Dehydration Assessment
Assess each of the 4 WHO clinical signs. Select the option that best matches the child.
kg โ for ORS volume calculation
โ
โ
โ
WHO Plan
โ
rehydration
ORS (4h)
โ
mL
WHO Dehydration Classification
| Sign | 0 โ No Dehydration | 1 โ Some Dehydration | 2 โ Severe Dehydration |
|---|---|---|---|
| General appearance | Well, alert | Restless, irritable | Lethargic, unconscious, floppy |
| Eyes | Normal | Sunken | Very sunken and dry |
| Thirst / drinking | Drinks normally, not thirsty | Thirsty, drinks eagerly | Drinks poorly or not able |
| Skin pinch | Returns immediately | Returns slowly (<2s) | Returns very slowly (>2s) |
WHO Rehydration Plans
- Plan A (No/Minimal Dehydration โ Score 0โ1): Home treatment with ORS. Give 10 mL/kg ORS for each loose stool passed. Continue breastfeeding. Zinc 20 mg OD ร 10 days (10 mg if <6 months). Return if worsening
- Plan B (Some Dehydration โ Score 2โ4): ORS 75 mL/kg over 4 hours in clinic. Reassess every hour. If vomiting: 5โ10 mL/kg NG ORS. After rehydration, continue Plan A. Zinc 20 mg OD ร 10 days
- Plan C (Severe Dehydration โ Score โฅ5): IV Ringer's Lactate (preferred) or NS: 100 mL/kg. Children: 30 mL/kg over 30 min, then 70 mL/kg over 2.5 hours. Reassess every 15โ30 min. Start ORS as soon as child can drink. Admit to hospital
Zinc Supplementation โ Why It Matters
WHO and UNICEF recommend zinc supplementation for all children with diarrhoea: 20 mg/day for children โฅ6 months, 10 mg/day for infants <6 months, for 10โ14 days. Zinc reduces the duration of diarrhoea by ~25%, reduces stool output, and reduces the risk of subsequent diarrhoeal episodes for up to 3 months. In India and South Asia, zinc supplementation is part of the national diarrhoea management protocol alongside ORS.
Red Flags โ When to Refer Urgently
- Severe dehydration (Plan C) โ always admit
- Bloody diarrhoea (dysentery) โ antibiotic therapy needed
- High fever (>39ยฐC) with diarrhoea in infants <6 months
- Persistent vomiting preventing ORS administration
- Abdominal distension โ possible ileus or obstruction
- Worsening dehydration despite Plan B
Frequently Asked Questions
How is dehydration severity classified in children?
Mild (<5% body weight loss): no clinical signs, alert, normal pulse/BP/capillary refill, eyes normal, moist mucous membranes. Moderate (5โ10%): restless/irritable, tachycardia, reduced skin turgor, sunken eyes/fontanelle, dry mucous membranes, capillary refill 2โ3 seconds. Severe (>10%): lethargic/unconscious, absent pulses, cold peripheries, capillary refill >3 seconds, deeply sunken eyes โ shock, immediate IV resuscitation required.
What is the WHO ORS plan for rehydration?
Plan A (no/mild dehydration): 10 mL/kg ORS after each loose stool at home. Plan B (some dehydration 5โ10%): 75 mL/kg ORS over 4 hours in ORT corner, reassess. Plan C (severe dehydration): IV Ringer's Lactate 100 mL/kg โ for infants: 30 mL/kg in 1 hour then 70 mL/kg in 5 hours; for older children: 30 mL/kg in 30 min then 70 mL/kg in 2.5 hours. Switch to ORS when able to drink.
What IV fluid is used for paediatric rehydration?
Ringer's Lactate (Hartmann's solution) is preferred over 0.9% normal saline for large-volume resuscitation in children โ reduces hyperchloraemic acidosis risk. 0.9% saline with 5% dextrose is the standard maintenance fluid (not hypotonic solutions which cause hyponatraemia). Avoid dextrose-containing fluids for resuscitation boluses. Add KCl 20 mmol/L to maintenance once the child is urinating.
How is oral rehydration therapy given?
Give ORS in small, frequent sips using a spoon or cup โ not a bottle. If the child vomits, wait 10 minutes then resume at slower rate (5 mL every 1โ2 minutes). Continue breastfeeding throughout. Start age-appropriate foods after 4 hours of ORS in Plan B. Zinc supplementation 10โ20 mg/day for 10โ14 days alongside ORS reduces duration and recurrence of diarrhoea.
What are the signs of hypernatraemic dehydration?
Hypernatraemic dehydration (Na >150 mEq/L) occurs with water loss > sodium loss โ typically in breastfed neonates with poor intake, or diarrhoea with high sodium ORS. Signs: doughy/thick skin turgor (paradoxically less obvious dehydration signs), irritability, high-pitched cry, fever, seizures (risk with rapid correction). Correct slowly โ rehydrate over 48 hours targeting Na fall of <10โ12 mEq/L/day to prevent cerebral oedema.
When should a child with diarrhoea be admitted?
Admit if: severe dehydration or shock, unable to tolerate oral fluids/ORS despite attempts, persistent vomiting (>3 times/hour), bloody diarrhoea with systemic illness (HUS risk), altered consciousness, age <3 months with any dehydration, hypoglycaemia (BGL <54 mg/dL), and social circumstances preventing safe home management. All severe dehydration requires IV access and hospital admission.
Related Calculators
โ Medical Disclaimer: Clinical dehydration assessment must integrate all 4 WHO signs, vital signs, urine output, and weight loss. This tool is a decision-support guide. Children with severe dehydration, shock, or inability to drink require immediate IV therapy and hospital admission. Always reassess after rehydration.