Dehydration is what happens when the body lacks sufficient fluids. It is a potentially dangerous condition, especially in the case of infants and small children.
As parents, you should exercise extra caution to ensure that your child does not suffer from dehydration and its ill-effects.
The dangers of dehydration
We must all be mindful of the fact that severe dehydration can lead to death. Dehydration occurs due to the sudden and copious loss of water and electrolytes from your child’s body. Due to their smaller size, infants and young children are particularly vulnerable to any sudden losses.
The World Health Organization (WHO) has data that shows dehydration (especially when caused by diarrhoea) to be one of the biggest causes of deaths in children around the world – this figure is estimated at around 2.2 million children worldwide, annually.
Causes of dehydration
The most common causes include:
• illness (possibly a viral infection that results in decreased ability to drink or eat)
• prolonged exposure to hot environ-ments
Admittedly, the signs listed above are very general – many common viral or bacterial infections cause them, such as rotavirus, adenovirus, salmonella or E. coli, just to name a few.
There have even been cases of parasitic infections (e.g. giardiasis) that cause diarrhoea, and subsequently, dehydration.
However, you should be constantly on the alert and take immediate action if any of the above occurs to your child.
When to be concerned
As parents, you should be keenly aware of your child’s physical condition at all times, especially when he is suffering from any of the conditions mentioned above (e.g. vomiting or diarrhoea).
There will be some dehydration if he exhibits any of the following signs:
• restlessness and/or irritability
• rapid breathing
• increased heart rate
• restlessness and/or irritability
• poor skin turgor (pinching a fold of skin at the abdomen results in it returning slower than usual to normal)
• sunken fontanelle (in infants)
• sunken eyes
• lack of tears when crying
• wants to drink a lot of water (but may vomit), excessive thirst
• decreased urine output:
➤ infants/babies – indicated by no wet diapers in a six to eight hour period or diapers with a little dark-yellow urine
➤ toddlers/older children – very little dark-yellow urine
Pay close attention if you see two or more of the above – your child may be suffering from some dehydration.
What you should do
If your child has mild to moderate dehydration, you should ensure that he gets rehydrated as soon as possible.
You can pick up oral rehydration solutions (ORS) from any pharmacy, which contain the proper combination of sodium and glucose to help the intestines absorb what the body needs.
He should also be fed with milk as usual and porridge if aged more than six months.
Ensure that he takes more fluids to replace what he has lost.
The amount of ORS and/or milk to provide your child with within the first four to six hours after signs of some dehydration are as follows:
• For a child weighing 3kg: mild dehydration – 135ml; moderate dehydration – 270ml.
• For 4kg: mild dehydration – 180ml; moderate dehydration – 360ml
• For 5kg: mild dehydration – 270ml; moderate dehydration – 540ml
• For 6kg: mild dehydration – 315ml; moderate dehydration – 630ml
• For 7kg: mild dehydration – 360ml; moderate dehydration – 720ml
• For 8kg: mild dehydration – 405ml; moderate dehydration – 810ml
• For 9kg: mild dehydration – 450ml; moderate dehydration – 900ml
• For 10kg: mild dehydration – 495ml; moderate dehydration – 990ml
• For 11kg: mild dehydration – 540ml; moderate dehydration – 1 litre
• For 12kg: mild dehydration – 585ml; moderate dehydration – 1l
• For 13kg: mild dehydration – 630ml; moderate dehydration – 1l
• For 14kg: mild dehydration – 675ml; moderate dehydration – 1l
• For 15kg: mild dehydration – 765ml; moderate dehydration – 2l
For children below one year of age, you can administer the ORS using either an oral syringe or a teaspoon. Older children (above one) can be given ORS in a cup – just let him take frequent sips over a period of time.
If your child vomits during this time, wait for about 10 minutes before you continue to rehydrate him – give him the ORS more slowly this time (e.g. one teaspoon or sip every two minutes instead of every minute).
Give small and frequent feeds to ensure the dehydration is corrected. An intravenous line may be needed in hospital if oral rehydration fails.
The danger signs
If your child exhibits any combination of the following, please get him immediate medical care:
• Sunken eyes
• More pronounced skin turgor (pinching a fold of skin pinch results in it returning very slowly to normal)
• Vomiting – either if his vomit is greenish in colour or if he vomits several times within 24 hours
• High fever – above 39.4°C
• The lining of his mouth/tongue is covered by a dry or sticky mucous covering
• He is very lethargic and is less active than normal (especially if he has difficulty waking up from sleep or lapses into unconsciousness)
• Infants/babies – very irritable (cries a lot for no apparent reason and/or is fussy to the point of being inconsolable).
Datuk Dr Zulkifli Ismail is president of the Asia Pacific Paediatric Association and chairman of the Positive Parenting Management Committee. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. This article is supported by an educational grant from Abbott Laboratories Malaysia Sdn Bhd. For further information, visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.