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Health & Wellbeing: Ensure children stay hydrated

Practice Health Wellbeing
It is important practitioners recognise the signs of dehydration and ensure children are drinking enough. By Annette Rawstrone

Staying well-hydrated is important whatever the weather, but as the days are warming up, it’s a good time to reconsider how you ensure the children in your care are having enough fluids.

Jo Kellam, nutritionist and eating behaviour specialist at Healthy Intuition, says, ‘Becoming dehydrated can not only decrease their energy levels but their concentration too, which in turn can affect learning and overall wellbeing.’

WHAT’S THE PROBLEM?

Dehydration happens when the body loses more fluids than it takes in, and children are more susceptible to this than adults. Along with causing tiredness, headaches and irritability, poor hydration in young children can lead to daytime bladder issues, such as constantly needingto wee (see Further information). The National Institute for Health and Care Excellence also warns that more severe symptoms such as an abnormally fast heartbeat and/or abnormally rapid breathing can be signs of clinical dehydration.

‘Children lose body water throughout the day when they urinate, as well as through evaporation from the skin and lungs and from sweat when it’s warm,’ explains Bridget Benelam, a nutritionist at the British Nutrition Foundation. ‘So if children don’t drink regularly, they will become dehydrated.’

She advises practitioners look out for children who are having fewer trips to the toilet or wet nappies. Other signs include:

  • Feeling thirsty.
  • Dark and strong-smelling wee.
  • Feeling dizzy and light-headed.
  • Feeling tired.
  • Dry mouth, lips and eyes.
  • Soft spot on their head that sinks inwards.
  • Cold and blotchy-looking hands and feet.
  • Few or no tears when they cry.
  • Sunken eyes.

Practitioners and parents should be on alert in especially hot weather, and particularly if a child is vomiting, has diarrhoea or a fever, or has a medical condition such as diabetes that can make them more prone to becoming dehydrated.

Kellam adds that children are also at an increased risk if they:

  • Are younger than one year old, particularly less than six months.
  • Had a low birth weight.
  • Have not been offered or not been able to tolerate extra liquids.
  • Have stopped breastfeeding during an illness.
  • Are showing signs of malnutrition.

If it is suspected that a child has mild dehydration, this can be treated at home by giving more sips or drinks of water, or oral rehydration fluids from a chemist. A child should be seen by a medical professional if they are confused or drowsy, they are breathing rapidly or if you have other concerns.

IN THE HEAT

‘Young children and babies need more water than adults, and not only is there more water in their bodies to be maintained, they also do a very good job at getting rid of the water that they have,’ says Kellam. ‘They have the ability to breathe faster than adults and as such lose more water through respiration, and they have a greater surface area of skin relative to their body size with which to lose water – so on a hot day when we’re all maintaining our body temperature by losing water (evaporation) through the skin in order to cool the body, children are losing considerably more.’

She says children need to learn to recognise the symptoms of thirst because they are not born with the knowledge. ‘They need to realise that a dry mouth indicates that they need to have a drink, otherwise they may go for long periods without consuming liquids,’ she explains.

Young children are also less able to access drinks for themselves, says Benelam, and are likely to be distracted from feeling thirsty by playing and completing activities. She says it is important young children are encouraged to drink regularly throughout the day and have ready access to drinking water.

Unfortunately there are no current official guidelines on how much water should be drunk, but as a guide, Benelam recommends children should be having around six to eight drinks (about 120-150ml per cup) across the day, and more when they are active, especially if the weather is hot.

‘Children should be offered a drink at all meal and snack times and should be encouraged to drink water at frequent intervals throughout the day,’ she advises. ‘Water and plain milk are the best choices to offer. Parents could provide a refillable water bottle for their child so that they have a familiar bottle that they can drink from when at their setting.’

HYDRATION TIPS

In order to ensure children are drinking enough water during the nursery day, Kellam advises practitioners to:

  • Have regular communication with the children at mealtimes and snack times about drinking a cup of water. Practitioners should take note of how much each child has drunk at these times.
  • Focus on interoception – regular check-ins on children’s understanding of thirst, so they can start to recognise when they need a drink (if a child is feeling thirsty then they are probably already dehydrated).
  • Provide easy access to safe, clean water for children to help themselves to.
  • Always provide extra drink breaks in warm weather and after exercise.
  • Encourage children to drink more water if strong urine is detected during nappy changing or a toilet visit.

It is recommended that children drink plain water and avoid sports drinks, fruit juices, soft drinks and flavoured mineral water because they contain sugar and are acidic, which can lead to tooth decay. If you are caring for children who are reluctant to drink water, you can:

  • Provide straws or fun cups.
  • Make your own ice lollies.
  • Infuse water with lemons, mint or cucumber.
  • Offer fruits and vegetables that have a high water content.

Practitioners should be role models by showing the children in their care that they are drinking plenty of water themselves – for the children’s benefit but also for their own health and performance.

CASE STUDIES: Fennies Nursery Woodside, Croydon

‘Many children can get absorbed in play, especially when they are outdoors, and forget the need to stay hydrated. So we try to create fun and regular ways for them to access water,’ says nursery manager Claire Martin.

‘Under-twos bring in their own personalised beakers and we have pit stops through the day to make sure they’re having drinks. With over-threes, we encourage them to have open-top cups and have jugs of fresh water available for them to pour from. We find children enjoy the process, especially filling the jug at the child-height sink, and it supports their independence. For pre-school children, we encourage them to tick a chart when they’ve had a glass of water. It’s about them starting to take accountability for their own hydration. There are also designated times of the day – snack and meal times – when we encourage the children to pour water for each other.

‘We only offer water or milk, not cordial and sugary drinks. We regularly have discussions about keeping our bodies healthy and include hydration in that. For example, when we’ve grown strawberries, we’ve talked about how they need sunlight and water and link that to what their growing bodies need.

‘Our children love water play and we have a garden with fountains, so in the summer months this also helps them to stay cool and hydrated.’

FURTHER INFORMATION