What are the symptoms of dehydration?
Dehydration is caused by a loss of body fluids, which are made up of water and salts. When sick children have diarrhea or are vomiting, they can lose large amounts of salts and water from their bodies and can become dehydrated very quickly.
Dehydration can be very dangerous, especially for babies and toddlers. Children can even die if they are not treated.
What are the signs of dehydration?
Call your child’s doctor or seek medical advice if you see signs of dehydration:
- decreased urination (fewer than 4 wet diapers in 24 h),
- increased thirst,
- no tears,
- dry skin, mouth and tongue,
- faster heart beat,
- sunken eyes,
- grayish skin,
- sunken soft spot (fontanelle) on baby’s head.
Healthy children can spit up, vomit or have a loose stool once in a while without being in danger of dehydrating.
What are the symptoms of diarrhea?
Diarrhea is a very common problem in babies and children. It is usually mild and brief. ”Acute” diarrhea lasts less than 1 week.
A child has diarrhea if she has more bowel movements than usual, and if stools are less formed and more watery than usual. Sometimes children with diarrhea have other symptoms, such as fever, loss of appetite, nausea, vomiting, stomach pains, cramps, and blood and/or mucus in the bowel movement.
Diarrhea can be dangerous if not treated properly because it drains water and salts from your child. If these fluids are not put back quickly, your child may become dehydrated and may need to be hospitalized.
How diarrhea spreads?
Diarrhea germs are easily spread from person to person, and especially from child to child. They usually spread quickly among children who have not learned to use the toilet.
What causes diarrhea?
There are many different possible causes of diarrhea. The most common are:
- Viruses, such as rotavirus, which can’t be treated with antibiotics.
- Bacteria, such as Campylobacter, Salmonella, Shigella and E. coli. Some bacterial diarrhea can be treated with antibiotics, but children usually start to get better before the bacteria are identified.
- Food poisoning.
- Parasites, such as giardia.
Rotavirus is the most common cause of acute diarrhea in babies and young children. It usually affects children between the ages of 6 months and 2 years.
Rotavirus illness starts between 12 hours and 4 days after being exposed to the germ. The first signs are usually a high fever (40ºC/104ºF) and vomiting. Within 12 to 24 hours, children start to pass large amounts of watery diarrhea. The illness usually lasts 3 to 7 days.
When children have rotavirus, their stools contain large numbers of germs. Rotavirus can spread directly (such as by coming in contact with an infected diaper and not washing hands properly afterward), or indirectly (for example, coming in contact with a toy that has germs on it).
Outbreaks of rotavirus in Canada usually happen in the winter and spring, between December and May. A vaccine to prevent rotavirus is available in Canada.
How to prevent diarrhea
Proper handwashing and safe food handling are the most important ways to prevent the spread of germs that cause diarrhea.
How to treat diarrhea
Children with diarrhea need to keep drinking the right amount of fluids to avoid dehydration.
Oral rehydration solutions
An oral rehydration solution (ORS) is an exact mixture of water, salts and sugar. These solutions can be absorbed even when your child is vomiting. The key is to give small amounts of ORS often (for example, 1 teaspoon every 5 minutes), gradually increasing the amount until your child can drink normally.
Oral rehydration solutions are available at pharmacies in ready-to-serve preparations, frozen popsicles and powders.
Although powders are cheaper and easier to store, they have to be mixed very carefully to work properly. It is better to buy an ORS that has already been mixed.
Oral rehydration solutions can be used to:
- keep children well hydrated when their diarrhea is serious.
- put back fluids when children show signs of mild dehydration.
If you are breastfeeding, keep feeding on demand. You can also offer your child the foods he usually eats.
If you are formula feeding, you don’t need to dilute the formula. Continue formula feeding, and offer your child the food he normally eats.
If your child is not breastfeeding or formula feeding well, offer ORS as follows:
For the first 4 hours
- For babies 6 months and younger: give 30 to 90 mL (1 to 3 oz.) every hour.
- At 6 to 24 months: give 90 to 125 mL (3 to 4 oz.) every hour.
- Children over 2 years of age: give 125 to 250 mL (4 to 8 oz.) every hour.
- If an infant refuses the ORS by the cup or bottle, give the solution using a medicine dropper, small teaspoon or frozen popsicles.
- If a child vomits, you may need to stop giving food and drink. But continue to give the ORS using a spoon. Give 15 mL (1 tbsp.) every 10 min to 15 min until the vomiting stops. Increase the amounts gradually until your child is able to drink the regular amounts. If vomiting does not stop after 4 to 6 hours, take your child to the hospital.
After 4 hours until 24 hours: Recovery stage
- Keep giving your child the oral rehydration solution until diarrhea is less frequent.
- When vomiting decreases (and depending on your child’s age), it is important to start your child breastfeeding as usual (or drinking formula or whole milk) or eating regular food in small, frequent feedings.
After 24 to 48 hours, most children can resume their normal diet.
Stools may increase at first (1 or 2 more each day). It may take 7 to 10 days or longer for stools to become completely formed. This is part of normal healing in a child’s bowel system (intestine).
Foods to avoid
Do not give your child sugary drinks such as: fruit juice or sweetened fruit drinks, carbonated drinks (pop/soda), sweetened tea, broth or rice water. These have the wrong amounts of water, salts and sugar and can make your child’s diarrhea worse.
If your child is having frequent diarrhea, do not offer plain water. Drinking only water may lead to low blood sugar or low sodium levels in your child’s blood.
Talk to your doctor before giving over-the-counter medications to stop diarrhea.
When to call the doctor?
- Your child has diarrhea and is less than 6 months of age.
- Your child has bloody or black stools.
- Your child is still vomiting after 4 to 6 hours.
- Your child has diarrhea and a fever with a temperature higher than 38.5°C (101.5°F).
- Your child has signs of dehydration (as listed above)
- Your child has stomach pains that are getting worse.
Diarrhea lasting for more than 1 to 2 weeks is considered chronic. Talk to your child’s doctor if this is the case.
Reviewed by the following CPS Committees:
Nutrition and Gastroenterology Committee
Public Education Advisory Committee
Last updated: February 2008