Dehydration in Children

Dehydration in Children

Children are particularly at risk of dehydration , more so than adults. Dehydration in children is a much feared condition. It manifests itself with quite specific signs and symptoms ; therefore, it is good to know them, in order to be able to intervene in time in the most appropriate way. As anticipated, in children, the water present in the body represents 80% of the body weight .

To prevent a child from experiencing a state of dehydration it is essential to pay attention to everything that causes a loss of body water and to provide an adequate supply of the nutrient from the outside. For example, it is very important to take into account the consistency of the stools ( prolonged diarrhea leads to a considerable loss of water) or a condition of repeated vomiting ; moreover, it is essential to consider the losses of water which occur through sweating (losses which are affected by factors such as the motor activity of the individual and, especially in the youngest, clothing).

Dehydration in Children: Why is it dangerous?

In both children and adults, dehydration is dangerous for several reasons; here are the ones:

• In a dehydrated body, the sweating mechanism is blocked, in order to save the little water left in the body.
  However, the lack of sweat secretion causes considerable organic overheating, with negative repercussions on the hypothalamic thermoregulatory center (see article on heatstroke ).
• In the presence of dehydration, blood volume decreases; as a result, the blood circulates less well in the vessels , the heart gets tired and, in extreme cases, cardio-circulatory collapse can arise .

Causes

Dehydration in Children: How Does It Happen?

As in adults, dehydration in children can also occur due to:

• An excessive loss of water and fluids , due to profuse sweating , fever , diarrhea and/or vomiting;
• An insufficiency of water intake from the outside , with the diet (i.e. poor hydration ).

Very often, the two situations mentioned above are concomitant, i.e. a large loss of water is not followed by an adequate supply of liquids from the outside.

It is important to point out that, although it may seem the most obvious remedy, the administration of liquids by mouth is not always feasible: this is the case, for example, of a child with vomiting, who is unable to retain any liquid swallowed by mouth.

Causes of Dehydration in Children: What are they?

The most common cause of severe dehydration in children is acute gastroenteritis .
Very rare under three months of age, acute gastroenteritis consists of a violent inflammation of the internal walls of the stomach and intestines , characterized by diarrhea and sustained mostly by viral infections ( Rotavirus , Norwalk virus and Adenovirus ).
It should be noted that vomiting may also be present in the initial stages of this inflammatory condition.

Other causes of dehydration in children include:

• Bacterial gastroenteritis , due to microorganisms such as Salmonella , Escherichia coli , Campylobacter or Clostridium difficile ;
• Type I diabetes ;
• Cystic fibrosis ;
• The malabsorption syndromes . _
  

  Symptoms

  Dehydration: typical symptoms in children

  In infants and children, dehydration typically manifests as:

  • Dry mouth , tongue and mucous membranes in general;
  • Absence of tears during crying;
  • Sunken eyes ;
  • Listlessness and irritability;
  • Lack of energy and lethargy (slowed activity, sleep and difficulty waking up);
  • Cold , dry and inelastic skin;
  • Significant reduction in the frequency of urination ;
  • Dry diaper for more than three hours (it is indicative of infrequent urination in younger children);
  • Sunken fontanelle (in the infant );
  • Tachycardia and tachypnea ;

  • Dehydration in Children: Degrees and Symptoms

    It is possible to distinguish three degrees (or levels ) of dehydration in children:

    • Mild dehydration , in which water loss is 3-5% of total body weight;
    • Moderate dehydration , in which water loss is equal to 6-9% of total body loss;
    • Severe dehydration , in which water loss equals or exceeds 10% of total body weight.

    Mild Dehydration in Children: Symptoms

    Generally, when it is mild, dehydration in children is asymptomatic . This is dangerous because the parents may not be aware of the problem.

    Moderate Dehydration in Children: Symptoms

    In the presence of moderate dehydration, the young patient becomes ill and manifests thirst, irritability, cold, dry and inelastic skin , dry lips and mucous membranes, sunken eyes, reduced lachrymation , reduced frequency of urination and sunken fontanel ( in the infant).

    In the presence of these symptoms, parents should contact the pediatrician immediately .

