Pediatric Dehydration Clinical Presentation

Updated: Nov 12, 2018
  • Author: Alex Koyfman, MD; Chief Editor: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA  more...
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Presentation

History

The goal of the history and physical examination is to determine the severity and etiology of the child's condition. Accurate classification of the degree of dehydration as mild, moderate, or severe allows for appropriate therapy and disposition of the patient in a timely fashion.

Obtaining a complete history from the parent or caregiver is important because it provides clues to the type of dehydration present. The emergency physician should be diligent in obtaining the following information:

  • Feeding pattern and fluids given

  • Fluid loss (eg, vomiting, diarrhea)

  • Number of wet diapers compared with normal, suggesting oliguria or anuria

  • Activity level

  • Possible ingestions that may cause vomiting

  • Heat and sunlight exposures for insensible losses

  • Current illness pattern, fever, ill contacts

  • Recent weight prior to current illness (infants typically have regular well child appointments with weight recorded)

Next:

Physical Examination

The severity of dehydration is typically measured as the acute weight loss (presumably fluid) as a percentage of preillness weight. However, the pre-illness weight is often not available in the ED setting and clinicians have to rely on the patient’s history and physical examination findings to assess the severity of dehydration.

On the basis of a systematic review, Steiner et al found that the most useful signs (ie, highest likelihood ratios) for recognizing 5% dehydration are the following [6] :

  • Abnormal capillary refill time

  • Abnormal skin turgor

  • Abnormal respiratory pattern

The Table highlights the physical findings seen with different levels of pediatric dehydration.

Table. Physical Examination Findings in Pediatric Dehydration (Open Table in a new window)

Symptom

Degree of Dehydration

Mild (< 3% body weight lost)

Moderate (3-9% body weight lost)

Severe (>9% body weight lost)

Mental status

Normal, alert

Restless or fatigued, irritable

Apathetic, lethargic, unconscious

Heart rate

Normal

Normal to increased

Tachycardia or bradycardia

Quality of pulse

Normal

Normal to decreased

Weak, thready, impalpable

Breathing

Normal

Normal to increased

Tachypnea and hyperpnea

Eyes

Normal

Slightly sunken

Deeply sunken

Fontanelles

Normal

Slightly sunken

Deeply sunken

Tears

Normal

Normal to decreased

Absent

Mucous membranes

Moist

Dry

Parched

Skin turgor

Instant recoil

Recoil < 2 seconds

Recoil >2 seconds

Capillary refill

< 2 seconds

Prolonged

Minimal

Extremities

Warm

Cool

Mottled, cyanotic

Adapted from King CK, Glass R, Bresee JS, et al. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. Nov 21 2003;52(RR-16):1-16. [5]

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