Dehydration in Infants & Children
This winter has been a rough one from an illness perspective. Flu was rampant across the US this year and we are finally seeing a decline in the number of flu cases! Norovirus also ran rampant this winter. With spring right around the corner, comes some of the other viruses that tend to love warmer weather, such as hand, foot, and mouth disease, which tends to peak in the fall and spring. With any illness that makes a child or baby not feel themselves, hydration can be tough. When children don’t feel well, they don’t eat and drink well. While as a provider, I do not get concerned when children’s appetites decrease, but I do get concerned if parents are having difficulty getting fluids in their kids or their kids cannot keep fluids down due to frequent vomiting.
Why do kids get dehydrated easier than adults?
Children and babies have a higher metabolic rate than adults, requiring more hydration to support growth and development. They also have a larger surface area relative to their body volume compared to adults, which means they lose more fluids through sweating and breathing. Combined with their inability to effectively communicate their feelings or needs—especially in toddlers and babies—this creates a perfect storm for dehydration to become a problem.
What illnesses often cause dehydration?
The most common illnesses I saw in primary care that caused dehydration were:
Hand, Foot, and Mouth disease: typically due to sores on the throat that cause pain and therefore children are hesitant to swallow anything
Strep Throat: for the same above reasons
RSV in babies: often the baby’s nose is so stuffy that they cannot breathe well when taking a bottle or a breast. This causes them not to feed well and they become dehydrated quickly.
And the most common….
Stomach Viruses: an example of this is Norovirus which was rampant this year. It causes significant nausea, vomiting, and diarrhea. This is an illness where despite children trying to drink fluids, they may be throwing up everything they are taking in, making it very hard to stay hydrated. Even if they aren’t throwing up, they are nauseous which causes an aversion to fluids and food and/or they are having diarrhea which causes significant fluid loss from the body.
What can you do at home prior to seeing your provider?
If your child is sick, isn’t drinking well, or can’t tolerate fluids, what can you do at home, and when should you see a provider?
First, while we as parents often want to push fluids quickly and aggressively, most sick children can’t handle that. If your child is vomiting, start with small sips of clear liquids. Once they can tolerate a few sips every 10–15 minutes without gagging or vomiting, gradually increase the amount of fluid they take each hour. The same applies to babies: I recommend shorter, more frequent nursing sessions for breastfed babies and smaller, more frequent bottles for bottle-fed babies.
Second, avoid dairy products as much as possible. I know this can be challenging for children who love their milk, but dairy is tough on the stomach and can worsen vomiting. Dairy is fine for children who aren’t vomiting or having diarrhea (such as those with strep throat, hand, foot, and mouth disease, or RSV), though it may increase congestion, so use caution when offering it. One exception: children under 6 months can’t have plain water, so they should continue with their usual formula or breast milk for hydration.
Electrolyte Solutions:
A lot of children do not want to drink water when they feel well, so it can be especially difficult during times of illness. A lot of providers recommend Pedialyte as an electrolyte solution to aid in hydration or watered down Gatorade. While there is nothing wrong with these products, I personally prefer not to provide my children with a lot of added sugar when they are sick as sugar is not inherently helpful to the gut biome in general, but especially not during sickness. My personal favorite electrolyte solution for children greater than 6 months of age is made by Kinder Farms and is called KinderLyte and comes in a ready-to-drink liquid or individual powder packets in multiple flavors. It has much less added sugar than Pedialyte and Gatorade and is naturally colored (no dyes). Additionally, my kids love the taste! We make it into popsicles as well so they feel like they are getting a treat when sick, which also helps to soothe sore throats.
When should you see your provider?
As always, you know your child best. So, if they are not acting themselves and your gut is telling you they need to be checked, they probably need to be checked.
Things I am looking for as a provider to determine if a child is dehydrated and possibly needs IV fluids:
Dry, cracked lips
Dry mucous membranes: their gums and inside of their mouth looks dry or pale
Inability to cry real tears
Child is not peeing at least 3-4x in a 24 hour period
Baby is not wetting at least 3-4 diapers in a 24 hour period
Lethargy: sleeping at unusual times of the day or difficult to wake
These are sure fire signs they need to be seen. Sometimes providers will keep the child or baby in the office for an extended period of time and provide an “oral challenge” where they time out amounts to give the child over a couple of hours and see what they can tolerate. If they tolerate fluids, I would typically provide detailed instructions for the parent to continue increasing fluid amounts as they tolerate it.
Sometimes, if symptoms are severe, your provider may refer you on to a local urgent care or emergency room for IV fluid administration.
Check out my reels @nuanced_newborns about dehydration and let me know if you have dealt with this issue in your child. If so, when did you know it was time to go to the pediatrician?