    Severe Dehydration in Children: Symptoms

    When it is severe, in addition to the previous symptoms, dehydration in children also leads to lethargy, tachycardia (increase in the number of heartbeats ), tachypnea (increase in the number of breaths ) and a lengthening of the capillary refill time.

    At these levels, dehydration is a medical emergency that should be treated in the emergency room . Here, the doctors will first evaluate the conditions of the hydro-salt balance of the little patient; then, subsequently, they will adequately correct the losses of water and salts by means of parenteral infusions (the loss of water leads, in parallel, to a dispersion of salts).

    Dehydration in Children: Associated conditions

    Generally, dehydration in children is associated with (as a consequence of) conditions, such as:

    • Vomit;
    • Diarrhea;
    • Fever greater than 38°C.Strong sense of thirst (this symptom is easier to notice in older children, who are able to express their needs better).

    Diagnosis

    Diagnosis of dehydration in children: how to recognize it

    For the diagnosis of dehydration in children, evaluation of symptoms and signs ( physical examination ), and medical history are essential .

    In particular, the objective examination deserves further study:

    • This investigation makes it possible to trace the degree of dehydration of the young patient; by comparing the child’s usual weight with that measured when dehydration is suspected, in fact, it is possible to calculate the water deficit.
    • Furthermore, during the physical examination, the doctor measures another important parameter for estimating the degree of severity of dehydration: the so-called capillary refill time .
      The capillary refill time (CRT) is a non-invasive diagnostic test, which allows to evaluate systemic perfusion very quickly and consists in compressing the capillary bed ( usually on the palm of the hand or on the fingertip) and counting the time taken for it to reappear of the flow, referring to the change in skin color .
      If the capillary refill time is greater than 2 seconds, it is pathological.
      Individuals in a state of dehydration have a lengthened capillary refill time.

    Clinical Dehydration Scale

    A useful tool for estimating dehydration in children, which doctors use but which can also be useful for parents, is the so-called clinical dehydration scale .
    The clinical dehydration scale takes into consideration the typical symptoms of dehydration in children and assigns them an increasing score from 0 to 2, based on their severity; consider, for example, lacrimation and assign a score of 0, if it is normal, 1, if it is only partially reduced, and 2, if it is absent.

    If the overall result of the various scores assigned to the symptoms is greater than 5, the small patient is in a state of moderate or severe dehydration.

    Treatment

    Dehydration in Children: What to Do?

    Once the severity of the dehydration has been estimated, the next step is to calculate how many fluids to administer to the patient. This operation is easily performed by remembering that a liter of fluid weighs a kilo ; therefore, a 20 kg child with 5% dehydration lost 1 kg of body weight (0.05 x 20 kg = 1 kg); therefore, she has a fluid deficit of one liter.

    In mild to moderate dehydration, oral moisturizing therapy is the method of first choice; it is based on the administration of special hyposmolar drinks , which can be purchased in pharmacies, such as Pedialyte or Infalytr .

    Rehydration  sports drinks can also be used for children over the age of two  .
    The guidelines recommend starting the therapy by administering  orally  ( orally ) 5 ml of rehydrating solution every five minutes, gradually increasing it according to tolerability.
    More generally, it is important to administer small amounts of fluids at very frequent intervals.

    For no reason should you use  carbonated drinks  and  fruit juices , which – being solutions rich in sugar , therefore hyperosmolar – would worsen diarrhea and dehydration.
    Plain water, on the other hand, does not normally contain enough  mineral salts  and can cause electrolyte imbalances, with the risk of  seizures .

    If you don’t have rehydration drinks available, the ideal is to prepare them yourself, dissolving four teaspoons of sugar, half a teaspoon of  salt , half a teaspoon of potassium chloride and half a teaspoon of sodium bicarbonate in a liter of water .

    Normal nutrition should be resumed as soon as the child is able to tolerate it.

    At the hospital level, when the child presents with severe dehydration , or if oral rehydration is not possible due to persistent vomiting, intravenous therapy is used (infused in boluses of 20 ml/kg until shock resolves). ). Vomiting, in itself, does not represent a contraindication to oral rehydration and can be resolved through the use of antiemetics (obviously according to what is recommended by the pediatrician).