How to manage dehydration in children

Dehydration means that a child’s body lacks enough fluid. Dehydration can result from not drinking enough water, vomiting, diarrhoea or any combination of these conditions. Rarely, sweating too much or urinating too much can cause dehydration. Infants are much more likely to become dehydrated than older children or adults, because they can lose relatively more fluid quickly.

Causes of Dehydration in Children
  • Dehydration is most often caused by a viral infection that causes fever, diarrhoea, vomiting, and a decreased ability to drink water or eat food.
  • Common viral infections causing vomiting and diarrhoea include rotavirus, Norwalk virus and adenovirus.
  • Sometimes sores in a child’s mouth (caused by a virus) make it painful to eat or drink, which helps to cause or worsen dehydration.
  • More serious bacterial infections may make a child less likely to eat and may cause vomiting and diarrhoea.
  • Common bacterial infections include Salmonella, Escherichia coli, Campylobacter, and Clostridium difficile.
  • Parasitic infections such as Giardia lamblia cause the condition known as giardiasis , which can lead to diarrhoea and fluid loss.
  • Increased sweating from a very hot environment can cause dehydration.
  • Excessive urination caused by unrecognized or poorly treated diabetes mellitus (not taking insulin) or diabetes insipidus are other causes.
  • Conditions such as cystic fibrosis or celiac sprue do not allow food to be absorbed and can cause dehydration.

Symptoms of Dehydration in Children
  • Be concerned if your child has an excessive loss of fluid through vomiting or diarrhoea, or if the child refuses to eat or drink.

Signs of dehydration are sunken eyes, decreased frequency of urination or dry diapers, sunken soft spot on the front of the head in babies (called the fontanel), no tears when the child cries, dry or sticky mucous membranes (the lining of the mouth or tongue), lethargy (less than normal activity) and irritability (more crying, fussiness with inconsolability).

The doctor will perform a thorough history and physical exam in an effort to determine the severity and cause of the dehydration.
  • Specific laboratory tests may be ordered.
  • A complete blood count may identify an infection.
  • Blood cultures may identify the specific kind of infection.
  • Blood chemistries may identify electrolyte abnormalities caused by vomiting and diarrhoea
  • Urinalysis may identify bladder infection, may give evidence of the 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).

Dehydration in children treatment

Self-Care at Home

Most children become dehydrated because of diarrhoea or vomiting caused by a viral infection. The way to help a dehydrated child is to give plenty of fluids while the child is ill. This is called fluid replacement.

Suitable fluid replacement for children younger than two years includes Pedialyte, Rehydralyte, Pedialyte freezer pops, or any similar product designed to replace fluids, sugar, and electrolytes (dissolved minerals such as sodium, potassium, and chloride). You can buy these products at most large grocery and drug stores.
You can make your own oral rehydration fluid by following this recipe:

1/2 teaspoon table salt

1/2 teaspoon potassium chloride (lite salt)

1/2 teaspoon baking soda

4 tablespoons sugar

dissolved in 1 liter (a little over a quart) of water
  • Children older than two years may be given flat soda (soft drinks that are opened then shaken to lose their fizz), Gatorade, or water-based soups.
  • Give a few sips every few minutes.
  • Although it may seem that your child is vomiting all that is given, usually an adequate amount of fluid is kept down.
  • Within four hours after vomiting stops, a BRAT diet (bananas, rice, apples, toast, and other simple starches, such as noodles or potatoes) may be started in children who are weaned from formula or breast milk.
  • Change slowly to a normal diet after one to two days on the BRAT diet. If you are breastfeeding, you may continue to breastfeed throughout the illness.
  • If you are bottle-feeding, restart half-strength formula feedings after one to two days of Pedialyte, and then return to full-strength formula feedings within another day.

Medical Treatment
  • If the dehydration is mild (three to five per cent total body weight loss), the doctor may ask you to give the child small sips of Pedialyte or other oral rehydration fluids. If your child is able to drink fluids (and no dangerous underlying illness or infection is present), you will be sent home with instructions on oral rehydration, information about things to be concerned with and reasons to return or call back.
  • If your child is moderately dehydrated (five to 10 per cent total body weight loss), the doctor may place a tube into a vein (intravenous line or “IV”) to give the fluids. If your child is able to take fluid by mouth after IV fluid replacement, improves after IV fluid replacement, and has no apparent dangerous underlying illness or infection, you may be sent home. When sent home, you will receive instructions on oral rehydration, instructions for close follow-up with your family doctor (most likely to be seen in the office the next day), and instructions on things to be concerned about and reasons to return or call back.
  • If your child is severely dehydrated (more than 10 to 15 per cent weight loss), the child will most likely be admitted to the hospital for continued IV fluid replacement, observation, and often further tests to determine what is causing dehydration. Children with bacterial infections will receive antibiotics, but viral infections will not usually require specific antibiotic therapy. In children, vomiting and diarrhoea are almost never treated with drugs to stop vomiting (called antiemetics) or anti-diarrhoea. Such treatment would usually prolong the diarrhoea.


This story was published in Newswatch Times on October 10, 2015.

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