Dehydration kills more children globally than almost any other condition. Yet many Indian parents cannot identify when a child is dangerously dehydrated. Dr. Sushma B explains the signs and the right way to rehydrate.
Key Points
- Mild dehydration: slightly dry mouth, reduced urine output — treat with oral rehydration solution.
- Moderate dehydration: sunken eyes, dry skin, reduced skin turgor, no tears — urgent oral rehydration.
- Severe dehydration: extreme lethargy, sunken fontanelle, cold extremities, no urine for 8+ hours — IV fluids emergency.
- ORS (oral rehydration solution) is more effective than plain water — contains sodium and glucose for intestinal absorption.
- Diarrhoeal disease with dehydration is still the leading cause of child death globally despite being fully preventable.
1.5M
children under 5 die from diarrhoeal dehydration annually — globally preventable
Source: WHO
90%
of mild-moderate dehydration cases respond to oral rehydration without IV fluids
Source: WHO
3 sachets
of ORS per episode of diarrhoea dramatically reduces hospitalisation rates
Source: WHO
"Parents instinctively try to force water into a dehydrated child. ORS is better than water alone — the glucose drives sodium and water absorption. But a child who is lethargic, glassy-eyed, and barely responsive needs IV fluids immediately — not more ORS at home."
Diarrhoeal disease with dehydration remains among the leading causes of child death under 5 in India — despite the fact that the treatment (oral rehydration solution — ORS) is inexpensive, widely available, and highly effective when given early. The gap is recognition: most parents do not know how to accurately assess their child's hydration status, leading to delayed treatment.
Grading Dehydration in Children
No/minimal dehydration (less than 3% body weight loss): Child is alert and playful; eyes normal; mouth and tongue moist; tears present when crying; normal urine output; drinking normally. Continue breastfeeding and normal feeds; give extra fluids for each loose stool.
Some dehydration (3–9% body weight loss): Restless or irritable; eyes slightly sunken; mouth and tongue dry; reduced urine output (fewer than normal wet nappies); drinks eagerly when offered fluids; skin pinch retracts in 1–2 seconds. Treat with ORS — 75ml/kg over 4 hours plus ongoing replacement for losses.
Severe dehydration (over 9% body weight loss) — EMERGENCY: Lethargic or unconscious; deeply sunken eyes and fontanelle (in infants); mouth very dry; no tears; no urine for 8+ hours; skin pinch retracts slowly (>2 seconds); drinking poorly or unable to drink. Call 108 or go to hospital immediately — IV fluids required.
The Right Way to Use ORS
ORS is not just sugar-salt water. It is specifically formulated with the correct concentration to maximise intestinal sodium-glucose co-transport — the most efficient intestinal absorption mechanism. Low-osmolarity ORS (available at any pharmacy in India as sachets) is the standard of care.
Common mistakes: giving undiluted ORS or the wrong concentration; giving sugary drinks, soft drinks, or fruit juice (high osmolarity worsens diarrhoea); stopping breastfeeding during illness (breastmilk should continue). Give ORS by spoon or cup (not a bottle) — 5ml every 1–2 minutes initially if the child is vomiting, then increasing as tolerated.
For paediatric illness and dehydration management: Dr. Sushma B at Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.
Dr. Sushma B
DNB Paediatrics · Fellowship PICU · Sri Anand CNC, Chanda Nagar Hyderabad · Sri Anand Child and Neuro Center
MD Paediatrician with 10+ years of clinical experience in child health, vaccination, developmental paediatrics, and newborn care. Practices at Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad.
References & Sources
- 1.Diarrhoea and Dehydration — WHO — World Health Organization
- 2.Dehydration in Children — NCBI StatPearls — NCBI StatPearls
- 3.Dehydration — NHS — NHS UK
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