Drinking Fluids — Decreased

Definition

• Child drinks less than normal amounts of fluid

Causes

• Main cause: Sore mouth or throat.
• Common cause in infants: Blocked nose in bottle or breastfed infant (Reason: can't breathe while sucking).
• Common cause: Nausea from viral stomach infection without vomiting.
• Difficulty breathing with bronchiolitis or croup. (Reason: not enough energy to both suck and breathe)

Complication

• Dehydration

When to Call Your Doctor for Drinking Fluids — Decreased

Call your doctor now (night or day) if

• Your child looks or acts very sick
• Signs of dehydration, such as:
  • If less than 1 year old and has not urinated in over 8 hours, or if older than 1 year old and has not urinated in over 12 hours.
  • Crying produces no tears
  • Very dry mouth (rather than moist)
  • Sunken soft spot
  • Excessively sleepy child
• Too weak to suck or drin
•  Refuses to drink anything for over 12 hours (8 hours if under 12 months old)
• Refuses to drink and new onset of drooling
• Could have swallowed a foreign body
• Wheezing or stridor with breathing
• Difficulty breathing not better after you clean out the nose

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

• You think your child needs to be seen
• Unexplained difficulty drinking and also has fever
• Poor drinking present over 3 days

Call your doctor during weekday office hours if

• You have other questions or concerns

Parent care at home if

• Drinking adequate amounts of fluid AND no signs of dehydration and you don't think your child needs to be seen

Home Care Advice for Decreased Fluid Intake

1. Increase Fluid Intake: Give your child unlimited amounts of her favorite liquid (e.g., chocolate milk, fruit drinks, Kool-Aid, soft drinks, water). The type doesn't matter, since your child doesn't have diarrhea or vomiting.
2. Solid Foods: Don't worry about solid food intake. It's normal for the appetite to fall off during illness. Preventing dehydration is the only important issue.
3. For Sore Mouth:
   • If the mouth is sore, give cold drinks.
   • Avoid citrus juices.
   • For infants, offer fluids in a cup, spoon or syringe rather than a bottle (Reason: The nipple may increase pain).
   • Older child can use 1 teaspoon of a liquid antacid as a mouthwash 4 times per day after meals.
   • Give acetaminophen (e.g., Tylenol) or ibuprofen for pain relief.
4. Nasal Washes to Open a Blocked Nose:
   • Use saline nose drops or spray to loosen up the dried mucus. If not available, can use warm tap water.
   • STEP 1: Instill 3 drops per nostril. (Age less than 1 year, use 1 drop and do one side at a time).
   • STEP 2: Blow (or suction) each nostril separately. Then do other side.
   • STEP 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
   • Frequency: Do nasal washes whenever your child can't breathe through the nose.
   • Saline nasal sprays can be purchased OTC.
   • Saline nose drops can also be made: add 1/2 tsp of table salt to 1 cup (8 oz) of warm water.
   • Reason for nose drops: suction or nose blowing alone can't remove dried or sticky mucus.
   • Another option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
   • Importance for a young infant: can't nurse or drink from a bottle unless the nose is open.
5. For Shortness of Breath: For mild bronchiolitis or difficult breathing, offer small frequent (every 1/2 hour) feedings so the infant can rest briefly between them.
6. Call Your Doctor If:
   • Difficulty swallowing becomes worse
   • Signs of dehydration
   • Poor drinking present over 3 days
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.

References

1. Armon K, Elliott EJ. Acute gastroenteritis. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health.London, England: BMJ Publishing Group; 2000. p. 273-286
2. Gorelick MH, Shaw KN, Murphy KO. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997;99(5):E6.
3. Jospe N and Forbes G. Fluids and electrolytes: Clinical aspects. Pediatr Rev. 1996;7:395-404.
4. Morrison JE Jr and Pashley RT. Retropharyngeal abscess in children: A 10-year review. Pediatr Emerg Care. 1988;4:9-11
5. Nicklane PJ and Kelley PE. Management of deep neck infection. Pediatr Clin North Am. 1996;43:1277-1296.

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/4/2010

Last Revised: 12/16/2009 12:55:59

Version Year: 2010

Copyright 1994-2010 Barton D. Schmitt, M.D.