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Is My Kid Getting Enough To Drink?

Thanks T.E. from Alabama for your question about your child not drinking.

What to do in the case of poor fluid intake/not drinking in an infant Anytime a parent presents a child who will not drink or is not drinking much (be it formula, breast milk, water, etc.), I always ask “why not?” Is the child sick? In which case, I will expect fluid intake to increase when the child feels better. Is the child naturally weaning off of breastfeeding? In which case, I need to introduce a cup or bottle (depending on the child’s age). Is the child just ready to transition to a “big boy/girl” cup or method of drinking? Or is there some other underlying issue? Once I figure out the “why,” I then know a bit more about what to expect.

When to worry: signs of dehydration

A baby, or older child, who isn’t drinking always runs the risk of dehydration. Signs of dehydration include the following (one or more signs is worrisome):

  1. Decreased wet diapers/no urine. At minimum, a child should have a wet diaper every 6-8 hours.
  2. Dry mouth
  3. No tears when crying
  4. Sunken fontanelle (this is the soft spot on the top of the head)
  5. Skin that looks dry, sunken, or wrinkled with poor elasticity (sometimes this is referred to as poor skin turgor)
  6. Delayed capillary refill. To test this, push on your child’s finger nails. The nail should be pink to start with and turn white with pressure. The time is takes to go back to pink is the “capillary refill.” Normally it should return to pink instantly or at least within one to two seconds. Three or more seconds is concerning.

What should I do?

Get creative. Get your child to drink in whatever way possible. If your child is sick, it may be small frequent sips out of a cup or syringe. If your child is less than a year old, try to continue breast milk or formula as tolerated. If your child is vomiting or has lots of diarrhea, the fluid of choice is generally Pedialyte (a balanced electrolyte solution). While some fluids are definitely better than others, the general rule of thumb is something is better than nothing. However, if your child is less than 6 months of age, steer clear of water/juice. If your child is well, you may just need a new way to present fluids (e.g., bendy straws, character sippy cups, a special water bottle just for the child).

What will a doctor do?

Your doctor will first determine how dehydrated your child is. If your child can tolerate it – that is, not throw up the liquid – then your doctor will likely try oral rehydration. If your child cannot tolerate oral fluids or is severely dehydrated, then your child will likely be given intravenous (IV) fluids. Some doctors do this in their office, while others send you to an Emergency Room (depending on what the office is equipped to do).