Which physical findings are characteristic of dehydration in children?

Updated: Nov 12, 2018
  • Author: Alex Koyfman, MD; Chief Editor: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA  more...
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Answer

On the basis of a systematic review, Steiner et al found that the most useful signs (ie, highest likelihood ratios) for recognizing 5% dehydration are the following [6] :

  • Abnormal capillary refill time

  • Abnormal skin turgor

  • Abnormal respiratory pattern

The Table highlights the physical findings seen with different levels of pediatric dehydration.

Table. Physical Examination Findings in Pediatric Dehydration (Open Table in a new window)

Symptom

Degree of Dehydration

Mild (< 3% body weight lost)

Moderate (3-9% body weight lost)

Severe (>9% body weight lost)

Mental status

Normal, alert

Restless or fatigued, irritable

Apathetic, lethargic, unconscious

Heart rate

Normal

Normal to increased

Tachycardia or bradycardia

Quality of pulse

Normal

Normal to decreased

Weak, thready, impalpable

Breathing

Normal

Normal to increased

Tachypnea and hyperpnea

Eyes

Normal

Slightly sunken

Deeply sunken

Fontanelles

Normal

Slightly sunken

Deeply sunken

Tears

Normal

Normal to decreased

Absent

Mucous membranes

Moist

Dry

Parched

Skin turgor

Instant recoil

Recoil < 2 seconds

Recoil >2 seconds

Capillary refill

< 2 seconds

Prolonged

Minimal

Extremities

Warm

Cool

Mottled, cyanotic

Adapted from King CK, Glass R, Bresee JS, et al. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. Nov 21 2003;52(RR-16):1-16. [5]


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