Dehydration in Children: How to Spot It Early and When It Becomes an Emergency

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.