Signs of Dehydration in Children: What to Look For

Bring them in now if

Any of the signs above. Dehydration in a small child can move from mild to serious within hours, and intravenous fluids are sometimes needed — which is not a failure of home care, just a fact about small bodies.

Early signs

These are the ones to catch, because home treatment works well at this stage:

• Thirst, and asking for drinks more than usual
• Dry lips and mouth; the tongue looks less glossy
• Fewer wet nappies, or fewer trips to the toilet
• Urine that is darker and stronger-smelling than usual
• Slightly less energetic than normal, but still interactive
• Crying with fewer tears than you would expect

Later signs

These mean the child needs to be seen:

• Sunken eyes, with a hollow look around them
• A sunken fontanelle — the soft spot on a baby's head dips inwards
• No tears at all when crying
• Very dry mouth and tongue
• Skin that stays tented briefly when gently pinched, rather than springing back
• Cold, mottled or blue-tinged hands and feet
• Fast breathing, or a fast heartbeat
• Marked drowsiness, floppiness, or irritability you cannot settle
• No urine passed for many hours

Checking nappies and urine

The most objective thing a parent can track. Write it down if you are worried — it is exactly what we will ask.

• Infants normally have around six or more wet nappies in 24 hours
• Fewer than three or four in 24 hours suggests dehydration
• None for 8 hours or more needs assessment now
• Dark, concentrated urine is a useful early sign; pale urine is reassuring

How to rehydrate at home

The principle is small amounts, very often — not a large glass that comes straight back up.

• Give 5 to 10 ml every few minutes with a spoon or syringe if the child is vomiting. A teaspoon every two minutes adds up to a surprising volume over an hour
• Continue breastfeeding if the baby is breastfed, more often and for shorter periods
• If vomiting, wait 10 minutes after a vomit then resume small amounts
• For diarrhoea, replace roughly what is lost — extra fluid after each loose stool
• Keep offering food once they will take it. Bananas, rice, curd, khichdi and toast are well tolerated. Do not withhold food for long

Making and using ORS correctly

Oral rehydration solution is one of the most effective treatments in medicine, and it is frequently prepared wrongly.

• Use a standard ORS sachet and the exact volume of water printed on it. Too little water makes it too concentrated, which can worsen diarrhoea
• Use clean drinking water. If in doubt, boil and cool it first
• Make a fresh batch each day and discard what is left
• Do not add sugar, salt, or flavouring to the mixture
• If you have no ORS at all, water and continued feeding is better than nothing — but get ORS as soon as you can

What not to give

• Plain sugary soft drinks and packaged fruit juice — the sugar concentration can pull more fluid into the bowel and worsen diarrhoea
• Sports drinks, which are formulated for adults exercising, not dehydrated children
• Anti-diarrhoeal medicines for young children, unless a doctor has specifically advised them
• Antibiotics from home. Most childhood diarrhoea is viral

Our paediatrics department assesses children with vomiting and diarrhoea, and the emergency department sees acutely unwell children without an appointment. Related: child fever — when to see a doctor.