What is the recommended daily fluid intake for a healthy 1‑year‑old child (approximately 10 kg) and how should hydration be managed if the child develops vomiting, diarrhea, or fever?

Hydration for 1-Year-Old Children

Daily Fluid Requirements for Healthy 1-Year-Olds

For a healthy 1-year-old child weighing approximately 10 kg, the recommended daily fluid intake is 1000 mL (100 mL/kg/day), calculated using the Holliday-Segar formula. 1

Calculation Method

• First 10 kg of body weight: 100 mL/kg/day 1
• For a 10 kg child: 10 kg × 100 mL/kg = 1000 mL per day 1
• This translates to approximately 40-45 mL/hour of total fluid intake 1

Sources of Daily Fluids

• Breast milk or whole milk (primary source for 1-year-olds) 1
• Water (plain, unflavored) 1
• Age-appropriate foods with high water content 1
• Avoid caffeinated beverages, soft drinks, and undiluted fruit juices as primary hydration sources 2

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Management of Dehydration During Illness

Assessment of Dehydration Severity

Evaluate hydration status through specific clinical signs before initiating treatment: 2

• Mild dehydration (3-5% fluid deficit): Slightly dry mucous membranes, normal mental status, normal vital signs 2
• Moderate dehydration (6-9% fluid deficit): Dry mucous membranes, loss of skin turgor with tenting, decreased urine output 2
• Severe dehydration (≥10% fluid deficit): Severe lethargy or altered consciousness, prolonged skin tenting (>2 seconds), cool extremities with poor perfusion, rapid deep breathing 2

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Rehydration Protocol for Vomiting and Diarrhea

Oral Rehydration Solution (ORS) - First-Line Treatment

Begin oral rehydration solution immediately using small, frequent volumes (5 mL every 1-2 minutes via spoon or syringe), which successfully rehydrates >90% of children with vomiting and diarrhea. 2

For Mild Dehydration (3-5% deficit):

• Administer 50 mL/kg ORS over 2-4 hours 2
• For a 10 kg child: 500 mL total over 2-4 hours 2

For Moderate Dehydration (6-9% deficit):

• Administer 100 mL/kg ORS over 2-4 hours 1, 2
• For a 10 kg child: 1000 mL total over 2-4 hours 1, 2

Replacing Ongoing Losses:

• Give 10 mL/kg (100 mL) for each watery stool 1, 2
• Give 2 mL/kg (20 mL) for each vomiting episode 1, 2

Critical Technique for Vomiting Children

Start with 5 mL every 1-2 minutes using a spoon or syringe, gradually increasing volume as tolerated without triggering more vomiting. 2 This slow, controlled approach prevents overwhelming the stomach and allows successful oral rehydration even with persistent vomiting 2.

When to Use IV Rehydration

Reserve intravenous fluids for severe dehydration (≥10% deficit), altered mental status, shock, or failure of oral rehydration after appropriate trial. 2

• Administer 20 mL/kg boluses of normal saline or lactated Ringer's until pulse, perfusion, and mental status normalize 2
• Transition to ORS once the child improves to replace remaining deficit 2

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Nutritional Management During Illness

Feeding During Rehydration

Resume age-appropriate normal diet immediately during or right after rehydration—do not withhold food or use restrictive diets. 1, 2

Recommended Foods:

• Starches and cereals 1
• Yogurt 1
• Fruits and vegetables 1

Foods to Avoid:

• High simple sugar foods (soft drinks, undiluted juice) - worsen diarrhea through osmotic effects 1, 2
• High-fat foods 1
• Caffeinated beverages 2

Formula Management

Continue full-strength formula immediately upon rehydration. 1 Do not dilute formula or switch to lactose-free products unless true lactose intolerance is confirmed by clinical worsening (more severe diarrhea) when lactose-containing formula is reintroduced 1.

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Fever Management and Fluid Adjustments

Increase baseline fluid intake by approximately 10-20% during fever to compensate for increased insensible losses. 1

• For a 10 kg child with fever: increase from 1000 mL/day to 1100-1200 mL/day 1
• Monitor for signs of dehydration more closely during febrile illness 2
• Continue ORS replacement for any vomiting or diarrhea episodes using the 10 mL/kg and 2 mL/kg guidelines 1, 2

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Red Flags Requiring Immediate Medical Attention

Seek emergency care immediately if the child develops: 2

• Severe lethargy or altered consciousness 2
• Prolonged skin tenting >2 seconds 2
• Cool extremities with decreased capillary refill 2
• Rapid, deep breathing (indicating metabolic acidosis) 2
• Bloody stools with fever 2
• Persistent vomiting despite small-volume ORS (5-10 mL every 1-2 minutes) 2
• Absent bowel sounds (absolute contraindication to oral fluids) 2
• No urine output for >8 hours 2

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Common Pitfalls to Avoid

Never use sports drinks, apple juice, or soft drinks as primary rehydration fluids—these lack appropriate electrolyte composition and contain excessive simple sugars that worsen diarrhea 2. Use only reduced-osmolarity ORS (Pedialyte, CeraLyte) 2.

Never give antimotility drugs (loperamide) to children under 18 years—serious adverse events including ileus and deaths have been reported 2.

Never delay rehydration while awaiting diagnostic testing—begin ORS immediately based on clinical assessment 2.

Do not underestimate dehydration in young infants—children under 3 months have higher body surface-to-weight ratio and higher metabolic rate, making them more vulnerable to rapid dehydration 2.