Assessing dehydration in a child with diarrhoea or vomiting, including intake and output
- Assessment
General state, eyes, thirst and skin pinch classify dehydration; weight, wet nappies and intake and output show if care is working.
What it is
Children, and infants above all, lose water and salts fast with diarrhoea, vomiting and fever: their bodies hold proportionally more water, they lose more through skin and lungs, and their kidneys concentrate urine less well. AIEPI classifies hydration with four signs: general condition, eyes, how the child drinks and the skin pinch. Two signs from the same row are needed to choose that row. Once a plan is started, the nurse follows the child with repeated assessment, weight, nappies or urine output and an intake and output record.
Reference values
- Diarrhoea for 14 days or more is classified separately as persistent diarrhoea; blood in the stool is classified as dysentery.
- Normal capillary refill is under 3 seconds; a sluggish refill is an unexpected finding.
- Concentrated urine and fewer wet nappies than usual point to fluid loss.
- A sudden fall in weight with low urine output is significant and must be reported.
What you need
- The AIEPI diarrhoea chart and recording form.
- Clean water or oral rehydration solution in a cup and spoon, to watch the child drink.
- A scale (the same one each time), a nappy scale if available, and an intake and output sheet.
How to measure it (and why)
- Ask how long the diarrhoea has lasted, if there is blood, and how many stools and vomits in 24 and in the last 4 hours — this sets risk and classification.
- Ask what the child has eaten and drunk and whether medicines were given — it guides counselling and the plan.
- Look at the general state: alert, restless or irritable, or lethargic — the brain shows severe fluid loss early.
- Look at the eyes: normal or sunken — sunken eyes are a sign in both the red and the yellow rows.
- Offer water or oral solution and watch: drinks normally, eagerly, poorly or not at all — thirst and inability to drink classify the row.
- Pinch the skin of the abdomen and release; time how fast it goes back — slow or very slow return reflects lost tissue water.
- Classify with two signs from the same row, starting at the top — one sign alone does not select red or yellow.
- Weigh the child and set up intake and output: every drink, feed and oral solution in; every stool, vomit and nappy out — trends show if the plan works.
- Reassess at the intervals the plan sets and record — a child can move from yellow to red.
How to read it
- No dehydration: home plan with more fluids than usual and continued feeding.
- Some dehydration: oral rehydration in the clinic, reassessing the child regularly.
- Severe dehydration: intravenous plan or urgent referral, per protocol.
- In infants, ask how many wet nappies a day; in hospital, nappies can be weighed for a more exact output.
- Watch for signs of approaching shock: fast pulse and breathing, cold clammy skin, confusion.
Next step: when to call for help
- Two signs of severe dehydration, a child who cannot drink, or signs of shock: call the nurse in charge and the doctor immediately.
- A child on oral rehydration who still cannot drink, keeps vomiting or has frequent watery stools: report for a change of plan.
- Blood in the stool, diarrhoea for 14 days or more, or a child under 6 months with persistent diarrhoea: report and follow the chart.
- Fewer wet nappies, falling weight or worsening general state on reassessment: report and record the trend.
Test yourself
Think of the answer, then tap the question to see it.
Which four signs does AIEPI use to classify hydration?
General condition, eyes, how the child drinks, and the skin pinch.
How many signs are needed to classify severe dehydration?
Two signs from the red row, for example lethargy and a skin pinch that goes back very slowly.
What does a child with some dehydration usually do when offered a drink?
Drinks eagerly, as if thirsty.
Why are infants at higher risk of dehydration?
They hold more water for their size, lose more through skin and lungs, and their kidneys concentrate urine less well.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Cuadro de procedimientos AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia) (Ministerio de Salud y Protección Social de Colombia, 2016); Nursing Fundamentals, 15.6 Applying the Nursing Process (fluids and electrolytes) (Open RN, CC BY 4.0) (Open Resources for Nursing (Open RN) / LibreTexts, 2021); Diarrhoeal disease (fact sheet) (World Health Organization, 2024); AIEPI: Guía del facilitador clínico (Ministerio de Salud y Protección Social de Colombia / Organización Panamericana de la Salud, 2012).
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Representative model, for educational purposes only.