Dehydration in infants can be fatal and can occur rapidly in hot weather or during illness. Signs include decreased urine output, weight loss, sunken fontanelles, lethargy, cool hands and feet, and slow capillary refill. Seek medical attention if symptoms occur.
Dehydration in infants can develop rapidly in hot weather, during illness when the infant is unable to retain fluids and/or refuses to drink. If left untreated, dehydration can be fatal. Parents and caregivers should be aware of the behavioral and physical signs and symptoms of both mild to moderate and severe dehydration in infants which include urine output, weight loss and tender spots on the head.
Urine production is a very good indication of dehydration. Healthy, hydrated babies usually produce a wet diaper every few hours. Babies with dehydration will have decreased urine output resulting in a wet diaper no more than every four to six hours. Urine may also have a strong odor and be dark in color.
Weight loss is another symptom of dehydration in infants. A child who has mild to moderate dehydration may lose 3-9% of body weight. In severe dehydration, the child’s weight loss can exceed 9% of body weight.
The fontanelles, or soft spots, on a baby’s head are normally flush with the rest of the scalp. In the case of a mildly to moderately dehydrated infant, the fontanelles may be slightly sunken or depressed. Deeply sunken fontanelles are a sign of extreme dehydration in newborns. The fontanelles can also have noticeable pulsations in the worst situations.
Children who have mild to moderate dehydration may be lethargic, listless, and/or more irritable than usual. Severe dehydration in infants can also cause extreme sleepiness. Caregivers may have difficulty waking babies from sleep. In the worst cases of dehydration, the child may lose consciousness and become unresponsive.
Cool hands and feet, producing very few tears when crying, and dry, sticky mucous membranes are other indicators of mild to moderate dehydration in children. Severely dehydrated children may also have cool hands and feet, as well as blotchy, mottled, or blue skin with parched mucous membranes. Very dehydrated babies do not produce tears when they cry.
Heart rate may be increased and pulse quality may be decreased in children who are mildly or moderately dehydrated. In severe cases, the baby will have a rapid heartbeat and a weak, thready pulse. The pulse may not even be detectable.
In a hydrated baby, the skin returns to normal instantly if it is gently pinched. In infants with mild to moderate dehydration, it may take up to two seconds for the skin to return to normal. The skin of dangerously dehydrated newborns remains wrinkled or takes more than two seconds to normalize.
Pressing a hydrated baby’s nail whitens it and the nail bed turns white. Once the nail is released, the capillaries instantly fill up and the color returns. The nail beds of mildly to moderately dehydrated infants also blanch, but capillary refill is prolonged. The capillary refill of a severely dehydrated infant is extremely slow or does not recharge completely.
Babies can live for a few days without eating, but can die suddenly if they become severely dehydrated. Healthcare professionals who notice any of the symptoms of dehydration should contact the doctor immediately or take the child to the emergency department of the nearest hospital. If a caregiver isn’t sure whether a child is dehydrated, it’s best to err on the side of caution and contact a doctor.
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