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Drinking Fluids - Decreased

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Definition

  • Drinking less than normal amounts of fluid

Causes For Drinking Less Fluid Than Normal

  • Sore Throat. A sore throat is the most common cause. The pain is made worse by swallowing. Most sore throats are caused by a virus. Strep bacteria cause 20% of sore throats with fever.
  • Mouth Ulcers are another common cause of a painful mouth. The pain is made worse by swallowing. Most mouth ulcers are caused by a virus (such as Coxsackie virus).
  • Nausea means a sick stomach feeling and loss of appetite. Also called an upset stomach, but without vomiting. Usually from a viral infection of the stomach or liver.
  • Blocked Nose. A common cause in bottle or breastfed infant. Reason: if nose is clogged, the baby can't breathe while sucking.
  • Trouble Breathing (Serious). Shortness of breath from any lung disease can reduce fluid intake. Examples are pneumonia, wheezing or severe croup. Reason: the baby quickly gets tired from sucking and breathing at the same time.
  • Foreign Object in the Esophagus (Serious). The esophagus is the tube from the mouth to the stomach. A swallowed foreign object can become stuck here. Examples are coins or small toy parts. The main symptoms are gagging, refusal of fluids or drooling. The peak age is 1 to 3 years.
  • Abscess of Tonsil (Serious). A bacterial infection of the tonsil can spread to the surrounding tissues. The main symptoms are severe trouble swallowing, fever and one-sided throat pain. It's also hard to fully open the mouth. The peak age is teens.

Dehydration: How to Tell

The main risk of not drinking enough fluids is dehydration. This means the body has lost too much water. It is a reason to see a doctor right away. Your child may have dehydration if not drinking much fluid and:

  • The urine is dark yellow and has not passed any in more than 8 hours.
  • Inside of the mouth and tongue are dry.
  • There are no tears if your child cries.
  • Slow blood refill test: longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.
  • A child with severe dehydration becomes too weak to stand. They can also be very dizzy when trying to stand.
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When To Call

Call 911 Now

  • Severe trouble breathing (struggling for each breath; can barely speak or cry)
  • Not moving or very weak
  • You think your child has a life-threatening emergency

Go to ER Now

  • Could have swallowed a coin or other foreign object
  • Too weak to suck or drink

Call Doctor or Seek Care Now

  • Signs of dehydration, such as:
    • Has not passed urine in more than 8 hours
    • Crying does not cause tears
    • Very dry mouth
    • Sunken soft spot
    • Sleepy child
  • Will not drink or drinks very little for more than 8 hours
  • Will not drink and new onset of drooling
  • Trouble breathing, but not severe
  • Can't move neck normally
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Poor drinking and also has fever
  • Poor drinking lasts more than 3 days
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Drinking adequate amount of fluids and no signs of dehydration
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Care Advice

What You Should Know About A Decreased Fluid Intake:

  • Eating less solids during an illness is normal.
  • Drinking less fluids is not.
  • So far, your child does not have any signs of dehydration.
  • Here are some tips to help increase fluid intake.

Fluids - Offer More:

  • Age less than 1 year: keep giving formula or breast milk. You can also try ORS (such as Pedialyte).
  • Age more than 1 year: offer chocolate or regular milk, fruit drinks, juice or water. You can also try popsicles.
  • The type of fluid doesn't matter, as it does with diarrhea or vomiting.

Solid Foods - Less Important:

  • Don't worry about solid food intake.
  • It's normal not to feel hungry or want to eat when sick.
  • Preventing dehydration is the only thing that is important.

Sore Mouth Treatment:

  • If the mouth is sore, give cold drinks.
  • Do not use citrus juices.
  • For babies, offer fluids in a cup, spoon or syringe rather than a bottle. Reason: the nipple may increase pain.
  • To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed.

Liquid Antacid for Mouth Pain (Age 1 Year and Older):

  • For mouth pain, use a liquid antacid (such as Mylanta or the store brand). Give 4 times per day as needed. After meals often is a good time.
  • Age 1 to 6 years. Put a few drops in the mouth. Can also put it on with a cotton swab.
  • Age over 6 years. Use 1 teaspoon (5 mL) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
  • Caution: do not use regular mouth washes, because they sting.

Nasal Saline to Open a Blocked Nose:

  • Use saline (salt water) nose spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water.
  • Step 1: put 3 drops in each nostril. If under 1 year old, use 1 drop.
  • Step 2: blow (or suction) each nostril out while closing off the other nostril. Then, do the other side.
  • Step 3: repeat nose drops and blowing (or suctioning) until the discharge is clear.
  • How Often: do nasal saline rinses when your child can't breathe through the nose.
  • Limit: if under 1 year old, no more than 4 times per day or before every feeding.
  • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
  • Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops.
  • Reason for nose drops: suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open.
  • Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
  • For young children, can also use a wet cotton swab to remove sticky mucus.

For Shortness of Breath - Give Smaller Feedings:

  • For trouble breathing, feed more often. Feed every ½ hour.
  • Offer smaller amounts per feeding.
  • Reason: this allows your baby to rest in between feedings.

Call Your Doctor If:

  • Trouble swallowing gets worse
  • Signs of dehydration occur
  • Poor drinking lasts more than 3 days
  • You think your child needs to be seen
  • Your child becomes worse

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Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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