Dehydration in Kids: Signs, Oral Rehydration and When to Get Help • Living Life as Moms | Mom Hacks, Toddler Snacks, and Kids Activities

Quick answer: dehydration happens when a child loses more fluid than they take in, most often during vomiting, diarrhea, fever or hot weather. Early signs include thirst, a dry mouth, fewer wet diapers or less urine and fewer tears. Offer small, frequent sips of an oral rehydration solution, a spoonful or a few sips every few minutes, and keep breastfeeding or formula feeding babies. Call the doctor if your child cannot keep fluids down, and go to the emergency room for sunken eyes, extreme sleepiness, no urine for eight hours or more, cold hands and feet or rapid breathing.

Children dehydrate faster than adults. Their bodies are smaller, they lose a larger share of their fluid when sick and they cannot always tell you they feel thirsty. A stomach bug or a high fever can leave a toddler dry and drowsy within a day. The good news is that most mild dehydration can be treated at home with the right fluids, given the right way. The key is to catch it early and know which signs mean the doctor, or the emergency room, needs to take over. This guide is part of our family health and safety guide, and it explains the signs, the safest way to rehydrate and the warning signs of serious trouble.

Sources: American Academy of Pediatrics (AAP) HealthyChildren.org guidance on dehydration, vomiting and diarrhea; Centers for Disease Control and Prevention (CDC) information on dehydration and diarrhea; Mayo Clinic and MedlinePlus (National Library of Medicine) information on dehydration in children; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This article is general information, not medical advice. Call your child’s doctor with specific concerns.

Why Kids Dehydrate Quickly

Water makes up a larger portion of a young child’s body weight than an adult’s, and children lose water faster through breathing and skin for their size. When they are sick, the losses add up.

Common causes include:

Vomiting and diarrhea, from stomach viruses such as norovirus or from food poisoning
Fever, which increases fluid loss through sweating and fast breathing
Not drinking enough, because of a sore throat, mouth sores or just not feeling well
Hot weather or heavy activity, especially without breaks for water
Certain conditions, such as diabetes, which can cause the body to lose extra fluid

Babies and toddlers are at higher risk, and so are children with chronic illness.

Signs of Dehydration by Severity

Doctors group dehydration as mild, moderate or severe. These lists draw on guidance from the AAP, the CDC and MedlinePlus.

Mild dehydration

Increased thirst
Slightly dry or sticky mouth
Fewer wet diapers, or urinating less often than usual
Slightly darker urine
Still playing and alert

Moderate dehydration

Very dry mouth and tongue
Few or no tears when crying
Sunken eyes, or a sunken soft spot on a baby’s head
Urine only a couple of times a day, or no wet diaper for six hours or more in a baby
Fatigue or irritability
Skin that is less stretchy than usual
Fast heartbeat

Severe dehydration (emergency)

Extreme sleepiness, difficulty waking or limpness
Very sunken eyes
No urine for eight hours or more
Cold, blotchy or pale hands and feet
Fast, deep breathing
Dizziness or fainting in older children
Confusion

Severe dehydration needs emergency care. If your child shows any of these signs, call 911 or go to the nearest emergency room.

Home Treatment: Oral Rehydration Solution

Oral rehydration solution, or ORS, is a drink that contains the right balance of water, sugar and salts to be absorbed by the body. The AAP and CDC recommend ORS for mild to moderate dehydration from vomiting and diarrhea. Pharmacies and grocery stores sell it under several brand names, in liquid form, powder packets and freezer pops.

How to give it:

Start small. Offer one teaspoon, or about 5 milliliters, every one to two minutes. Use a spoon, syringe or medicine cup.
Increase slowly. As your child tolerates it, give larger sips.
Pause after vomiting. Wait about 10 to 15 minutes, then restart with small amounts.
Keep going for hours. It may take several hours to replace lost fluids.
Return to normal food as soon as your child is willing. Starving a child on clear liquids for days is not recommended.

Ask your child’s doctor for the right amount based on age and weight. Follow the label instructions, and do not water down the solution or mix a powder with less or more water than directed.

Homemade recipes are not recommended, because small errors in measuring salt and sugar can be harmful. Use a commercial product.

Breastfed and Formula-Fed Babies

For babies, continue breastfeeding or formula feeding. Offer smaller amounts more often. Breast milk is easy to digest and helps protect against infection. If a baby is vomiting or has frequent watery stools, your doctor may suggest adding ORS between feedings. Do not give plain water to babies under six months unless a doctor tells you to, because it can cause dangerous salt imbalance.

Call the doctor the same day for any baby under three months with vomiting, diarrhea or fever, and promptly for babies who have six or more watery stools a day or who are refusing feeds.

Drinks to Avoid

During an illness, some drinks can make things worse.

Fruit juice and apple juice in large amounts, since sugar can pull water into the intestines and worsen diarrhea.
Soda, which is high in sugar and low in salts.
Sports drinks, which are designed for athletes, not for treating dehydration in a sick child, and they often contain too much sugar and too little sodium for the job.
Caffeinated drinks.
Plain water only, for prolonged vomiting or diarrhea, because it does not replace salts.

Water is fine for a mildly thirsty child who is otherwise well, but ORS is better when fluids are being lost.

