Dehydration in children: Causes, symptoms, treatment, managing tips for parents

According to the World Health Organization, dehydration s a condition that results from excessive loss of body water and it is a very common problem in babies and particularly in young children. It is a condition in which your body does not have the required amount of water that it needs and now with summer starting, they may end up not maintaining their hydration status due to various reasons which means that they are losing a lot more fluid than what they’re consuming and end up dehydrated.

Causes:

In an interview with HT Lifestyle, Dr BK Vishwanath Bhat, Pediatrician and MD at Bengaluru’s Radhakrishna Multispecialty Hospital, explained, “Dehydration means abnormal loss of liquids from the system. It is caused by vomiting, loose stools and excessive sweating. Dehydration is graded into mild, moderate and severe. Mild is upto 5% of weight loss, 5-10% weight loss is moderate and more than 10% weight loss is severe dehydration. There are three main types of dehydration where sodium level is low hypotonic (primarily a loss of electrolytes), hypertonic (primarily loss of water) and isotonic (equal loss of water and electrolytes).”

Echoing the same, Dr Shashidhar Vishwanath, Lead Consultant in Neonatology and Paediatrics at SPARSH Hospital for Women and Children, said, “When the fluid input that we take in is less than the output, there’s an imbalance between what goes in and what comes out of your body. It’s very common in summer mainly because of vomiting and diarrhoea. When children have viral infections, we call it viral gastroenteritis. It’s an infection of the tummy and the intestine. Every time they vomit or have diarrhoea, they lose fluids along with electrolytes like sodium, potassium, chloride, bicarbonate and other important salts in the body.”

Symptoms:

Dehydration is seen when there is excessive vomiting and frequent passing of watery stools and getting exposed to extreme high temperatures which can cause heat stroke also. Dr BK Vishwanath Bhat highlighted, “Mild dehydration of upto 5% weight loss can be easily managed at home and if the weight loss is 5-10% it’s called moderate dehydration and if the baby is able to take orals then enough liquids can be given. If the baby is not taking enough liquids then it needs admission in the hospital. Severe dehydration of >10% weight loss needs admission.”

He added, “Thirsty , Dry mouth and tongue, No tears when crying, No wet diapers for more than two hours, Sunken eyes, cheeks, loss of skin turgor , Sunken soft spot-on top of skull, listlessness or irritability are some of the signs. In severe dehydration one may start losing their consciousness. Summer is the time for gastroenteritis and fever is also part of the symptoms along with vomiting and loose motion.”

Since it is caused by reduced water in the body, Dr Shashidhar Vishwanath pointed out that initially, children feel more irritable, thirsty and eventually they become more tired and end up being lethargic. He revealed, “They pass less and less urine. In extreme cases the child may become quiet and may be unresponsive too, but this is in very rare cases. They also pass much less urine and may also have fever because it’s a sign of infection. These are some of the signs of dehydration.”

Dr Shashidhar Vishwanath added, “As the dehydration progresses, their tongues and lips become dry, and their eyes look sunken. The eyes are quite deep inside their socket. If it progresses further, the skin becomes less elastic, losing its natural softness. This condition is called ‘Reduced Skin Turgor’. Eventually, the body stops passing urine because the body tries to conserve whatever fluid is left. Not passing urine is one of the key signs of dehydration.”

Treatment:

According to Dr BK Vishwanath Bhat, mild dehydration is treated at home with ORS. He elaborated, “Moderate Dehydration can be treated at home with ORS and if the child is not tolerating oral feeds, he/she may need admission for IV fluids. Severe dehydration needs admission and IV fluids. Probiotics and zinc supplements have minimal role in treatment of dehydration. Antibiotics are given in bacterial infections. By drinking lots of fluids we can prevent Dehydration in summer months.”

Dr Shashidhar Vishwanath too was of the opinion that mild dehydration is quite common and easily treatable at home itself. He advised, “When the baby or the child is drinking less or eating less, the first step is to make sure the child is drinking enough liquids. Don’t worry much about solid food. Make sure you keep giving them liquids. Water can be a good first option but it’s better to include something with sugar and salt. Mix one packet of ORS with one litre of water and keep giving it as required. There’s no specific quantity.”

He suggested that as long as the child is drinking, you can give it but in cases where the vomiting is severe and the child is unable to keep the liquids down, then you must consult a paediatrician to assess what is happening and medicate the child to reduce the vomiting. Dr Shashidhar Vishwanath alerted, “In some cases, even when they are given fluids and vomiting does not stop after giving oral medicines, then the child might have to be admitted to the hospital for an intravenous rehydration. The child has to be put on a drip for giving fluids through the drip. We give a special fluid which has salt as well as sugar.”

He said, “The idea of intravenous (IV) rehydration is to make sure that whatever fluid the body loses, it’s replaced through the IV. When there is severe vomiting or diarrhoea, an intravenous rehydration is helpful because it gives rest to the stomach. I want to reiterate that only about 1/3 of the children who need fluid therapy need to come to hospital and the rest actually can be managed at home.”

Managing tips for parents:

Since dehydration is quite common and during the peak of summer, almost 30% of patients who go to doctors are for dehydration, parents need to be aware about the health condition and watch out for its symptoms. However, Dr Shashidhar Vishwanath said that parents should not worry too much when the solid food intake is lesser instead, they should focus on the child’s liquid intake. He said, “When children are unwell, they won’t feel like eating solid food. They prefer to have something liquid. Parents can give them water, home made juice, home prepared ORS solution or tetra packs of ORS solution that you get in pharmacies.”

Dr Shashidhar Vishwanath listed the warning signs that a parent should be aware of. These include:

1. When the child is excessively lethargic, tired or excessively irritable

2. When the child has not passed urine for 17-18 hours.

3. When there is continuous vomiting and diarrhoea it’s better if they are analysed by the paediatric team.

He advised, “Other precautions include hygienic food, proper hygiene, handwashing before eating, and handwashing after using the bathroom, especially if someone in the household has vomiting or diarrhoea. It’s important to maintain hand hygiene. It’s best to avoid eating out at places where hygiene is questionable and more importantly, parents must be aware of the signs and symptoms of severe dehydration wherein they know when to get the child to the hospital.”