Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm your host, Melanie Cole and joining me today is Isabel Reckson. She's a registered dietician and certified diabetes care and education specialist in pediatrics at Weill Cornell Medicine. And we're here to discuss dehydration in our little kiddos.

Isabel, thanks so much for joining us today. Tell us a little bit about how fast dehydration can happen and what are some of the main causes.

Isabel Reckson: Yeah. Thank you for having me, Melanie. I'm happy to be here. So, our bodies are made up of so much water. The human body is made up of 55-75% water. So, what happens is dehydration occurs when there's not enough water in the body. That also can occur when we just lose more water than we're able to take in. There's a lot of different reasons that we need water. We need it to protect our organs and our joints. We need it to regulate our body temperature and help with digestion, helps with blood pressure. And it keeps us focused and concentrated. So, water is one of those really important nutrients.

In terms of how quickly dehydration can happen, there's no real one answer. There's a lot of factors and things that contribute. So, our risk of dehydration increases during hot weather, during sicknesses, and even with certain medications. Younger children and babies along with older adults are at highest risk of dehydration.

Melanie Cole, MS (Host): So, are there guidelines for hydration for children? What are the recommended hydration guidelines? Tell us how much liquids our kids should be taking in every day.

Isabel Reckson: There is no one answer again for this one. And the reason is that there's so many different factors that can contribute to a child's hydration needs. If your kid is really active that day and they're sweating a lot, they're going to need a lot more than if it's a colder day and they're not moving around as much. So, activity levels, size, how big a child or small child is and their age all really contribute. A general rule that we'll use child's weight in pounds and divide it by two and that can give you a rough estimate of ounces of fluid that they need per day. Infants, so young infants over six months who are eating solids, they'll need much less water that's like two to eight ounces a day depending on the infant.

Melanie Cole, MS (Host): Wow. Well, thank you for that. That's important information for all of us to know for adults as well as kids. Does it have to be water, Isabel? Do all liquids apply? Tell us a little bit about some of the liquids. And I'd like you to address the viral trends around flavored waters, the ones we're seeing on TikTok, and whether those forms of beverages are actually healthy for us to consume.

Isabel Reckson: Yes. So, different fluids can be hydrating. It doesn't have to just be water. The reason we go towards water first is that we do know it generally meets hydration needs, and it doesn't have added sugar, salts or anything else. So, it's kind of an easy best way to be hydrated. That being said though, like milk, milk alternatives, so what I mean by that is like oat milks, almond milk, fruit-infused water, naturally flavored water, seltzers, unsweetened teas, these all do count towards hydration. So, they can all apply to your daily hydration needs.

In terms of flavored waters, the thing that we want be mindful about is what waters are flavored with. On TikTok, there is a new trend called Water Talk, where there's so much enthusiasm about increasing hydration, which is absolutely wonderful. Most of us are not meeting our hydration needs. So. I think that just the drive and desire to increase fluids is great. So, one thing like we mentioned that we wanna be mindful of is what the water is flavored with. The specific flavorings from the TikTok beverages do have what we call artificial or alternative sweeteners. And those are things that we may have heard of like Stevia, monk fruit, sucralose, aspartame, tends to be a lot of diet products. So, those are generally recognized as being safe in moderation. For kids though, there are not a lot of studies about long-term effects and there are concerns about actually if these products make us hungry or if they have any kind of effect down the road on things like heart health, behavior. So, what I tell my patients, if you have an occasional diet Coke or a vitaminwater zero, is that fine? A hundred percent. But I wouldn't use these as a replacement for daily, like water. Instead, I would choose things that are more, what we say like fruit-infused water, more naturally flavored waters that aren't going to be sweetened with an artificial sweetener, and that are also going to be on the lower sugar end for that too.

Melanie Cole, MS (Host): That was great information, Isabel. So, how do we know? Are there some signs and symptoms of mild dehydration at the start of it? How do we know if our children are hydrated enough? And I'd like you to kind of go along that continuum from mild to severe.

