Dehydration occurs when more water is lost from the body than taken in. In different age groups, there are specific clues to look for to identify dehydration. These symptoms are particularly harsh in the young since babies and toddlers as they do not regulate their own fluid intake very well. Their bodies often compensate for the lack of fluid by simply decreasing blood flow to the extremities and vital organs. Any time a toddler is suspected to be moderately to severely dehydrated, it is a medical emergency.
Appearance
In mild dehydration, most toddlers will appear normal. The only visible sign may be decreased saliva production. If the dehydration continues, the skin may start to mottle and be cool to the touch, the eyes will start tearing, and the mouth and other mucous membranes will be dry. If the toddler does not have much hair, there may be a visible, slightly sunken skin near the anterior fontanel (one of the original soft spots on the top of the head at birth). When dehydration is severe the skin, becomes cool and clammy to the touch. Also, if the skin is stretched up and away from the body it will tent and return slowly into place. The mouth and other mucous membranes will still be dry and the eyes will now have a sunken in appearance.
Organ Systems
It is imperative to monitor how the body's internal organs are functioning. The most useful indicator of dehydration in infants and toddlers overall is urine output. In mild to moderate dehydration, urine output is decreased and also has a darker appearance than normal. Keep track of the number of diaper changes or the amount of urine in the potty to help track output. In severe dehydration, there is no urine output at all. An abnormal pulse can indicate dehydration, and can be checked by pressing into the bicep muscle, in the upper arm, and feeling for the brachial pulse near the bone. Toddlers have a higher heart rate than adults, so a rate of 70 to 80 beats per minute is normal. In mild dehydration there will be no change in pulse. In moderate dehydration there will be a mild increase in pulse. In severe dehydration, the pulse will be quite elevated. The American Academy of Orthopedic Surgeons states that a pulse higher than 160 beats per minute is a sign of impending shock. Blood pressure will start to drop in severe dehydration once shock has set in. This can be checked with a blood pressure cuff or by checking the capillary refill rate of the fingers. Gently squeeze the fingers until they blanch white. Once pressure is release from the finger, normal color should return in less than 1 second. A delay in refill rate is a sign of severe dehydration. Emergency medical care must be sought for any of these symptoms.
Activity and Level of Consciousness
Observing how a child plays and acts is another clue to dehydration. In mild dehydration, it may be hard to notice since the level of activity and consciousness will be normal to mildly reduced. As dehydration progresses, the level of activity will be slowed and the level of consciousness will be altered as in the child grows tired. In severe dehydration, the toddler will be weak, unresponsive and more lethargic.
References
- "Emergency Care and Transportation of Sick and Injured Ninth Edition;" American Academy of Orthopedic Surgeons; 2005.
- Mayo Clinic: Dehydration
- Baby Center: Dehydration
