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Dehydration in Children

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Introduction

Importance of Water and Dehydration

L’water it is a substance and a nutrient fundamental for the human organism. It is no coincidence that, without being able to count on it, human beings are only able to survive for a few days.

Water is the main constituent of the human organism: in fact, it represents between 50 and 80% of the body weight of a human being (50%, in elderly people, and 80%, in children).

The importance of water is obviously to be found in its functions, which are:

The lack of water in the human organism is called dehydration.
Associated with one loss of saltsdehydration is a condition very dangerous: a decrease of 6-7% in total body water, in fact, is enough to endanger the survival of human beings.

To know more:
Dehydration: What is it?

Dehydration in Children

I children are particularly subject to risk of dehydrationmore than adults.
Dehydration in children is a much-feared condition.
It manifests itself with quite specific signs and symptoms; therefore, it is good to know them, in order to intervene in the most appropriate way in time.
As anticipated, in children, the water present in the body represents 80% of body weight.

To prevent a child from becoming dehydrated, it is essential to pay attention to everything that causes a loss of body water and provide an adequate supply of the nutrient from the outside. For example, it is very important to take into account the consistency of the stool (the presence of prolonged diarrhea leads to a significant loss of water) or a condition of repeated vomiting; furthermore, it is essential to consider the losses of water that occur through sweating (losses which are affected by factors such as the individual's motor activity and, especially in the little ones, clothing).

Dehydration in Children: Why is it dangerous?

In both children and adults, dehydration is dangerous for several reasons; here are the ones:

  • In a dehydrated organism, the sweating mechanism stops, in order to save the little water left in the body.
    The lack of sweat secretion, however, causes significant organic overheating, with negative repercussions on the hypothalamic thermoregulatory center (see article dedicated to heat stroke).
  • In the presence of dehydration, blood volume is reduced; as a consequence, the blood circulates less well in the vessels, the heart becomes tired and, in extreme cases, cardiovascular collapse can occur.

Cause

Dehydration in Children: how does it happen?

As in adults, dehydration in children can also occur as a result of:

Very often, the two situations mentioned above are concomitant, i.e. a significant loss of water is not followed by an adequate supply of liquids from the outside.

It is important to point out that, although it may seem like the most obvious remedy, the administration of liquids by mouth is not always feasible: this is the case, for example, of a child with vomiting, who is unable to retain any liquid ingested by mouth.

Causes of Dehydration in Children: What are they?

The most common cause of severe dehydration in children is acute gastroenteritis.
Very rare under three months of age, acute gastroenteritis consists of a violent inflammation of the internal walls of the stomach and intestine, characterized by diarrhea and supported mostly by viral infections (Rotavirus, Norwalk virus e Adenovirus).
It should be noted that in the initial stages of this inflammatory condition, vomiting may also be present.

Other causes of dehydration in children include:

To know more:
Rotavirus: What is it?

Symptoms

Dehydration: Typical Symptoms in Children

In infants and children, dehydration typically manifests as:

  • Dryness of the mouth, tongue and mucous membranes in general;
  • Absence of tears when crying;
  • Sunken eyes;
  • Listlessness and irritability;
  • Lack of energy and lethargy (slowed activities, sleep and difficulty waking up);
  • Cold, dry and inelastic skin;
  • Significant reduction in urination frequency;
  • Dry diaper for more than three hours (indicates infrequent urination in younger children);
  • Sunken fontanel (in infants);
  • Tachycardia and tachypnea;
  • Significant sense of thirst (this symptom is easier to notice in older children, who are able to express their needs better).

To know more:
Symptoms of Dehydration

Dehydration in Children: Degrees and Symptoms

It is possible to distinguish three degrees (o levels) of dehydration in children:

  • Degree dehydration lievewhere the water loss is equal to 3-5% of total body weight;
  • Degree dehydration moderatein which the water loss is equal to 6-9% of the total body weight;
  • Degree dehydration severein which water loss is 10% or more of total body weight.

Mild Dehydration in Children: Symptoms

Generally, when it is mild, dehydration in children is asymptomatic. This is dangerous, because parents may not realize the problem.

