Is Your Baby Dehydrated?

Know the Signs and Proper Treatment

If your baby has diarrhea, it's very important that you keep him well hydrated, or you may end up having to go to the emergency room.

Babies, in particular, can get dehydrated very quickly if they have a high output of diarrhea. Their little bodies have relatively small fluid reserves and a high metabolic rate that makes it easy to lose the water and electrolytes the body needs to function. If fluids are not replaced, the outcome can be critical within a matter of days.

Here are some signs of dehydration to watch out for:

• Sleepiness
• Irritability
• Thirst
• Less elasticity in the skin
• Eyes and fontanel (or soft spot on head) appear sunken
• Decrease or absence of tears
• Dry mouth
• Decrease number of wet diapers

For your convenience, print the dehydration chart provided.

Doctors often recommend an oral rehydration solution (ORS) such as Pedialyte, Ceralyte, or Gastrolyte, in small and frequent doses, to get a baby's body rehydrated. Even if the baby is vomiting, parents are encouraged to administer the solution. The aim, according to the National Digestive Diseases Information Clearinghouse, is to prevent the output of fluids from exceeding the intake. The rehydration treatment will not stop the diarrhea, but it will keep the body hydrated until the illness runs its course. A person is considered hydrated if there is a normal urine output -- at least six wet diapers a day in the case of infants and toddlers.

The amount of rehydration fluid you should give your baby depends on her size and the degree of dehydration. According to the Centers for Disease Control (CDC), children weighing less than 10 kg (22 pounds) should drink 60 to 120 ml (2-4 ounces) of ORS for each episode of vomiting or diarrhea. And those weighing more than 10 kg should drink 120 to 240 ml (4-8 ounces) of ORS.

How to Treat Dehydration

The Rehydration Project provides the following rough guide to the amount of ORS needed in the first 4 to 6 hours of treatment for a mildly dehydrated person:

• Up to 11 pounds: 200-400 ml
• 11-22 pounds: 400-00 ml
• 22-33 pounds: 600-800 ml
• 33-44 pounds: 800-1000 ml
• 44-66 pounds: 1000-1500 ml
• 66-88 pounds: 1500-2000 ml
• 88+ pounds: 2000-4000 ml

For quick reference, a rehydration chart is provided at the end of this article.

If acute diarrhea is present, the Food and Drug Administration (FDA) recommends that milk products be withheld for 24 to 48 hours because they may be difficult to digest. However, if you are breastfeeding, you should continue to do so. Infants who are bottle-fed should continue to drink formula diluted to half strength. Young children should not drink soda, juices, or sports drinks such as Gatorade. Unlike ORS, they do not contain the right amount of glucose, sodium, chloride, and potassium to properly balance the electrolyte levels.

As your child improves, the pediatrician may recommend what is called the BRAT diet: bananas, rice, applesauce, and toast.

If you find that your child shows signs of moderate to severe dehydration, you should seek medical attention. Most likely, doctors will draw some blood to check your child's electrolyte levels and prescribe intravenous fluids (IV). Don't be surprise if treatment includes nasogastric (NG) tube feedings, in which a small tube is placed into the child's stomach through the nose so that fluids may be administered.

Lastly, to prevent the spread of the virus that is causing the diarrhea, it is very important to wash your hands very well and often.

Dehydration Chart

Degree of dehydrationPretty ParchedMoodRestless, irritableEyes or soft spot on head

No tears, sunken

Mouth and tongueDryThirstThirsty, drinks eagerlyUrinationLess frequent than normalWhat to doIf your child has two or more of these signs, call your pediatrician, give liquids or an electrolyte solution.

Degree of dehydrationDangerously DehydratedMoodLethargic or not consciousEyes or soft spot on head

Very sunken and dry, no tears

Mouth and TongueVery dryThirstDrinks infrequently or unable to drinkUrinationMinimal or noneWhat to doIf your child has any of these signs, call 911.

Treatment Based on Degree of Dehydration Chart

Degree of dehydrationMinimal or no dehydrationRehydration TherapyJust replacement of losses

Replacement of losses

Children under 22 lbs (10 kg): 2 to 4 ounces (60 to 120 mL) oral rehydration solution (ORS) for each diarrheal or stool or vomiting episode

Children more than 22 lbs (10 kg): 4 to 8 ounces (120 to 240 mL) ORS for each diarrheal stool or vomiting episode

Nutrition

Continue breastfeeding, or resume age-appropriate normal diet after initial hydration, including adequate caloric intake*

Degree of dehydrationMild to moderate dehydrationRehydration TherapyORS, 1.6 to 3.3 oz for each 2 lbs of body weight (50 to100 mL per kg body weight) over 3 to 4 hoursReplacement of losses

Children under 22 lbs (10 kg): 2 to 4 ounces (60 to 120 mL) oral rehydration solution for each diarrheal or stool or vomiting episode

Children more than 22 lbs (10 kg): 4 to 8 oz. (120 to 240 mL). ORS for each diarrheal stool or vomiting episode

NutritionContinue breastfeeding, or resume age-appropriate normal diet after initial hydration, including adequate caloric intake*

* Overly restricted diets should be avoided during bouts of diarrhea. Breastfed infants should continue to nurse even during acute rehydration. Infants too weak to eat can be given breast milk or formula by medical personnel through a tube. Lactose-containing formulas are usually good. If the baby can't absorb lactose-based formula, lactose-free formulas can be used. Complex carbohydrates, fresh fruits, lean meats, yogurt, and vegetables are all recommended. Carbonated drinks or commercial juices with a high concentration of simple carbohydrates should be avoided.

• Source: Managing Acute Gastroenteritis Among Children