Conan Gasque (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Conan Gasque. Thanks so much for joining us today. Dehydration is the topic we're talking about today, and I'm joined by Gary Atchley, a Clinical Nutritionist here at Children's of Alabama and also a Sports Nutritionist.

Gary, thanks so much for your time.

Gary Atchley: Thanks. Happy to be here.

Host: So, again, talking about dehydration, I want to talk first about some of the hazards of dehydration. We all know it's a very important topic, but can you talk a little bit about some of the dangers of a child not staying hydrated? What's kind of the worst case scenario?

Gary Atchley: Worst case scenario, we start with a heat stroke, heat exhaustion, you know, which can lead to a hospital stay. That's going to be the worst. I mean, you also have injuries that happen because joints and cells in the body are not properly hydrated. So, you know, if you don't get enough fluid on the knee, it's going to be some friction there, uh, so we just want to make sure kids in general, stay hydrated just to stay out of trouble. Signs are pretty evident though.

Host: And I guess cramping if you're out in the heat, playing a sport, uh, you hear about that in football games, is that kind of a result of dehydration as well?

Gary Atchley: Yeah, that's a big one, uh, which we see, you know, obviously in sports, performance related cramps, you know, those will go away with rehydration and rest, but, uh, for the child athlete or the athlete in general, that's a big concern because you get a cramp, you're out of the game.

Host: How quickly can some of these things start to manifest themselves if you're not staying hydrated?

Gary Atchley: They can happen very fast. Uh, as soon as you start to lose a little bit more fluid than you should, uh, generally within like 30 minutes. Um, as fast as that, if you don't go into the game properly hydrated. Then you'll see these things, uh, show their faces pretty fast, uh, and you'll be able to tell. The kids are going to be tired, hands on the hips, fatigued pretty quickly. Um, and you know, if they're not sweating, obviously that's a big concern as well.

Host: So for athletes, since we're kind of on this topic, how soon do you need to start the process of hydration before a game?

Gary Atchley: It kind of varies. Uh, it depends on the game length, intensity, where it's going to be taking place, if it's going to be outside in the heat or not. But generally, to be safe, hydration is an all day game plan.

Uh, that's what I like to tell my athletes. About four hours before the game is when we can initially start this. You start it off by waking up, drinking a full bottle or glass of water. And then we want to get foods that contain a lot of fluids. Uh, foods contain about 20% of our daily fluid intake, so if we're eating a proper diet. So we're talking about fruits and vegetables, that's going to be the top ones that are, you know, generally 90, 95% fluid, if you break them down. We want to get a lot of vegetables and fruits that have electrolytes, things like potassium, magnesium, and then plus real foods. So even meats, eggs. Uh, less processed foods are mostly water when you, uh, break them down. So, trying to minimize the processed, pre packaged, uh, things like chips as much as possible.

And that's going to kind of start us out on the right foot. Plus, if we want to do, if we know we're going to be in the heat for quite some time, it's good to have some sodium. So maybe some pretzels, something like that.

Host: Okay. And you mentioned, uh, having that bottle of water right when you start out the day, is, is it important to make sure that water is the first thing that you put into your body, uh, during the day, or, or is it okay to have food first? Do you need to start with water regardless of athlete or not?

Gary Atchley: Definitely. Uh, ideally for everyone, for general health. Bottle of water first thing in the morning is going to be essential because all the cells in your body require fluid to work. They have to be properly hydrated. So if you start off with that bottle of water a day, that just makes sure you're not behind the game. So you're already out ahead and that's our goal to stay ahead the whole time.

Host: And I guess bottle of water before coffee is a good idea, especially.

Gary Atchley: Ideally. Yeah, uh, the caffeine in the coffee will dehydrate you. So, it's going to have a very little hydrating effect. You know, maybe a small percentage of that cup of coffee would count as water. Uh, but definitely, if you drink caffeine in the forms of coffee, soda, anything like that, um, it's going to increase your urination. So when that happens, you're going to excrete the water that you've drank with it. So then we've got to get more water. I would definitely, you know, if you have a cup of coffee, have a bottle of water with it.