Moderate Dehydration in Children: Symptoms

In the presence of moderate dehydration, the little patient becomes suffering and shows thirst, irritability, cold, dry and inelastic skin, dry lips and mucous membranes, sunken eyes, reduced tearing, reduced frequency of urination and a sunken fontanel ( in the infant).

If these symptoms occur, parents should contact their pediatrician immediately.

Severe Dehydration in Children: Symptoms

When severe, in addition to the previous symptoms, dehydration in children also causes lethargy, tachycardia (increased number of heartbeats), tachypnea (increased number of breaths) and a prolonged capillary refill time.

At these levels, dehydration represents a medical emergency, requiring treatment emergency room. Here, the doctors will first evaluate the hydrosaline balance conditions of the little patient; therefore, subsequently, they will adequately correct the losses of water and salts by means of parenteral infusions (the loss of water leads, in parallel, to a dispersion of salts).

Dehydration in Children: associated conditions

Generally, dehydration in children is associated (as it is a consequence) with conditions, such as:

  • Vomit;
  • Diarrhea;
  • Fever greater than 38°C.

Diagnosis

Diagnosis of Dehydration in Children: how to recognize it

To diagnose dehydration in children, the evaluation of symptoms and signs is essential (objective examination), and themedical history.

In particular, the objective examination deserves further study:

  • This investigation allows us to trace the degree of dehydration of the young patient; in fact, by comparing the child's usual weight with that measured when dehydration is suspected, it is possible to calculate the water deficit.
  • Furthermore, during the objective examination, the doctor measures another important parameter for estimating the degree of severity of dehydration: the so-called capillary refill time.
    The capillary refill time (CRT) is a non-invasive diagnostic test, which allows the systemic perfusion to be assessed very quickly and consists of compressing the capillary bed (generally on the palm of the hand or fingertip) and counting the time it takes for it to reappear of flow, referring to the change in skin color.
    If the capillary refill time is greater than 2 seconds, it is considered pathological.
    Individuals in a dehydrated state have a prolonged capillary refill time.

Clinical Dehydration Scale

A useful tool for estimating dehydration in children, which doctors use but which can also be useful to parents, is the so-called clinical dehydration scale.
The clinical dehydration scale takes into consideration the typical symptoms of dehydration in children and assigns an increasing score from 0 to 2, based on their severity; considers, for example, tearing and assigns a score of 0, if it is normal, 1, if it is only partially reduced, and 2, if it is absent.

If the overall result of the various scores assigned to the symptoms is greater than 5, the small patient is in a state of moderate or severe dehydration.

Treatment

Dehydration in Children: What to Do?

Once the severity of dehydration has been estimated, the next step is to calculate how many fluids to administer to the patient. This operation is easily carried out remembering that one liter of fluids weighs one kilo; therefore, a 20 kilo child with 5% dehydration lost one kilo of body weight (0.05 x 20 kg = 1 kg); therefore, you have a fluid deficit of one liter.

In the mild and moderate dehydration the oral hydrating therapy it is the method of first choice; is based on the administration of specific hyposmolar drinkswhich can be purchased in pharmacies, such as Pedialyte o l’Infiltr.

They can also be used for children over the age of two rehydrating drinks for sports.
The guidelines recommend starting therapy by administering per us (orally) 5 ml of rehydration solution every five minutes, gradually increasing it according to tolerability.
More generally, it is important to administer small amounts of fluids at very frequent intervals.

For no reason use carbonated drinks and fruit juices, which – being solutions rich in sugar and therefore hyperosmolar – would worsen diarrhea and dehydration.
Plain water, on the other hand, normally does not contain enough mineral salts and can cause electrolyte imbalances, with the risk of seizures.

If you don't have rehydrating drinks available, the ideal is to prepare them yourself, dissolving four teaspoons of sugar, half a teaspoon of salt, half a teaspoon of potassium chloride and half a teaspoon of sodium bicarbonate in a liter of water.

Normal feeding should be resumed as soon as the child is able to tolerate it.

At hospital level, when the child presents with severe dehydrationor if it is not possible to rehydrate orally due to persistent vomiting, we resort to therapy intravenous (infused with boluses of 20 ml/kg until shock resolution). Vomiting, in itself, does not represent a contraindication to oral rehydration and can be resolved through the use of antiemetics (obviously as recommended by the pediatrician).

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