Ten-year-old Danielle and her teammates walked off the soccer field in single file, slapping the outstretched palms of their opponents, who were walking in the opposite direction. Then they slumped down in the grass on the sidelines. The girls had won the three-day, seven-game tournament, but Danielle didn’t seem to care.

“Mum,” she said, “I have a headache.” In the car on the way home, a listless Danielle gulped down some Gatorade and soothed her chapped lips with cherry lip balm. For the next two days her headache lingered, and she didn’t feel like eating. All she wanted to do was sleep.

Even though Danielle had water and sports drinks available during the tournament, she had a minor case of heat exhaustion and had become dehydrated. Children often don’t recognise when they need more liquids because they are preoccupied with activities and they haven’t learned to monitor their bodies.

The obvious signs of dehydration include thirst, headaches, decreased appetite, dry lips and mucous membranes, and decreased urination. Another sign is “tenting” of the skin. When the body is dehydrated, the skin lacks its normal elasticity. If a portion of dehydrated skin is gently pinched, it will remain elevated, raised like a tent above the ground.

Water is essential to help blood deliver nutrients and oxygen throughout the body. Hydration keeps children’s systems operating at full capacity, allowing for optimum physical and mental functioning. Without enough water, your child’s kidneys may suffer injury. Also, children thrive with the right amount of water — they focus better, have more energy and usually have a more pleasant disposition.

Illness can cause dehydration

When children don’t get enough water, they wilt. Six-year-old Sophia, who was normally a vivacious ballerina, trudged into the doctor’s office with her lips parched and her eyes sunken. Her mother said that Sophia had been up all night, throwing up and experiencing several bouts of diarrhoea. Sophia had a low-grade fever, and her heart rate was elevated. When children get sick with viral illnesses, their risk for dehydration increases.

Once home, Sophia’s mum monitored her daughter’s fluid intake closely. Since Sophia was able to take sips (1 to 2 teaspoons) of fluid every few minutes, she did not require intravenous fluids. Sophia was feeling much better by the next day, and though she wasn’t quite up to dancing, she was wearing her tutu.

Sophia’s mum used the preferred method to replenish fluid during an illness, which is with an oral rehydration solution (ORS), such as Gastrolyte, that contains the necessary balance of sugar and electrolytes.

Offering milk, caffeinated beverages or fruit juices to your child may make the condition worse. Milk is often difficult to digest during a viral illness and can cause more diarrhoea. Caffeine is believed to stimulate the kidneys to release more urine, which can make the dehydration worse. Even fruit juices and sports drinks aren’t recommended because they contain high levels of fructose or other sugars, which may worsen diarrhoea. Sugary drinks can also bloat the stomach, increasing abdominal pain.

When your child is ill, especially if vomiting and diarrhoea are involved, monitor your child’s fluid consumption carefully. Also, seek medical attention right away if your child has any of these four symptoms of a more complicated infection: fever of 38.4 degrees or higher, blood in the stool, no urine output for four to six hours, or too frequent or painful urination.

Dehydration and physical activity

Illness isn’t the only dehydration threat. Danielle, the soccer athlete, experienced insensible water loss during the three-day tournament. Insensible water loss refers to water that passes through the skin and is lost by evaporation. It also includes water vapour emitted through the respiratory tract and the fluid component of bowel movements.

Since children have a larger percentage of surface area for their weight than adults, children are more prone to insensible water loss from their skin. Children breathe faster than adults, and this increased respiratory rate leads to more water loss as well. The higher metabolic rate of children causes them to require proportionately greater volumes of water than adults.

Want to help your child remain hydrated during periods of physical exertion? Here are some helpful guidelines.

– Account for humidity. Humidity is a huge factor to consider when preventing your child’s insensible water loss. For example, if it were 32 degrees in both Cairns and Alice Springs, a child hiking in humid Cairns would need more water than the one in the arid desert.

– Consider your child’s size. Body weight also plays into your child’s water consumption needs. During sports, a child between the ages of 6 and 12 needs 150 to 250 mls of water every 20 minutes. A child of 40 kgs would need about 150 mls. A child of 60 kgs would require closer to 250 mls.

– Don’t ignore altitude. Hiking in elevations of 5,000 feet or higher can result in increased urination, increased respiratory rate and blunting of the thirst response. The insensible water loss from respiration at high altitude is estimated to be twice that at sea level. While you may be tempted to pack light when enjoying a family trek through the mountains, please don’t skimp on your water supply.

– Watch the clock. Your child’s thirst is not a reliable indicator of his or her water needs because a child’s thirst can be quenched before he or she has consumed enough liquid. Encourage your children to drink every 20 minutes during periods of physical activity.

– Make sure your child has bathroom accessibility. Children often won’t drink water during a sporting event because they don’t want to take time to go to the bathroom. Danielle didn’t like using a Portaloo because it was dirty and smelly, so she would avoid drinking during tournaments. Ross, a young hiker participating in an outdoor day camp, didn’t like going to the bathroom in the wilderness where other campers might see him, so he avoided drinking liquids. As a result, he became light-headed, slowing down the group and becoming a risk to himself and other hikers.

Parents can talk with coaches, mentors and leaders to make sure their children are encouraged to drink and be given enough time to use the restrooms. Parents can also bring toilet paper and cleaning supplies to restroom facilities that may be unsanitary. A small baggie filled with disinfectant cloths can do much to relieve a child’s fear of “icky” places. If your child has modesty concerns like Ross did, make sure he or she is comfortable in rustic environments before signing him or her up for the experience.

– Choose your child’s liquids wisely. During exercise, offering your child cool, filtered water is usually the best option. Sports drinks with electrolytes may be helpful for your children, but teach them to avoid the three Cs: caffeinated, calorie-laden or carbonated drinks. Sugary drinks often pack quite a high-caloric punch and are habit-forming. That combination can quickly add unwanted pounds. Encourage your children to eat and drink lower-calorie options. For example, eating an orange with 60 calories and drinking a 250 ml glass of water with zero calories is a much better option for your child than allowing him or her to chug a 250 ml glass of orange juice with 120 calories.

Let It Flow

Water is as necessary as air for your child’s health. Just as you would never deprive your child of oxygen, don’t limit liquids. Younger children often have a challenging time sensing that their bladder is full, which can be inconvenient, but water intake is a necessary ingredient to their overall health. Their skin will be clearer, their energy will be higher and their health will be stronger.

© 2016 Marianne Hering. All rights reserved. Used with permission. Published at focusonthefamily.com.

Dr. Patricia Landry and Marianne K. Hering

Dr. Landry, MD is a practicing Family Practitioner in Easley, SC. Dr. Landry graduated from Medical University of South Carolina College of Medicine in 1989 and has been in practice for 30 years.
As a writer and editor for more than two decades, Marianne has experience in all phases of prepress book and magazine production.

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