Host: So we're talking a lot about athletes, but obviously hydration is important for everyone. So let's say for parents in particular, this time of year, it's July. We're in the state of Alabama. It's very hot outside. Uh, what do parents need to do? Are there any general rules of thumb for keeping their kids hydrated when they're outside playing a lot?

Gary Atchley: Sure. Uh, rules of thumb, the main one we just talked about. Which is the one I harp on the most, just, uh, starting out on the right foot. Drink that bottle of water, eat plenty of fruits and vegetables. And then, for every hour that a child is outside in the heat playing, generally, we're going to need at least a bottle of water, about 16 to 20 ounces would be okay.

But, uh, if they're going to be out longer, we want to get some electrolytes in there. So, just give them some fruit. If they're not playing sports, the fruit, you know, will be okay to not upset your stomach, so. Fruit's a good, uh, form of electrolytes to add with water when you're going to be out for an extended period of time in the heat.

Host: What about sports drinks? I know when people think electrolytes, they think about things like Gatorade and Powerade. Are those good or should you kind of stay away from those?

Gary Atchley: Oh, they're fantastic. They're needed. They've been proven time and time again for performance. They will increase your performance, extend your time that you're able to stay out on the field.

So, super important for athletes out there sweating. You know, the electrolytes along with the water. You need them both because your muscles need both to perform properly. And if you have one or the other in too much, then it's, you know, going to be the negative effect. So we want to get both, especially for athletes.

Ideally, um, if we're out more than, say, an hour in the heat or more than an hour of intense exercise, even indoors, we need to maybe drink, uh, you know, a bottle of Gatorade or Powerade along with a bottle of water.

Host: Is sugar a concern at all when you start talking about sports drinks like that? Is that something that parents need to be concerned about?

Gary Atchley: It can be, um, if we're drinking sports drinks during non exercise time.

Host: Right.

Gary Atchley: So that would be the issue. Uh, the sugar, which is, you know, the carbohydrate in sports drinks is generally going to be the right ratio, which is a six to 8% of what you want, uh, to make sure it helps shuttle the electrolytes and fluid into your muscles properly and helps you perform longer. So the muscles need that carbohydrate too if you're out there exercising.

Host: So it's really about what you're doing that kind of dictates what's the right thing to go with.

Gary Atchley: That's exactly it. There's a place and time for everything. So yeah.

Conan Gasque (Host): And I know a lot of people think about dehydration being something of a front of mind topic during this time of year when it's so hot outside, but hydration is really important all year round, right?

Gary Atchley: Definitely. Definitely. Uh, it's needed for so many things. I mean, we talked about injuries. I mean, that happens to the general population. You know, if you have not enough fluid in your joints, you can have knee issues, uh, problems.

Um, also, you know, you need it for every cell in your body, which, you know, includes muscles like your heart, your brain to function properly. So if we don't have the right amount of fluid in us, then you're going to be putting your entire body under a strain, which, you know, over time, it's going to wear it out a little bit faster.

So if we stay properly hydrated all the time, then it's going to pay dividends. You're going to win in the long run.

Host: Sounds good. Any other general advice about the importance of hydration and how people can make sure that they're doing it the right way year round?

Gary Atchley: Uh, year round, so yeah. If it's not summertime and it's not in the heat, you kind of drink to thirst. It's a pretty good indicator to let you know when you should be drinking. If you're playing sports, a good rule of thumb would be about every 15 minutes, try to get at least 7 to 10 ounces of fluid. And that's, you know, again, a mix of sports drinks, water, or even electrolyte powders you can just put in water.

That's fine, too. But, in general, if we drink to thirst, and we eat plenty of fruits and vegetables, and real foods, and less processed foods, we're probably going to be okay.

Host: All right. Once again, Gary Atchley , Atchley, Clinical Nutritionist and also a Sports Nutritionist here at Children's of Alabama. Gary, thanks so much for your time.

Gary Atchley: Thank you.

Host: Thanks for listening to Inside Pediatrics. For more podcasts like this one, go to childrensal.org/insidepediatrics.