Vomiting and diarrhea in children can create a significant loss of the fluids that are required for healthy functioning of the body. The fluid that is lost when children are suffering from vomiting and/or diarrhea contains important electrolytes. The loss of water and electrolytes can result in a potentially dangerous state of dehydration.
An infant or child who is vomiting and/or experiencing diarrhea most often has a viral gastroenteritis. The gastrointestinal symptoms often come on quite suddenly and may be accompanied by a fever.
Often other members of the child’s household develop similar symptoms. Pediatricians and family physicians will often recommend that parents simply keep their child well hydrated and give the viral infection time to clear.
On occasion, diarrhea and vomiting in a child signify a more serious underlying illness. Diarrhea that is chronic, bloody, or oily and accompanied by severe stomach or back pains requires further workup.
Similarly, vomiting that is unusually persistent, potentially caused by a suspected toxic ingestion, or that contains blood requires further investigation and treatment.
A child who has fluid losses from diarrhea or vomiting requires careful attention from their caregiver in order to avoid dehydration. Children should be encouraged to drink fluids that are used as oral rehydration solutions.
In a child or infant who quickly vomits fluids up it may be necessary to give them a teaspoon or two every 5 to 10 minutes.
The ill child’s care providers should monitor the child’s urine production to ensure they are having a normal number of wet diapers or trips to the bathroom to urinate.
Inadequate urine production, called oliguria, is an early sign of dehydration in children. Another early sign of mild dehydration in kids is dry mucous membranes. This is easily determined by inspecting the child’s mouth and lips.
Signs of more moderate dehydration in infants or children include a fast heart rate, quicker breathing, significant oliguria, poor skin turgor, delayed capillary refill time and a sunken fontanelle.
Severe dehydration in children causes sunken eyes, a rapid heart rate and breathing rate with weak or absent pulses in the extremities, and in late stages low blood pressure and decreased responsiveness.
A child with moderate dehydration can often be adequately managed with oral rehydration. An oral rehydration solution should initially be provided at a rate of a tablespoon and a half (5 ml) every 5 minutes and may be gradually increased as tolerated over a 4 hour period.
When a child has severe dehydration they may progress to hypovolemic shock and require urgent intravenous fluid resuscitation. This is often provided as a normal saline fluid bolus in the amount of 20 ml/kg of body weight.
The vital signs, pulses and capillary refill time are monitored for improvement as a second or even third fluid bolus may be required.
Dehydration is a common occurrence in infants and young children who are suffering from diarrhea and/or vomiting. It is important that parents and health care providers are familiar with the topic of dehydration and rehydration in these ill children.
eMedicine: Pediatrics Dehydration
Pediatric Advanced Life Support Provider Manual