How do you assess skin turgor in a 3-month-old infant?

How to Check Skin Turgor on an Infant

To assess skin turgor in a 3-month-old infant, gently pinch and lift the skin on the abdomen (preferred site in infants) between your thumb and forefinger, then release it and observe how quickly the skin returns to its normal position—normal skin should snap back immediately, while delayed return (>2 seconds) suggests dehydration. 1, 2, 3

Technique for Infants

Preferred Assessment Site

• Use the abdomen as the primary site for skin turgor assessment in infants, as this location provides the most reliable assessment in this age group 1, 2
• The abdomen is preferred over other sites (such as the back of the hand or forearm commonly used in adults) because infant skin has unique physiological properties during its maturation process that affect turgor assessment 4

Proper Pinch Technique

• Gently pinch a fold of skin on the infant's abdomen between your thumb and forefinger 1, 2
• Lift the skin fold slightly upward 2
• Release the skin and observe the time it takes to return to its normal flat position 1, 3

Interpretation of Results

• Normal turgor: Skin returns immediately to baseline (snaps back instantly) 3
• Abnormal turgor (decreased skin elasticity): Skin returns slowly, taking >2 seconds, appearing to "tent" temporarily—this finding has a likelihood ratio of 2.5 for detecting 5% dehydration 3
• Abnormal skin turgor becomes more frequent with increasing severity of dehydration 2

Critical Clinical Context

Limitations of Skin Turgor as Isolated Finding

• Skin turgor should never be used in isolation to assess dehydration status 3
• When used alone, skin turgor has only modest accuracy (LR 2.5) and is insufficient for definitive diagnosis 3
• The precision of skin turgor assessment is limited, making it difficult to estimate exact degrees of dehydration 3

Combine with Other Clinical Signs

• Skin turgor performs markedly better when combined with other physical examination findings 3
• The most useful combination for predicting dehydration includes: abnormal skin turgor, sunken eyes, weak radial pulse, and altered general appearance 2
• Also assess capillary refill time (most useful single sign with LR 4.1) and respiratory pattern (LR 2.0) 3
• Check for sunken eyes, which combined with decreased skin turgor provides strong explanatory power 2

Special Considerations in Infants

• Infant skin is in an active maturation process during the first months of life, with unique characteristics that differ from older children and adults 4
• The skin barrier is still developing during this period, making objective assessment particularly important 4
• Visual assessment alone is unreliable—always perform the actual physical maneuver of checking skin turgor 5

Common Pitfalls to Avoid

• Do not rely on skin turgor as your only assessment tool—it must be part of a comprehensive dehydration evaluation that includes multiple clinical signs 3
• Do not assess skin turgor on the extremities in infants, as the abdomen provides more reliable information 1, 2
• Be aware that the number of dehydration findings increases with severity: median of 3 findings in mild dehydration (<5% deficit), 6.5 in moderate (5-9% deficit), and 9 in severe (>10% deficit) 2
• Historical points and laboratory tests have only modest utility compared to physical examination findings for assessing dehydration 3