Signs of Dehydration in Infants and Children

6 minute read

By: Dr Tarek Sari (Paediatric and Family Chiropractor)
BChiro Sc, MChiro, DACCP, CGFI TPI(USA)

Why is it important to know the clinical signs of dehydration? The answer is simple. Dehydration can kill a child and even an adult and it is a condition that can be easily avoided if we knew the signs and what to do when we are dehydrated. So first let’s begin with the definition of dehydration. Dehydration is defined as:

 

“The condition that results from excessive loss of body water. In severe acute malnutrition, dehydration is caused by untreated diarrhoeal disease which leads to the loss of water and electrolytes.” [1]

 

In other words, it’s a condition whereby your body has lost a lot of its body water and essential salts (electrolytes). Knowing this now let us look at some of the clear signs of dehydration:

        • Abnormal skin turgor: a healthy child or adult should have hydrated skin. When you pinch their skin, their skin should snap back to its normal position immediately. However if you pinch their skin and its stays pinched or looks like a little “tent” or takes more than 2 seconds for the skin to return to its position than this is a clear sign that the child is severely dehydrated and needs medical attention! If it snap back in under 2 seconds than this is a sign that the child is suffering moderate dehydration.

 

        • Abnormal respiratory pattern: We all know what our children normal breathing rate. Just look at the child every day and that can be classified as our normal breathing or respiratory rate. If the child is suffering from mild to moderate dehydration the respiratory rate can be normal or will start to be intensified. A close eye needs to be paid attention to how the child is breathing because this is an important sign to assess how healthy your child is. If their breathing becomes deep and acidotic than this is a clear sign of severe dehydration where urgent medical attention is required!

 

        • Weak pulse: Similar to the respiratory rate one must assess their children’s pulse to identify what is normal for that child. In mild to moderate dehydration one will notice the pulse rate of the child starting to become elevated. In a severely dehydrated child their pulse rate will become fast, or otherwise known as tachycardia. This is an abnormally rapid heart rate and is a sign the child is in clear distress and needs urgent medical attention!

 

        • Cool extremities: Your child’s hand and feet should always remain warm. When dehydration happens in a child can notice in some that their hands and feet start to become cool or cold. In some instances you may also notice a colour change whereby their hands and feet start to become pale and in some instances turn bluish. This is an urgent medical referral and needs medical attention!

 

        • Poor capillary refill: This is an easy test and can be quite reliable especially when done in conjunction with the signs mention above. Capillary refill basically means when you apply pressure to an area and that area turns white (such as the sole of the foot), how long does it take for that white area to return to red or its natural colour. So we use the sole of the foot generally for the child. If you press on the heel of the foot for example with mild pressure you will notice that the heel of the foot where your thumb was will turn white. A normal or healthy capillary refill is when that area turns red or back to its normal colour in under 2 seconds. More than 2 or 3 seconds is an unhealthy response and can be a sign of dehydration which if seen with other signs is a cause for immediate medical attention! [2]

 

Other Indications to keep an eye out on and seek medical assistance when caring for a child at home are when you see the following:
  1. Sunken fontanelle; your health professional will assess for this.
  2. Dry mouth; as we know the mouth is an area that is normally moist. A dry mouth can be a sign of dehydration.
  3. Absence of tears; if dehydrated your child will look and feel unwell. Some will even cry. If they cry with no tears than this is a sign of dehydration.
  4. Sunken eyes; this is quite an obvious sign and your child will look unwell.
  5. Poor overall appearance; sometimes the parents gut instinct is quite accurate. If the parent looks at his/her child and sees them unwell then more often than not that child IS unwell.
  6. Abnormal breathing ; this was covered above and is a sign not to be missed as abnormal breathing is also a sign of other potential serious childhood illnesses.[2]

 

Knowing all this, when is your child at the heightened risk of being dehydrated? As per the definition at the start your child is at a heightened risk of malnutrition when they are suffering from malnutrition which sadly still occurs in many countries across the world and when they are not being treated for a diarrhoeal disease; such as gastroenteritis (gastro) or food poisoning. In this case hydrating your child is critical and your medical health professional can go into steps to best hydrate your child.

 

In Conclusion, we have covered some important signs of dehydration so onemust now remember that: Dehydration KILLS!
Measurement of the vital signs should not delay any urgent therapeutic intervention that the serious ill child may need. [3]

 

References

  • Dorland. Dorland’s illustrated medical dictionary. Philadelphia, W.B Saunders, 2007
  • Green R, Jeena P, Wells M. Management of acute fever in children: Guideline for community healthcare providers and pharmacists. SAMJ, Dec 2013, Vol.103, No 12, p. 951-952.
  • Meyburg J, Bernhard M, Hoffmann G, Motsch J. Principles of Pediatric Emergency Care. Dtsch Arztebl Int 2009; 106(45): 745

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