Is Your Baby Dehydrated? Check for These Signs

If your baby is dehydrated, it means she's losing too much fluid or not taking enough in. Depending on degree, dehydration can be a life-threatening condition. Learn how to prevent dehydration in babies, how to spot dehydration, how to treat it and when to get medical help.

What is dehydration?

Dehydration is "drying out" of the body due to the loss of water and electrolytes (i.e. mineral salts such as sodium, potassium and chloride) which are essential for normal body functions.

Dehydration can be mild, moderate or severe. Mild dehydration is the loss of no more than 5% of the body's fluid. A loss of 5 - 10% is considered moderate dehydration. Severe dehydration, which involves the loss of 10 - 15% of body fluid, is a life-threatening condition that requires immediate medical care.

Signs of dehydration in babies and young children

Signs of dehydration vary depending on the level of fluid and electrolyte loss i.e. mild, moderate or severe dehydration. Signs of dehydration may include the following...

Babies - no wet diapers for 3 hours or more.
Children - passing no urine for more than 6 hours.
Dry or sticky mouth and tongue.
Cracked lips.
Skin that does not flatten when pinched and released.
Sunken fontanel (soft spot on your baby's head).
No tears when crying. (Young babies often cry without tears.)
Listless.
Irritability.
Abnormally sleepy.
High fever.
Skin becomes cold and pale.
Pulse races and breathing becomes rapid.
Sudden loss of weight.

If you suspect your child is dehydrated, call a doctor immediately. Severe dehydration requires hospitalization.

What causes dehydration?

Dehydration occurs when the body loses more fluid than it takes in. Dehydration in babies and children can be due to either or both of the following...

inadequate intake of fluids;
excessive loss of fluids.

Inadequate fluid intake can occur due to...

nausea;
infections of the mouth or throat, i.e. Strep throat, severe tonsillitis, pharyngitis or stomatitis;
acute illness which results in a loss of appetite.

Excessive loss of fluids can occur from...

vomiting;
diarrhea;
excessive urine output, due to medical conditions e.g. kidney disease, diabetes, or poisoning (which includes medications);
heat stroke from prolonged exposure to the sun or high temperatures.

Complications of dehydration

Dehydration can happen very quickly in babies and young children because they have less "extra" fluids in their body to lose.

Complications associated with dehydration vary depending on the level of fluid and electrolyte loss. Complications due to mild dehydration are generally minor and reversible. Complications due to severe dehydration can be permanent and life threatening if dehydration is no corrected quickly.

Complications of dehydration can include...

thirst;
electrolyte imbalance;
confusion;
drowsiness;
loss of consciousness;
hypovolemic shock; (This condition, which is also called 'physical collapse', is characterized by pale, cool, clammy skin. rapid heartbeat and shallow breathing).
temperature rises; (After temperatures reach 107 F (41.7 C) damage to the brain and other vital organs occur quickly).
kidney failure;
severe brain damage;
death.

When to see a doctor

See a doctor if your child...

has any of the signs or symptoms of dehydration mentioned in the list above;
has pain in the stomach along with vomiting;
has blood in the diarrhea;
is under 6 months of age, as soon as vomiting or diarrhea start;
is under 2 years old, if vomiting or diarrhea lasts for more than 12 hours.

What fluids to offer your baby

What are oral rehydration solutions?

Oral rehydration solutions are drinks which are designed for children who are dehydrated. They contain a mixture of water, electrolytes (mineral salts like chloride, sodium and potassium) and sugar, which is necessary for the body to function properly. Oral rehydration solutions are readily absorbed by the body, even when a child continues to vomit.

During episodes of vomiting and diarrhea, oral rehydration solutions can help replenish fluid and electrolytes that have been lost, as well as provide an energy source until your child is well enough to return to a normal diet. (Oral rehydration solutions will not stop the diarrhea illness).

What oral rehydration solutions are available?

There are many different brands of oral rehydration solutions on the market (not all are mentioned below). You may also find generic brands available. Better known brand names include...

