dehydration pictures

Dehydration in Infants and Children

by Rebecca D. Williams
Public Domain From FDA Consumer Magazine

Petite even for a 3-year-old, Tiffany Pressnell weighed 27 pounds in February 1995 when a stomach virus swept her town of Oak Ridge, Tenn.

When Tiffany caught the bug, she had vomiting and diarrhea so severe that she lost 3 pounds in two days.

"Her eyes were sunken. Her lips were dry," remembers her mother, Tammy. "Her mouth didn't have any wetness in it. Her skin was white--when we pinched it, it stayed pinched."

Tiffany was severely dehydrated. Admitted to the local hospital by her pediatrician, she was given intravenous fluids to restore the water and minerals she had lost. Her weight slipped another 2 pounds, however, before the virus subsided and she was well enough to go home.

"Now if she has any diarrhea at all, we give her Pedialyte," says Tammy Pressnell. "We keep it on the shelf, and I keep the travel pack in a diaper bag. You just never know."

Pedialyte is a brand name for a fluid known as oral rehydration therapy (ORT). Along with other brands like Infalyte, Naturalyte and Rehydralyte, it is a simple mixture of water, salts and carbohydrates to prevent dehydration in children with bouts of diarrhea and vomiting.

ORT, regulated by the Food and Drug Administration as a medical food, is perhaps one of the greatest advances in life-saving treatments of the 20th century, especially in developing countries where diarrhea-producing diseases like cholera, combined with unsanitary water and food, kill 4 million children annually.

Here in the United States, an estimated 500 American children die annually from diarrhea, and the illness is not seen as a major threat. As a result, doctors often do not recommend ORT for their young patients.

The deaths that do occur happen mostly in the winter months while the flu season is in full swing. Nearly all of them are preventable, researchers say, because dehydration can be avoided with proper medical attention and oral rehydration fluid.

Treating Diarrhea

Oral rehydration therapy was developed in the 1950s for developing countries, where diarrhea is common. American children average only one or two bouts with diarrhea yearly. But those illnesses can still be dangerous. The best way for parents to keep their children from getting dehydrated is by stocking the medicine chest with at least one bottle of oral rehydration fluid.

"I think it's very reasonable for every family to have it at home," says John Snyder, M.D., a researcher in the field of ORT and professor of pediatrics at the University of California Medical School in San Francisco. "Diarrhea frequently starts at night, and a small child can get dehydrated very quickly."

Yet many physicians do not recommend ORT for children suffering from diarrhea. According to a 1991 study published in the medical journal, Pediatrics, most pediatricians don't follow the guidelines for treating diarrhea set by the American Academy of Pediatrics in 1985.

More commonly, doctors frequently tell parents to withhold food from a child and give clear liquids such as fruit juice, chicken broth, and sports drinks. Neither of these practices is recommended by the academy.

Common clear liquids don't contain the proper balance of sodium, chloride and potassium salts that the body needs. These and other minerals change in the body into electrically charged particles called ions. If electrolytes are not perfectly balanced in the body, many organs, including the heart, cannot function properly. Children under 5 are especially vulnerable to diarrhea because their bodies are small. It doesn't take much fluid loss to get their electrolytes out of balance.

Only a physician can diagnose dehydration, but parents can watch for some obvious signs: a dry mouth, no tears, sunken eyes, a reduction in urination, and skin that stays compressed when pinched.

The AAP Guidelines Are

For diarrhea with no dehydration, feed the child normally and give supplemental commercial rehydration fluids within four to six hours after a diarrheal episode. If the diarrhea persists, call the child's doctor. For diarrhea with mild dehydration, take the child to a physician. The child should be given oral rehydration fluids in the doctor's office, with food and rehydration fluid continued at home. For moderate or severe dehydration, the child should be treated in a health-care facility. Moderate dehydration may be treated orally, but severe dehydration requires intravenous fluids. The old advice to let the intestine "rest" after a bout with diarrhea is now not recommended by AAP. "Early feeding isn't just a good idea, it helps to make the diarrhea better," says Snyder.

Food can help the intestine absorb more water, which helps slow down the diarrhea. A child should eat as soon as possible after a bout of diarrhea, and at least within six hours. A balanced diet rich in calories is recommended. Foods such as rice, wheat, potatoes, sorghum, corn, and chicken have all been proven helpful in slowing diarrhea. Just about anything the child tolerates is OK, except for foods high in sugar or salt.

Milk products, because they can be difficult to digest, can be withheld for 24 to 48 hours during significant bouts of diarrhea. Infants who are bottle-fed, however, should continue drinking formula diluted to half strength. Breast-fed infants should continue nursing.

The once favored "BRAT" diet--an acronym for bananas, rice, applesauce, and toast--is no longer recommended for children. Instead, parents should offer a more balanced diet that is higher in calories.

Giving anti-diarrhea medicine to children is not the best treatment, according to John Udall, M.D., Ph.D., chairman of pediatric nutrition and gastroenterology at the Children's Hospital in New Orleans.

"Diarrhea is really a purging of the intestine," he says. "Giving medicines to slow down the intestine actually gives the bacteria more time to grow, which prolongs the illness."

Allowing the illness to run its course, while preventing dehydration with fluids, is usually the quickest way toward health.

Dosage information for ORT depends on weight and is listed on the label. Side effects with ORT are rare, but parents should watch for signs of too much sodium in the body: dizziness, a fast heartbeat, irritability, muscle twitching, restlessness, swelling of the feet or lower legs, weakness, and convulsions.

Rehydration fluids have a brief shelf life. Once a bottle has been opened or a mix prepared, it must be used or thrown out within 24 hours because bacteria rapidly grow in the solution. A child could easily drink three or four bottles of the fluid during an illness.

ORT is effective to a lesser degree when the child is vomiting. If the child can keep the liquid down, it will be absorbed. But if the child vomits it back up, intravenous rehydration may be necessary.

ORT is effective for all ages, although the brands available at most grocery stores and drugstores are usually formulated just for children. Adults are usually able to tolerate a bout with diarrhea better than small children because they have more fluid reserves in their bodies. But older adults and those weakened by diseases like cancer and AIDS are at a greater risk for complications from diarrhea. These patients should call their doctors if diarrhea and vomiting persist.

Parents should also remember that ORT will not stop the diarrheal illness. In fact, the child may have even more episodes of vomiting and diarrhea until the illness runs its course. As long as the child is keeping some rehydration fluid down, however, the chances of dehydration are greatly reduced.

If a child under 5 has diarrhea and vomiting for longer than an hour or so, it's always a good idea to call a physician.

According to Snyder, "Parents should have a low threshold of concern to [prompt them to] phone the pediatrician."

Parents don't have to wait for a prescription to use oral rehydration fluids, however. The products are available at grocery stores and drugstores in premixed bottles. National brands can cost as much as $6 per liter, but less expensive generic brands are available as well for as little as $2.

According to a 1991 study in the Journal of the American Medical Association, cost is one reason why more parents do not use ORT for their children suffering from diarrhea. Deaths from diarrhea are most common in the South and in low-income, African-American families headed by young single mothers.

To help with that expense, the federally funded and state-administered WIC (Women, Infants and Children) Program pays for ORT along with certain foods for pregnant women, new mothers, and children under 5. In most states, Medicaid also covers ORT if a doctor prescribes it.

As the use of ORT increases, the number of deaths from diarrhea is slowly declining in the United States. This simple solution of water, minerals and carbohydrates will not eliminate the problem of stomach viruses and flu, but perhaps it will make diarrhea less of a life-threatening risk to America's children.

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