Department of Emergency Medicine | Dehydration

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In young children, mild to moderate dehydration can happen very easily, particularly if the child has been in hot weather without drinking a sufficient amount of fluids, or if she has been experiencing diarrhea and/or vomiting. Timely and appropriate care is crucial in the assessment and management of dehydration in children because inadequate treatment can lead to serious, but preventable, complications.

Although prevention is ideal, in some cases—like with excessive vomiting and diarrhea brought on by a bad “stomach flu”—dehydration is challenging to prevent. Making an accurate assessment that the child is dehydrated, or at serious risk of becoming dehydrated, is the single most important factor in making and carrying out the proper treatment decisions.

Assessing dehydration

If you suspect a child may be dehydrated, performing a thorough history and physical examination should be enough to confirm the diagnosis, help determine its cause and establish its severity. Factors like sunken eyes, crying without tears, lethargy, decreased frequency and/or volume of urination and fussiness are some of the signs of dehydration in children.

Depending on the situation, a provider may perform the following tests to determine whether there is an underlying cause to the child's dehydration:

  • blood count to determine the presence of a serious infection
  • blood cultures to identify the type of bacterial infection
  • blood chemistry to identify any electrolyte abnormality
  • urinalysis to identify bladder infection, give evidence of severity of dehydration and/or identify sugar and ketones in urine (indicating inadequately treated diabetes)

Managing dehydration in children 

Children who are dehydrated should begin treatment with oral re-hydration solutions (ORS), which help replace not just water, but also lost sugar, salts and minerals. Fluids should be administered every five to ten minutes, even if child continues to vomit. At Boston Children's Hospital, we commonly recommend Pediatlye®, white grape juice, apple juice, or popsicles as ORS. Plain water is not recommended, as a child can develop a low blood sugar level if she is only drinking water and not eating and drinking anything else.

If after 30 minutes to an hour all re-hydration attempts have failed—meaning the child continues to vomit or is simply not drinking an adequate volume of fluids—medication may be administered. One common medication used for children with vomiting is ondansetron (Zofran®), an anti-emetic that comes as a solution, tablet or orally-dissolving tablet. The tablet does not need to be swallowed—it can just be placed in the in the mouth—making it a good option for children who are actively vomiting. If a child has severe dehydration, is still not drinking adequately, or continues to vomit, an intravenous (IV) line may be placed to get fluids directly into the child's system. If symptoms persist, admission to a hospital may be needed so the patient can receive fluid, orally or intravenously, for a longer period of time.

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