Isabel Reckson: So, one of the easiest ways to see if you are hydrated enough is to check out your child's urine. If your child's urine is a dark yellow or more orange color or brown, brown would be most severe there, there's likely dehydration going on. What we want to look for is a pale yellow. So, that's the easiest way to do that at home. And especially if you have an active child who's sweating a lot, like we said, if you're sweating a lot, you have to replace all that sweat. So, the more you sweat, the more water you need.

Signs and symptoms of mild dehydration may include dizziness, lightheadedness, overall less urine along with the darker urine. A smaller child will have fewer diapers, and then you might notice dry lips, tongue, mouth, throat, things like that. As it becomes more severe, a child will be lethargic. In very severe cases, you might see cold hands and feet, breathing faster, having a fast heart rate, irritable, confused, drowsy. In very severe cases, you know, we always want to reach out to our pediatrician and/or, depending on the concern, the child may need to go to the emergency room and get IV fluids.

Melanie Cole, MS (Host): Well, I'm glad you pointed that out. So, when is it emergent? When does it require medical care? How would we know if they're lethargic, if they're out of it, if they've passed out, that sort of thing?

Isabel Reckson: If you're ever not sure if you require care, the best thing to do is ask. You know, if you're ever not sure, call the pediatrician and talk about the symptoms, and they can tell you the severity if they do think the child needs to be seen or if you're able to do some rehydration at home. So when it comes to rehydration, like we were talking about, water is awesome for hydrating, but we do need electrolytes in cases of dehydration.

As far as rehydration, we do recommend giving water along with certain electrolytes such as potassium and sodium as these are going help the water get back to the balance it needs in the body. There's something called oral rehydration solutions, Pedialyte is an example. There are a lot of other options out there. And those are going to be primarily recommended for rehydrating. Sports beverages like Gatorade are not the same as oral rehydration solutions. So, those can be helpful for if you are not dehydrated, but your child is very active in the summer, running around for an hour, and you do just want to keep them hydrated, more preventative. They do not need those kinds of sports beverages unless they are moving around for, I would say, usually we use an hour as the cutoff of sweating and also does replace some sugar, carbs that are lost in the body. But with specific dehydration, we want to look toward those oral rehydration solutions and giving our kids those beverages to help them meet those hydration needs. If again we're unsure, reaching out to our pediatrician is the best way to determine what kind of care they'll need in that moment.

Melanie Cole, MS (Host): This is great information and so important for parents to hear. So Isabel, as we get ready to wrap up, give us your best tips for keeping our kids hydrated. And you mentioned sports drinks and in the summer, if they're running around and that those are okay to keep those electrolytes in balance and kind of keep them hydrated. But give us really your best advice when you're speaking to parents about keeping our kids hydrated all year round.

Isabel Reckson: A reminder to stay hydrated is that kids need fluid throughout the day and not just at one time. One of the big challenges I do hear from a lot of my patients is getting enough fluid at school. So, sending your child with a water bottle is a great thing to do. You can jazz up the water bottle. If it's a younger kid, they might like stickers or colors on their water bottle. Older kids, myself included, do well with motivational water bottles where they have ticks in terms of goals for how much water to drink at different times. There's other things you can put in water bottles, like fruit infusers. You can use silly straws or fun cups. Those are all ways to help promote water drinking. Like we mentioned, other beverages can contribute to hydration. So, it might be an unsweetened tea or a fruit-infused water such as a Hint Water, things along those lines, a seltzer, those all work as well. Water challenges at home, you know, competitions who can drink water, that kind of stuff, can be helpful. Having routines where you always have a beverage at meals, in between meals helps. Even hydrating foods, watermelon, cantaloupe, grapefruit, berries, some vegetables like cucumbers, lettuce, celery, tomato, popsicles that are homemade. Those foods do contribute to fluids throughout the day as well. So, those all ways that we can work on getting more fluids in our kids.

Melanie Cole, MS (Host): Great information, Isabel. Thank you so much for joining us today. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, and Google Podcast. And for more health tips, go to weillcornell.org and search podcasts. And don't forget to check out all the great podcasts we have on Back to Health. I'm Melanie Cole, MS.

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