[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Paediatric nursing](https://durgical.com/en/nursing/areas/pediatric/) › Assessing dehydration in a child with diarrhoea or vomiting, including intake and output # 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. Updated Nov 13, 2026 ## Key points - Severe dehydration (red), two of: lethargic or unconscious, sunken eyes, not able to drink or drinking poorly, skin pinch goes back very slowly (2 seconds or more). - Some dehydration (yellow), two of: restless or irritable, sunken eyes, drinks eagerly and thirsty, skin pinch goes back slowly (under 2 seconds). - High risk of dehydration: high-output diarrhoea, persistent vomiting or refusal of oral fluids, without enough signs for the rows above. - Two signs from the same row are needed for the red or yellow classification; always start at the red row. - Weigh on the same scale at the same time, count or weigh nappies, and record every intake and every loss. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/assessing-dehydration-in-a-child-with-diarrhoea-or-vomiting-including-intake-and/) ## Elsewhere in DurgiPedia - [Hydration status: signs of dehydration](https://durgical.com/en/clinical-exam/hydration-status-signs-of-dehydration/) - [Dehydration and fluid overload](https://durgical.com/en/clinical-exam/dehydration-and-fluid-overload/) - [Dehydration and fluid overload](https://durgical.com/en/physiology/dehydration-and-fluid-overload/) ## Connections ## Related 2 - [Oral rehydration at home and in the clinic: plans A and B, continued feeding and warning signs](https://durgical.com/en/nursing/oral-rehydration-at-home-and-in-the-clinic-plans-a-and-b-continued-feeding-and-w/) - [Fluid balance: recording intake and output](https://durgical.com/en/nursing/fluid-balance-recording-intake-and-output/) ## Related conditions 2 - [Dehydration in children (acute diarrhoeal disease)](https://durgical.com/en/conditions/dehydration-in-children/) - [Acute (viral) gastroenteritis](https://durgical.com/en/conditions/acute-gastroenteritis/) [← All of nursing](https://durgical.com/en/nursing/) 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)](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/cuadro-procedimientos-atencion-integrada-enfermedades-prevalentes-infancia.pdf) (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)](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/15:_Fluids_and_Electrolytes/15.06:_Applying_the_Nursing_Process) (Open Resources for Nursing (Open RN) / LibreTexts, 2021); [Diarrhoeal disease (fact sheet)](https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease) (World Health Organization, 2024); [AIEPI: Guía del facilitador clínico](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/guia-facilitador-atencion-integrada-enfermedades.pdf) (Ministerio de Salud y Protección Social de Colombia / Organización Panamericana de la Salud, 2012). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/assessing-dehydration-in-a-child-with-diarrhoea-or-vomiting-including-intake-and/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/assessing-dehydration-in-a-child-with-diarrhoea-or-vomiting-including-intake-and/