British Journal Of Nursing Vol 28 No 21 2019

1366 British Journal Of Nursing 2019 Vol 28 No 21 2019mahealt

Care for children with dehydration is a crucial skill for nurses working in acute paediatric settings. Recognising and promptly treating dehydration can prevent rapid deterioration and potentially fatal outcomes. Children are more susceptible to dehydration than adults due to their higher proportion of water in body weight, immature kidney function, and higher metabolic rates. This article aims to guide nurses in effectively identifying and managing dehydration in children.

Paper For Above instruction

Dehydration remains a significant clinical concern in pediatric healthcare, especially given its prevalence in acute settings such as emergency departments and inpatient wards. Effective management of dehydration not only mitigates immediate health risks but also prevents long-term complications, including electrolyte disturbances, kidney injury, and shock. Recognising the signs early and understanding the appropriate treatment protocols are essential competencies for nursing professionals caring for children.

Children are particularly vulnerable to dehydration because water constitutes a larger part of their body mass compared to adults. According to the World Health Organization (WHO, 2009), infants and young children have an even poorer ability to conserve water due to immature renal function, which makes early recognition essential. The primary reasons for dehydration in children include diarrhoea, vomiting, systemic infections, and malnutrition. These conditions cause fluid loss which, if not replaced adequately and promptly, can lead to severe dehydration and hypovolaemic shock.

The clinical assessment of dehydration in children involves a systematic approach, often guided by frameworks such as the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) assessment. During this process, clinicians look for specific signs such as irritability, lethargy, sunken eyes, dry mucous membranes, decreased skin turgor, and alterations in vital signs like increased heart rate and respiratory rate (NICE, 2015). Recognising these features promptly enables early intervention, which is vital to prevent clinical deterioration.

Assessment of severity is critical and is often assisted by clinical features that serve as red flags. For example, a child presenting with hypotension, cold extremities, mottled skin, or markedly decreased urine output indicates severe dehydration or hypovolaemic shock. These signs necessitate urgent intervention, including fluid resuscitation (NICE, 2015). Health professionals should also be attentive to at-risk populations, such as infants under six months, children with low birth weights, or those with a history of multiple diarrhoea episodes, as these groups are at increased risk of rapid dehydration progression (NICE, 2009).

Management begins with accurate hydration assessment and classification of dehydration severity. Mild to moderate dehydration can often be managed initially with oral rehydration therapy (ORT). The World Health Organization recommends administering oral rehydration solutions (ORS) containing an appropriate balance of sodium and glucose, such as Dioralyte, Dioralyte Relief, Electrolade, or Rapolyte (NICE, 2009). The typical approach involves administering 50 mL/kg over four hours, with adjustments based on the child's response and ongoing assessment of clinical signs like urine output and skin turgor.

For children unable to tolerate ORT due to persistent vomiting, altered consciousness, or severe dehydration signs, intravenous (IV) rehydration becomes necessary. The initial IV fluid choice should be isotonic crystalloids, commonly sodium chloride 0.9% with glucose 5% (NICE, 2015). The calculation of maintenance fluids is often performed using the Holliday–Segar formula, which considers the child's weight to determine the appropriate hourly volume (Holliday & Segar, 1957). The formula suggests 100 mL/kg/day for the first 10 kg of weight, 50 mL/kg/day for the next 10 kg, and 20 mL/kg/day for each additional kilogram.

In hypovolaemic shock cases, rapid fluid resuscitation is critical. This involves administering a bolus of 20 mL/kg of isotonic fluid over less than ten minutes, reassessing clinical response thereafter. If the child's condition improves, maintenance fluids are continued with cautious ongoing monitoring of vital signs, urine output, and fluid balance (NICE, 2015). Repeated boluses may be necessary, but care must be taken to avoid fluid overload, especially in children with cardiac or renal conditions.

Monitoring during rehydration is vital to prevent complications such as hyponatraemia or fluid overload. Blood tests, including electrolytes and blood glucose levels, should be checked initially and at regular intervals to guide ongoing treatment. As the child's condition stabilizes, gradual reintroduction of oral feeds, including breast milk or formula, is recommended, avoiding fruit juices and carbonated drinks until recovery is complete (NICE, 2009).

Once rehydration is achieved, nutritional rehabilitation becomes a priority. The child's usual diet can generally be resumed, with fluid intake gradually normalized. Special attention should be given to the importance of continued hydration and nutritional support, especially in children with ongoing illnesses or malnutrition (WHO, 2009). Education of caregivers about early signs of dehydration and maintaining adequate hydration during illnesses remains essential in preventing future episodes.

In summary, early detection and appropriate treatment of dehydration in children are critical responsibilities of nurses working in pediatric care. Recognising the clinical signs, assessing severity, and delivering timely rehydration—either orally or intravenously—are fundamental to preventing morbidity and mortality. Ongoing training and adherence to clinical guidelines such as those from NICE and WHO are necessary to ensure optimal outcomes for pediatric patients experiencing dehydration.

References

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• NICE. (2009). Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management. Clinical guideline CG84.
• NICE. (2015). Intravenous fluid therapy in children and young people in hospital. NICE guideline NG29.
• NHS. (2019). Dehydration. National Health Service. Retrieved from https://www.nhs.uk/conditions/dehydration/
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