Pedialyte
Gastrolyte
Ceralyte
Infalyte
Rehydralyte
Resol
Naturalyte

These are available from drugstores, pharmacies and some supermarkets in...

Ready-to-serve solutions.
Powders (which you add water to).
Frozen pops (for children older than 1 year).

IMPORTANT: Do not add water to ready-to-use solutions. Do not use oral rehydration solutions to dilute infant formula.

Home-made rehydration solutions

Although it is preferable to use commercially produced rehydration products (because the balance of electrolytes and sugar are exact) where cost or inconvenience make it difficult for you to purchase these, you can make a rehydration solution at home using the following ingredients...

1 quart (950ml) water.
1/2 teaspoon baking soda (bicarbonate soda).
1/2 teaspoon table salt.
4 tablespoons of sugar.
1/4 teaspoon salt substitute (such as 'Lite Salt') if available.

Measure ingredients carefully! CAUTION should be taken when offering home-made rehydration fluids which contain salt because too much salt may increase dehydration. Too little salt will cause no harm but will be less effective in treating dehydration.

Are there any side associated with using oral rehydration solutions?

Side effects are rare, but it's worth being aware that they can exist. Side effects, which are related to high levels of sodium, include...

fast heartbeat;
irritability;
muscle twitching;
restlessness;
swelling of the feet or lower legs;
weakness;
convulsions.

PLEASE NOTE: It's important to follow instructions on the label or packaging carefully when preparing oral rehydration solutions to reduce the risk of these side effects developing.

Are oral rehydration solutions necessary?

If your child is vomiting over and over or is refusing breast milk or infant formula, or will not eat solid foods then offering fluid in the form of an oral rehydration solution (which contain both electrolytes and some form of sugar) is the best option.

However, if your child displays no signs of dehydration, is eating his regular diet (including breast milk or formula) and has also stopped vomiting, then offering clear fluids (described below) in addition to his regular diet is all that is necessary while diarrhea continues (because he will receive the electrolytes and sugar he needs from his milk and food).

Can I use other fluids?

Where your child is tolerating breastfeeds, infant formula or solid foods, water or other fluids given at a diluted strength can be use to replace fluid lost while diarrhea continues. These include...

Lemonade or cola (not low calorie) 1 part to 4 parts water.
Sucrose (table sugar) 1 teaspoon to 4 ounces (120ml) water.
Glucose 1 teaspoon to 4 ounces (120ml) water.
Cordials (not low calorie) 1 part to 6 parts water.
1 cup juice (unsweetened pure fruit juice) mixed with 4 cups of water.

If your child is refusing to drink additional fluids try the following...

Gelatin water can be substituted for oral rehydration solutions. Dilute a 3-ounce package in 1 quart (950ml) water.

Is there anything that should be avoided?

Providing the right balance of salts (electrolytes) and sugars in the fluids you offer is important. At full strength the following fluids, which are okay when your child is well, have the wrong amounts of water, salts and sugar to be used to assist with rehydration when your child is unwell. These can potentially make your child's diarrhea worse and increase the risk of dehydration.

Fruit juice/drinks.
Sodas i.e. lemonade, ginger ale or Sprite®.
Pops e.g. Icy Poles®.
Cordials e.g. Kool-Aid®.
Sports drinks e.g. Lucozade®, Gatorade®.
Sweetened tea.
Broth.
Rice water.
Jelly e.g. Jello-O®.

Preventing dehydration when your child has a gastro-intestinal infection

The most common cause of dehydration in babies and children is because of fluid and electrolyte loss during an episode of a viral gastro-intestinal infection (also known gastroenteritis, infectious diarrhea, stomach flu).

Encouraging your child to drink plenty of fluids, to replace fluid lost from vomiting and/or diarrhea, during these periods of illness may prevent the development of severe dehydration.

While your child is vomiting

If your child vomits only once, and has no other signs of illness, there is no need for any special treatment, simply continue with his present diet. However, if your child vomits repeatedly it is recommended to avoid milk* and other foods and offer oral rehydration solutions (described above) until the vomiting settles. (Usually, after it's empty the stomach only attempts to vomit a further 3 or 4 times.)

