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Infants and children are more likely to become dehydrated than older adults because they tend to lose more fluids quickly¹.  It is most likely due to a febrile illness, excessive vomiting or diarrhea, diseases causing excessive urination, or exposure to hot weather².

Signs of dehydration include³: 

1. Sunken eyes and decreased tearing 
2. Decreased frequency of urination/ dry diapers
3. Dark urine
4. Sunken soft spot on the front of the head in babies (fontanel)
5. Decreased activity 
6. Increased fussiness and crying
7. Their mouth and tongue seem dry and sticky
8. Their breathing and heart rate can speed up 
9. Their arms and legs can feel cool to the touch
10. Their capillaries are slow to fill. You can test this by pressing on the nail bed of one of their fingers until the nail whitens. If it takes more than two seconds for the nail to return to its normal pink color, the child is becoming dehydrated.
11. They have a slow skin turgor response. To check this, gently squeeze a fold of skin on the belly, hold it for a few seconds, and release. If it takes longer than two seconds for the skin to return to normal, the child is becoming dehydrated.

The most suitable and preferred fluid replacement for children are called "oral rehydration solutions," or ORS which are designed to replace fluids, sugar, and electrolytes⁴. Try to give small sips (5-10ml) slowly every few minutes, using a teaspoon or a syringe if needed, over 3 to 4 hours as tolerated. For a breast-fed infant, reduce the amount per feeding but increase the frequency of nursing sessions. If not tolerated, you can give an ORS trial or bring him/her to the emergency room. Sodas and juices must be avoided. If sports drinks are to be used in older children, they must be first diluted with water.⁵

Bring your child to the emergency room for intravenous access if:⁶

1. Your child doesn’t appear to be recovering and shows signs of extreme sleepiness and decreased responsiveness, no urine output for 8 hours, cold extremities, extremely dry mucous membranes 
2. Your child is having excessive loss of fluid but refuses to drink or have an oral rehydration solution
3. Young infants, since they might deteriorate quickly if fluid losses could not be replenished 

Dr. Dany Hamod

Pediatric, Neonatologist

¹ eMedicineHealth. 2020. How Do You Know If A Child Is Dehydrated? Signs, Symptoms & Home Remedies. [online] Available at: <https://www.emedicinehealth.com/dehydration_in_children/article_em.htm> [Accessed 21 October 2020].

² Mayo Clinic. 2020. Dehydration - Symptoms And Causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086#:~:text=The%20most%20common%20cause%20of,increase%20the%20risk%20of%20dehydration.> [Accessed 21 October 2020].

³ Cleveland Clinic. 2020. Dehydration In Children: Signs, Treatments. [online] Available at: <https://my.clevelandclinic.org/health/articles/8276-dehydration-and-your-child> [Accessed 21 October 2020].

⁴ Canavan, A. and Billy S. Arant, J., 2020. Diagnosis And Management Of Dehydration In Children. [online] Aafp.org. Available at: <https://www.aafp.org/afp/2009/1001/p692.html> [Accessed 21 October 2020].

⁵ Kidshealth.org. 2020. Dehydration (For Parents) - Nemours Kidshealth. [online] Available at: <https://kidshealth.org/en/parents/dehydration.html> [Accessed 21 October 2020].

⁶ Emedicine.medscape.com. 2020. Pediatric Dehydration Treatment & Management: Approach Considerations, Mild Volume Depletion, Moderate Volume Depletion. [online] Available at: <https://emedicine.medscape.com/article/801012-treatment> [Accessed 21 October 2020].