From the Desk of Dr Stutts

Management Strategies for Pediatric Dehydration

It’s important to understand the connection between acute gastroenteritis and dehydration, as acute gastroenteritis is one of the most common causes of dehydration among pediatric patients. Here, I will provide essential insights into these conditions, as well as strategies for managing them effectively.  

Understanding Pediatric Dehydration

Dehydration occurs when the body experiences a deficit in total body water, leading to fluid and electrolyte imbalance.¹ Common causes of dehydration in young children are diarrhea, vomiting, and fever.¹ Signs and symptoms of dehydration in pediatric patients may include:  

• Dizziness²  
• Headache²  
• Dark-colored urine²  
• Fatigue² or lethargy 
• Few or no tears when crying³ 
• Dry mouth 
• Unusual sleepiness or fussiness³  
• Decreased urine output³

Acute Gastroenteritis and Dehydration in Pediatrics

The following are common acute gastrointestinal infections that can cause dehydration: 

• Norovirus is an extremely contagious virus that causes inflammation of the stomach or intestines.⁴ Symptoms will usually develop 12 to 48 hours after exposure, and while most people recover within 1 to 3 days, the virus can still be contagious for a few weeks after recovery.⁴ Infants and young children with norovirus may vomit and/or have diarrhea many times a day, which can lead to dehydration.⁴ 
• Rotavirus often causes severe watery diarrhea and vomiting in infants and young children.² Symptoms of rotavirus usually start about 2 days after exposure, and the vomiting and watery diarrhea can last for 3 to 8 days.² Infants and young children with rotavirus may become severely dehydrated and need to be hospitalized in extreme cases.²

Several Management Strategies

Good hand hygiene is key to preventing acute gastrointestinal infections that may cause dehydration. Once acute gastroenteritis has been identified, approaches to manage hydration status may include:

• Oral rehydration therapy (ORT) 
• IV fluids 
• Monitoring hydration status 

ORT is a very effective method for managing mild to moderate dehydration at home, as caregivers can be instructed to give small amounts of fluids every few minutes over a few hours.⁴ As the patient’s symptoms resolve, they can begin eating small amounts of food and gradually return to an unrestricted diet.¹ In a course of ORT for a mild-to-moderately dehydrated patient, a 50 to 100 mL volume should be administered over 3 to 4 hours,¹ but factors such as the child’s age and level of dehydration should be taken into account:  

• Children younger than 2 years with mild dehydration should receive an additional 50 to 100 mL of fluid for every episode of vomiting or diarrhea.¹  
• For older children, age, weight, and estimated or measured losses should guide the replacement volume. Typically, 10 to 20 mL of body weight should be replaced for each diarrheal stool.¹

Drinks such as Pedialyte^® and other oral rehydration solutions (ORS) can be purchased in the baby or pharmacy aisle at the store and are helpful for managing mild dehydration, as they can help replace much-needed fluid and electrolytes.³

Note: Infants under the age of 1 should only be given an ORS under medical supervision. Remind caregivers to ask for your input if they are ever concerned about their infant or child’s hydration levels.

Be Proactive

Proactive strategies are key in helping to recognize and manage dehydration in children. Being prepared in advance for acute gastroenteritis can help address mild to moderate dehydration and replenish fluid and electrolytes. Healthcare professionals can support caregivers by providing them with hydration education, as well as reminding them to ask for input if they are ever concerned about their child’s hydration levels. As a healthcare professional, you are in the best position to know, examine, and assess children for management of acute gastroenteritis and dehydration.

References: 1. Daley SF, et al. Pediatric Dehydration. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan. https://www.ncbi.nlm.nih.gov/books/NBK436022/. Accessed August 2025. 2. US Centers for Disease Control and Prevention. About Rotavirus. https://www.cdc.gov/rotavirus/about/. Accessed August 2025. 3. Nationwide Children’s. Dehydration: Giving Liquids at Home. https://www.nationwidechildrens.org/conditions/dehydration#:~:text=Dehydration%20means%20that%20your%20child,the%20main%20causes%20in%20babies. Accessed August 2025. 4. US Centers for Disease Control and Prevention. About Norovirus. https://www.cdc.gov/norovirus/about/?CDC_AAref_Val=https://www.cdc.gov/norovirus/about/treatment.html. Accessed August 25, 2025.