Food While Recovering

Once your child is rehydrating and can keep fluids down, bring back regular food in small amounts. Bananas, rice, toast, applesauce, crackers, plain pasta, cooked vegetables, lean meats and yogurt are usually well tolerated. The old advice to restrict children to the BRAT diet is no longer recommended by the AAP, since a normal, balanced diet helps children recover and gives them more nutrition. Avoid very fatty, greasy or heavily sugary foods until the stomach settles.

Fever and Dehydration

Fever raises fluid needs. Offer cool drinks often, dress your child lightly and keep the room comfortable. Our guide on fever in kids and when to call the doctor covers temperature thresholds and treatment. Check with your doctor or pharmacist before giving any fever medicine, and follow the dose for age and weight. See our medicine safety guide for dosing tips.

Heat and Exercise

Dehydration is not only about illness. Kids who play hard in hot weather can lose significant fluid. Encourage water breaks every 15 to 20 minutes during sports, dress kids in light clothes and keep them in the shade when possible. Heat can lead to heat exhaustion or heatstroke, which are emergencies. Signs include a high body temperature, red, hot, dry or damp skin, confusion, headache, nausea and fainting. Move the child to a cool place, cool the body with water and call 911 for suspected heatstroke.

A Sample Plan for the First Day of a Stomach Bug

When a child starts vomiting, parents often feel unsure about what to do first. This outline shows how the steps fit together. It is a general example and does not replace your doctor’s advice.

The first hour. Let the stomach rest for about 15 to 30 minutes after the last episode of vomiting. Then start oral rehydration solution, one teaspoon at a time. A small syringe or spoon makes measuring easy. Keep your child sitting up or lying on one side, with a bowl, a towel and a change of clothes nearby.

The next few hours. If your child keeps down the small amounts, double the amount every 15 minutes or so until sips of an ounce or two feel comfortable. If your child vomits, wait 15 minutes and start again at a teaspoon. This slow pace can feel too gentle, but small, steady amounts are far more likely to stay down than a big drink.

Later in the day. As your child perks up, offer more ORS, along with breast milk or formula for babies. Offer a small snack of a mild food, such as crackers or banana, once your child asks for food.

Overnight. Wake a sleeping child for sips only if the doctor has told you to. Otherwise, let rest help recovery, and watch for signs of dehydration when your child wakes up. Keep a light on and the bowl by the bed.

Using Popsicles and Other Tricks

Children who refuse to drink may accept ORS in other forms. Freezer pops made from ORS are sold in many stores, and some children like them. Chewing on ice chips or a frozen treat can slow things down and avoid overloading the stomach. Offering fluid in a fun cup with a straw, or letting a child pick the color of the medicine cup, can turn drinking into a game. Older children can sip from a favorite water bottle while watching a show. Keep the tone upbeat and patient, because children who feel pressured tend to refuse more.

Children Who Are Hard to Rehydrate

Some children need extra help. Babies with a stuffy nose may tire during feeding, so clear the nose before offering fluid. Children with mouth sores from illnesses such as hand, foot and mouth disease may avoid drinking because swallowing hurts. A cold drink and a pain reliever recommended by your doctor can help. If your child still will not drink, call the doctor, since IV fluids are sometimes needed to prevent a serious problem.

How to Tell Whether Home Care Is Working

Within a few hours of starting ORS, you should see signs of improvement:

More wet diapers or more urine, and lighter colored urine
More energy and a return of interest in play
Tears when crying
A moist mouth
Less vomiting and fewer loose stools, though diarrhea may last several days

Keep a simple log of fluids in and out, noting times of vomiting, stools and wet diapers. The log helps your doctor decide the next steps.

When to Call the Doctor

Call your child’s doctor if:

Your child cannot keep down fluids for several hours
There are signs of moderate dehydration, such as few tears or very dry mouth
Vomiting lasts more than 24 hours in a child, or more than a few hours in an infant
Diarrhea lasts more than a week, or there is blood or mucus in the stool
Your child has a fever above 102 degrees Fahrenheit, or a fever in a baby younger than three months
Your child has a chronic condition, such as diabetes or kidney disease, and becomes ill
You are worried and cannot tell whether your child is improving

Doctors can examine your child, check for dehydration and, if needed, arrange treatment such as medicine to control vomiting or IV fluids.

When to Go to the Emergency Room

Go to the emergency room or call 911 if your child shows signs of severe dehydration, including extreme sleepiness, no urine in eight hours, a sunken soft spot, cold hands and feet, fast breathing or fainting. Also seek emergency care for vomit that is green or bloody, severe belly pain, a stiff neck or a swollen, hard belly.

Preventing Dehydration

Offer fluids early when your child is sick, before signs of dehydration appear.
Wash hands often to prevent stomach illnesses. Our guide to norovirus in kids explains how that virus spreads and how to clean up.
Keep children out of the heat on very hot days, and give water breaks.
Offer water throughout the day, and put a small cup or bottle within reach.
Include water-rich foods, such as fruit and soup.

Frequently Asked Questions

How can I tell if my child is dehydrated?

Look for a dry mouth, fewer wet diapers or less urine, few tears, sunken eyes, unusual sleepiness and a fast heartbeat. Severe signs need emergency care.

What should I give a child with a stomach bug?

Small, frequent sips of an oral rehydration solution. Babies should continue breast milk or formula.

Is Pedialyte better than water for dehydration?

Oral rehydration solutions contain a balance of salts and sugar that helps the body absorb fluid, so they work better than plain water for illness-related dehydration.