Dehydration in Children
Dehydration is a common emergency presentation in childhood-most often from gastroenteritis, poor intake or fever-and may progress rapidly, particularly in infants. Early recognition and appropriate rehydration prevent shock, metabolic disturbance and organ injury.
Management is guided by severity: oral rehydration is first‑line for most children; nasogastric or intravenous therapy is reserved for those who cannot tolerate oral fluids, have red‑flag features or show circulatory compromise (NICE CG84; Resus Council UK 2025).
Assessment: practical approach
- Use a global, repeatable clinical assessment-no single sign rules dehydration in or out. Combine appearance, vital signs, fluid intake/output and targeted physical signs (NICE CG84).
- Rapid bedside framework (Look, Talk, Listen):
- Look: assess general appearance, activity and responsiveness; check for sunken eyes, mucous membranes and skin colour/mottling.
- Talk: obtain history of vomiting or diarrhoea, recent fluid intake, urine output, pre‑illness weight if available, and time course of illness.
- Listen / measure: measure heart rate, respiratory rate, capillary refill time (CRT) and temperature; consider capillary blood glucose if reduced conscious level or prolonged vomiting.
Key clinical signs
- Dry mucous membranes, sunken eyes, decreased tear production, and reduced urine output-especially useful in infants.
- Skin turgor is more reliable in infants; sensitivity diminishes in older children.
- Peripheral perfusion: CRT
> 2 seconds suggests impaired perfusion and should be used in conjunction with other signs.