In the previous blog, “How much water is enough for my child?”; we discussed about the importance of water in the life of a child and how much water is really needed for your child to stay healthy and hydrated.
In succession to the same, this one deals with what really would happen if your child does not take in the required amount of fluids and if the situation arises, what are the steps to deal with it.
Let’s start off with ‘what is dehydration?’
In the simplest of terms, by breaking down the word we get ‘de’- which means removal and ‘hydration’, derived from the word hydros which means water. So simply put, dehydration is the removal or loss of water from the body.
Now, medically there are different factors and variables associated with the term dehydration, but in the large sense it simply means what has been mentioned above.
Although, it can’t be stressed enough that dehydration maybe associated with loss of electrolytes or imbalance of electrolytes, which is a major reason for many signs and symptoms of dehydration and is hence, potentially life-threatening.
Causes of dehydration:
Diarrhoea and vomiting are the two major causes of dehydration (these may be due to various underlying disorders like gastroenteritis, congenital disorders like pyloric stenosis, and thyroid disorders like thyrotoxicosis among others.)
Reduced intake, due to oropharyngeal disorders like mouth ulcers, stomatitis, pharyngitis, tonsillitis etc.
Disorders of the adrenal gland responsible for major electrolyte imbalances. Juvenile Diabetes leading to ketoacidosis, diabetes insipidus (excessive output of watery urine)
Excessive losses due to burns, fever and heat stroke are also very commonly implicated.
Excessive sweating in tropical countries when associated with any of the above mentioned causes may act as a precipitating factor. It may however also be the only cause in a few cases when accompanied with decreased intake.
Effects of Dehydration (signs and symptoms):
Dehydration can be classified into three grades: mild, moderate and severe.
The effects of dehydration vary according to the grade and so does the management.
The clinical assessment by a doctor includes various examinations and a few investigations if necessary which help in determining the grade and hence the management. However, as parents, there are a few signs and symptoms that must alert you about the possibility of your child being dehydrated.
These include:
A) In the early stages (Mild/Moderate)
Restlessness or irritability
Sunken eyes
Excessive thirst or drinking eagerly
Skin turgor is assessed by pinching the skin of the abdomen or thigh longitudinally between the thumb and the bent forefinger.
-Normal: skin fold retracts immediately.
-Mild or moderate dehydration: slow; skin fold visible for less than two seconds.
Mild loss of body weight, between 1-10% of the total body weight.
The mucus membranes of the body (esp. Mouth) may appear dry in moderate dehydration.
Urine output might also be reduced in Moderate dehydration, while it might be normal in Mild dehydration.
B) Severe Dehydration: (red flag signs**)
Abnormally sleepy or lethargic.
Sunken eyes.
Drinking poorly or not drinking at all.
Loss of skin turgor.
The child might cry but the tears will be absent.
No urine output.
Mucus membranes are very dry.
Rapid breathing.
Increased pulse rate.
Cold extremities.
Altered/Decreased consciousness.
Management:
In any case of diarrhoea or vomiting, immediately consult a Doctor. Homoeopathy offers a wide range of medicines for treatment of the same and is safe as well as effective.
Mild dehydration can be managed at home. For this purpose, the parents need to be guided as regards the 3 most important points of management at home:
Give the child more fluids than usual to prevent dehydration. Continue giving fluids till diarrhoea stops. These include ORS, water, gruel etc.
Give the child plenty of food to prevent undernutrition. Breastfeeding should be continued. And the child should be given milk/solid foods according to the age.
If adequate relief is not seen with any of the symptoms like, many watery stools, poor eating or drinking, repeated vomiting, fever or marked thirst; rush the child to a doctor/hospital immediately.
ORS also known as ORAL REHYDRATION SOLUTION, is available in the market with the same name. Be sure to purchase WHO ORS or a brand recommended by the doctor.
Here is a table to show how much is to be given at what age, the recommended amount after each stool and the amount that can be given per day.
AgeAmount of ORS to be given after each stoolMaximum amount to be given per day
Less than 24 months
50-100 ml500 ml/day
2-10 years100-200 ml1000 ml/day10 years and aboveAs much as wanted
2000 ml/day
-Remember to give a teaspoonful every 1-2 minutes for a child below 2 years.
-Give frequent sips from a cup for an older child.
-If the child vomits, wait for 10 minutes. Then give the solution slowly (a spoonful every 2-3 minutes.)
– One pack of ORS should be prepared in 1 litre of water.
– ORS should not be given in cases of persistent vomiting, severe dehydration, altered sensorium and complicated diarrhoea. Such cases require hospitalization and recommended treatment in the presence of experienced healthcare professionals.
Home based ORS solutions: ORS can be prepared at home as well in the following ways:-
1/2 litres of water + 4 teaspoons of sugar + 1/2 tablespoon of salt
1/2 litre of water + 4 teaspoons of sugar + 1-3 pinches of salt + a twist of lemon.
Rice kanji- 2 heaped tablespoons of rice boiled for 10 minutes in 1 litre of water with 1 tablespoon of salt.
Coconut water and buttermilk can also be given on and off.
Dal water, juices etc can also be used. However, the amount of sugar needs to be controlled in juices.
“Ways to eat your water”
Moderate dehydration requires hospital based treatment usually.
Start with 100 ml/kg of ORS in the first 4 hours.
Reassess after 4 hours. If improved: home based treatment as mild dehydration can be continued, if not: IV fluids need to be considered.
For severe dehydration hospital based treatment is a must with IV fluids.
In all of the above mentioned cases, treatment of the underlying cause is of utmost importance and hence, consulting a doctor is a must.
I will conclude by saying that prevention is better than cure. So maintain good hygiene, keep hydrated, keep your child engaged with interesting versions of healthy & nutritious food and follow the advice of your Paediatrician always!
Watch out for the upcoming blogs on topics related to paediatrics and mother’s health.
Till then, stay healthy, stay happy :).
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