* Breastfeeding should be continued where possible.

While your child continues to vomit, small amounts of fluids given frequently are better than large amounts given less often. Start with the following amounts and slowly increase if tolerated.

Under 6 months: 1 - 2 teaspoons of fluid every 5 - 10 minutes.
6 to 24 months: 3 to 4 tablespoons of fluid every 10 - 15 minutes.
Over 2 years: 4 - 8 tablespoons of fluid every 15 - 20 minutes.

After 8 hours without vomiting, you can start your child back onto infant formula. If formula (or breast milk) is tolerated, then return your child to solid foods (that is if he has been eating solids in the past). Rehydration fluids should not replace formula or solid foods for more than 24 hours.

PLEASE NOTE: Spitting up, which occurs with gastro-esophageal reflux is mistaken as vomiting.

While your child has diarrhea

Children often experience episodes of diarrhea without vomiting. Many children with diarrhea continue to have a good appetite. If your child is not vomiting there's no need to hold back on his regular diet (i.e. breastfeeds, formula or solids).

If your child has an appetite and is tolerating his regular diet, offer fluids (described above) in addition to his regular diet until the diarrhea is happening less often.

Offer your baby or child additional fluid every 30 minutes.

If your child lacks appetite and refuses his regular diet, you will need to encourage frequent, small amounts of oral rehydration fluids (described above). As a guide try to offer the following amounts (or more if your child tolerates it)...

Under 6 months: 2 - 4 teaspoons of fluid every 15 minutes
6 - 24 months: 1 - 2 tablespoons of fluid every 20 minutes.
Over 2 years: 2 - 4 tablespoons of fluid every 30 minutes.

When to breastfeed

While your baby is vomiting breastfeed more often, for example every half an hour for 10 minutes on one breast, but for a shorter amount of time, plus offer oral rehydration fluids between breastfeeds.

While your baby has diarrhea offer more frequent breastfeeds (for as long as your baby wants) plus offer clear fluids or oral rehydration fluids between breastfeeds.

Once vomiting and diarrhea settles return to your baby's normal breastfeeding pattern. (You may need to pump or hand express, to empty your breasts and maintain lactation, if your child refuses to breastfeed while he's unwell).

When to bottle feed

While your baby is vomiting infant formula should be stopped. Continue to offer oral rehydration fluids for 12 - 24 hours or until vomiting improves. Once vomiting has stopped for a period of 8 hours, try 1/2 strength formula for 1 or 2 feedings. If this is tolerated, return to normal feedings with regular strength formula. (No more than 2 feeding should be 1/2 strength formula.)

While your baby has diarrhea only continue to offer regular formula. Don't dilute your baby's formula; instead offer oral rehydration fluids regularly between formula feeds. If diarrhea lasts for longer than a week your doctor may recommend using a soy infant formula or lactose-free formula for a few weeks before switching back to your baby's regular formula.

When to offer solid foods

When your child has stopped vomiting for several hours and can keep fluids down, let him try a small helping of solid foods. Never go more than 24 hours without feeding solid foods to your child without consulting your child's doctor.

Even while your child continues to have diarrhea, aim to get him back to a normal diet as soon as possible. The old advice to let the intestines "rest" after a bout of diarrhea is no longer recommended. Food can help the intestines absorb more water, which helps slow down the diarrhea.

What foods to offer

A BRAT diet (i.e. bananas, rice, applesauce and toast) can be a good starting point when your child returns to solid foods after vomiting has stopped but diarrhea continues.

If your child tolerates a BRAT diet, then try cooked carrots, boiled potatoes, mashed vegetables, crackers, bread, cereals, lean meat, chicken or eggs. Yogurt can help to actively treat diarrhea from any cause. (Yogurt contains 'probiotics' such as Bifidus and Acidophilus, which are friendly bacteria).

Foods to avoid

High-fiber foods.
Sweet foods.

DISCLAIMER: This information should not be used as a substitute for the medical care and advice of your child's doctor. There may be variations in treatment that your child's doctor may recommend based on individual facts and circumstances.

Written by Rowena Bennett