This document provides information on assessing and treating dehydration in children. It defines dehydration as an excess loss of water and body fluids, and lists various causes including gastroenteritis, fever, burns and more. It describes methods for assessing dehydration severity based on weight loss, clinical signs/symptoms, and skin pinch test. Mild dehydration shows thirst and sunken eyes; moderate shows lethargy and poor drinking; severe shows collapse and sunken fontanel. Oral rehydration solution is given as treatment, with recipes provided for making solutions with salt, sugar and water.

1. ASSESSING
DEHYDRATION
IN
CHILDREN

2. INTRODUCTION

3. DEFINITION
OF
DEHYDRATION

4. Dehydration is a condition that can occur
with excess loss of water and other body
fluids. Dehydration results from decreased
intake, increased output (renal,
gastrointestinal or insensible losses), a shift
of fluid (e.g. ascites, effusions), or capillary
leak of fluid (e.g. burns and sepsis).

5. CAUSES
OF
DEHYDRATION

6. Gastroenteritis

7. Mouth ulcers, stomatitis, pharyngitis, tonsillitis:
pain may severely limit oral intake

8. Diabetic ketoacidosis (DKA)
Febrile illness: fever causes increased insensible
fluid losses.

9. Burns: fluid losses may be extreme and require
aggressive fluid management

10. Congenital adrenal hyperplasia: may have
associated
hypoglycaemia, hypotension, hyperkalaemia, and
hyponatraemia.
Gastrointestinal obstruction, e.g. pyloric stenosis:
often associated with poor intake, vomiting.
Bowel ischaemia may cause extensive capillary
leak and shock.

12. Heat stroke

13. Cystic fibrosis: excessive sodium and chloride
losses in sweat.
Diabetes insipidus: excessive output of very
dilute urine.
Thyrotoxicosis: increased insensible losses and
diarrhoea.

14. ASSESSMENT

16. Of the clinical indicators used, the pinch test (skin
turgor) has been shown to be the most reliable in
several studies but is still not a reliable test when
used without other clinical indicators.

17. Loss of body weight:
oNormal: no loss of body weight.
oMild dehydration: 5-6% loss of body
weight.
oModerate: 7-10% loss of body weight.
oSevere: over 10% loss of body weight.

18. Clinical features of mild-to-moderate
dehydration; 2 or more of:
Restlessness or irritability.
Sunken eyes (also ask the parent).
Thirsty and drinks eagerly

20. Clinical features of severe dehydration; 2 or
more of:
Abnormally sleepy or lethargic.
Sunken eyes.
Drinking poorly or not at all

21. PINCH TEST
(SKIN TURGOR):

22. Skin turgor is assessed by pinching the skin of
the abdomen or thigh longitudinally between
the thumb and the bent forefinger.
The sign is unreliable in obese or severely
malnourished children.
Normal: skin fold retracts immediately.
Mild or moderate dehydration: slow; skin
fold visible for less than 2 seconds.

24. Mild or moderate dehydration: slow; skin fold visible for
less than 2 seconds.
Severe dehydration: very slow; skin fold visible for
longer than 2 seconds.
Other features of dehydration include dry mucous
membranes, reduced tears and decreased urine output.
Additional signs of severe dehydration include
circulatory collapse (e.g. weak rapid pulse, cool or blue
extremities, hypotension), rapid breathing, sunken
anterior fontanels

26. CLINICAL
ASSESSMENT
OF
DEHYDRATION

27. Mild Moderate Severe
Weight loss Up to 5% 6-10% More than 10%
Appearance Active, alert Irritable, alert, thirsty Lethargic, looks sick
Capillary filling
(compared to your
own)
Normal Slightly delayed Delayed
Pulse Normal Fast, low volume Very fast, thready
Respiration Normal Fast Fast and deep
Blood pressure Normal Normal or low
Orthostatic hypotension
Very low
Mucous memb. Moist Dry Parched
Tears Present Less than expected Absent
Eyes Normal Normal Sunken
Pinched skin Springs back Tents briefly Prolonged tenting
Fontanel (infant
sitting)
Normal Sunken slightly Sunken significantly
Urine flow Normal Reduced Severely reduced

28. ORAL
REHYDRATION
SOLUTION
(ORS)

30. Recipe 1
Making a 1 (one) litre solution using Salt, Sugar and Water
Ingredients:
• One level teaspoon of salt
• Eight level teaspoons of sugar
• One litre of clean drinking or boiled water and then
cooled
5 cupfulls (each cup about 200 ml.)
Preparation Method:
Stir the mixture till the salt and sugar dissolve

32. Recipe 2
Making a 1/2 (half) liter solution using
Salt, Sugar and Water
Ingredients:
A 3 finger pinch of salt ( approx. 1.75 gms.)
A scoop of sugar ( approx. 20 gms.)
1/2 (half) liter of clean drinking or boiled
water
2.5 cupfuls (each cup about 200 ml.)

33. PREPARATION METHOD:
Pour 1/2 (half) liter of clean drinking or boiled water,
after it has cooled, into a large vessel.
Add a 3-finger pinch of salt (approx. 1.75gms).
Taste the solution. It shouldn't be more salty than your
tears.
Add a scoop of sugar ( approx. 20 gms.)
Stir the mixture till the salt and sugar dissolve.