What is the treatment for dehydration in children?

Treatment of Dehydration in Children

Oral rehydration therapy (ORT) is the preferred first-line treatment for mild to moderate dehydration in children, while intravenous fluids should be reserved for severe dehydration cases. 1, 2

Assessment of Dehydration Severity

The severity of dehydration should be assessed using a combination of clinical signs:

• Mild dehydration (3-5% fluid loss):

  • Thirst
  • Slightly dry mucous membranes
  • Normal capillary refill (<2 seconds)

• Moderate dehydration (6-9% fluid loss):

  • Dry mucous membranes
  • Decreased tears
  • Prolonged capillary refill (2-3 seconds)
  • Decreased skin turgor
  • Sunken eyes

• Severe dehydration (≥10% fluid loss):

  • Abnormal respiratory pattern
  • Significantly prolonged capillary refill (>3 seconds)
  • Very poor skin turgor
  • Altered mental status
  • Signs of shock (tachycardia, hypotension)

Weight loss is the most accurate indicator of dehydration severity when pre-illness weight is available 2, 3.

Treatment Algorithm

1. Mild to Moderate Dehydration

• First-line: Oral Rehydration Therapy

  • Use commercially available oral rehydration solutions (ORS)
  • For mild dehydration, half-strength apple juice followed by preferred liquids can be effective 4
  • Administer 50-100 mL/kg over 3-4 hours 1
  • For each liquid stool, administer 10 mL/kg of ORS 1
  • For each episode of vomiting, administer 2 mL/kg of ORS 1

• Technique for vomiting children:

  • Administer small amounts frequently (1 teaspoon every 1-2 minutes) 3
  • Gradually increase volume as tolerated

• If vomiting persists:

  • Consider ondansetron to improve ORS tolerance 4
  • Avoid antimotility agents like loperamide in children <18 years 1

2. Severe Dehydration

• Immediate intravenous rehydration
  • Continue until pulse, perfusion, and mental status normalize 1
  • Initial fluid bolus: 20 mL/kg of isotonic crystalloid
  • Reassess and repeat boluses as needed
  • After stabilization, transition to maintenance fluids

3. Nutritional Management

• Continue feeding during rehydration:

  • Maintain breastfeeding throughout the illness 1
  • Resume age-appropriate diet during or immediately after rehydration 1
  • Offer food every 3-4 hours 1
  • Avoid foods high in simple sugars and fats 1

• For formula-fed infants:

  • Full-strength formulas can be safely reintroduced immediately after rehydration 1
  • Consider lactose-free formulas if lactose malabsorption is suspected 1
  • May need increased caloric intake (120-150 kcal/kg/day) for catch-up growth 1

Special Considerations

• Nasogastric tube feeding should be considered for children unable to meet nutritional requirements orally 1

• Avoid inappropriate fluids such as cola drinks, which contain too little sodium and excessive sugar that may worsen diarrhea 3

• Hypernatremic dehydration requires more gradual correction to prevent cerebral edema 5

Prevention Strategies

• Hand hygiene is crucial after using toilet, changing diapers, and before preparing food 1

• Rotavirus vaccination reduces incidence of gastroenteritis and subsequent dehydration 1, 4

• Continued breastfeeding reduces severity of diarrheal illness 3

• Home preparation - parents should keep ORS sachets at home with written instructions for use 3

Common Pitfalls to Avoid

1. Underutilizing oral rehydration therapy - ORT is as effective as IV fluids for mild to moderate dehydration but is often underused 2, 5

2. Delaying refeeding - early reintroduction of normal diet shortens illness duration 1, 3

3. Using inappropriate fluids for rehydration such as sports drinks or sodas 3

4. Administering antimotility medications to children under 18 years, which can be harmful 1

5. Failing to recognize severe dehydration requiring immediate IV therapy and hospitalization 4