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New study finds keeping kids hydrated can be a challenge

July 23, 2015
Girl on swing with a water bottle

Water, it does the body good.

About 70% of the human body is made up of water. It is needed to carry nutrients to your cells, keep your body temperature normal, lubricate and cushion joints, protect your spinal cord and other sensitive tissues, and to get rid of wastes through urination, perspiration and bowel movements. And, for children, adequate hydration can improve their cognitive function.

Not getting enough water

But, according to a new study from the Harvard T. H. Chan School of Public Health, more than half of children and teens in the United States are not properly hydrated. Some 54.5% of the students who participated in the study had urine concentrations that showed they were well below their minimum daily water intake. Even more surprising, nearly one in four kids said they drank no water at all during the course of their day.

“Don’t wait for your child to tell you he or she is thirsty. They probably won’t. And, if they do, there’s a good chance that they are already dehydrated,” said Dr. John O’Reilly, a pediatrician at Baystate Children’s Hospital. “Don’t wait to hydrate.”

Children should drink water at least 30 minutes before going outdoors on days when the temperatures are 90 degrees and above. The American Academy of Pediatrics (AAP) recommends 5-9 ounces (depending on a child’s weight) of cold water or sports drink every 20 minutes for children outside in those high temperatures.

Our bodies are constantly losing water through sweat and the process of urination. Poor hydration interferes with sweating and increases the risk of heatstroke or sunstroke, and heat exhaustion. Infants and younger children (as well as people over 65 years of age) are at greater risk for heat illnesses because they sweat less and their bodies are less likely to dissipate the heat.

Signs of dehydration

The AAP warns parents to be alert for the following signs of dehydration in their children and to call their pediatrician immediately if any develop:

Mild to Moderate Dehydration

  • Plays less than usual
  • Urinates less frequently (for infants, fewer than six wet diapers per day)
  • Parched, dry mouth
  • Fewer tears when crying
  • Sunken soft spot on the head in an infant or toddler
  • Decreased bowel movements

Severe Dehydration

The following symptoms are in addition to the ones listed above.

  • Very fussy
  • Excessively sleepy
  • Sunken eyes
  • Dark, brownish urine; and urinates only one or two times per day
  • Cool, discolored hands and feet
  • Wrinkled skin

“Children look to their parents for what is right and wrong, and setting a healthy example for kids is important for their overall well-being,” said Dr. O’Reilly, who noted parents need to remind their children to drink water.

How much do you need?

According to Nancy Anderson RD, a pediatric dietitian from Baystate’s Food and Nutrition Services, the amount of water you need daily depends on various factors such as age, size, overall health, environment, and activity level.

The Institute of Medicine notes adequate fluid intake for adult men is about 3 liters of total beverages daily, while for women it is slightly less at 2.2 liters. Perhaps easier to remember is the popular rule cited over and over again to: “Drink eight 8-ounce glasses of water daily,” which is equal to about 2 liters.

While, in general, kids require less than eight glasses of water a day, that intake changes over time depending on their size and age, noted Dr. O’Reilly, who suggests talking to your pediatrician about what is right for your child.

Set an example

Like Dr. O’Reilly, Anderson agrees that parents should be setting an example for their children.

“Parents are the gatekeepers and shouldn’t buy sugary beverages to tempt their children. I always tell parents that sugary beverages don’t live at home, that they are something a child has at a party, grandma’s house, or when visiting a friend,” Anderson said.

Not only do sugary beverages contribute to the current obesity epidemic when consumed in quantity (for example, replacing a 20 oz. sugar-sweetened soda with a healthy glass of water will save you about 240 calories), but those with caffeine can serve as a diuretic, resulting in losing more water from the body through urination.

Kids love bubbles like that found in soda, but there is another way to satisfy that craving without serving up a sugary carbonated beverage, noted the Baystate pediatric dietitian.

“Sparkling waters (seltzer) are great to introduce to children. And if you start a child drinking them while young, it’s a healthy habit they will likely continue into adulthood,” Anderson said.

She suggested introducing to kids as simply “bubbles.”

“You can also add a splash of juice or even fresh fruit to them for some additional flavor,” she added, noting many adults often add a slice of lemon or lime to the water they are drinking.

Strategy for your child's day

It’s not just good old-fashioned straightforward water. Other beverages such as milk and juices are also decent sources of water.

“Keep juice to one serving per day for kids, and consider milk for an afternoon snack and at bedtime,” Anderson said. “Water with meals is best for kids. It hydrates them without filling them up and they will eat better.”

To ensure that your child is getting enough water while in school, Anderson suggested filling halfway a freezer-safe water bottle (BPA-free) overnight, then topping it off with water in the morning and sending your child off to class with it.

“The frozen water bottle assures that their water will stay cool most of the day, and is especially convenient if they can’t get to a water fountain in school,” said Anderson.

Also in the frozen category, Anderson said parents should choose only frozen pops made with real fruit juice for their child instead of a colored, flavored sugary concoction on a stick.

While some kids don’t like the taste of tap water, Anderson suggested purchasing a Brita filtered pitcher for better taste, which you can fill from the sink and leave in the fridge for kids to drink from.

“It makes water taste so much better. It’s also a cheaper alternative and more environmentally sound than purchasing cases of water in plastic bottles, which can leach potentially harmful chemicals,” Anderson said.

While the Centers for Disease Control (CDC) noted most of our fluid needs are met through the water and beverages we drink, we also get fluids from some of the foods we eat. For example, they site broth soups and foods with high water content such as celery, tomatoes, or melons as contributing to fluid intake.

Message for athletes

Dr. Yvonne Paris, chief of Pediatric Cardiology at Baystate Children’s Hospital, has a special message directed to those student athletes whose teams hit the fields before school is in session.

“The hot and humid days of late summer can place extra stress on even the healthiest of young athletes as they practice out on the field,” Dr. Paris said.

“We see many young athletes who do not keep up with their fluids on especially hot days, resulting in dizziness and fainting. Staying hydrated is very important and the body needs to be replenished with water, about one quart per hour during the steamy weather,” she added.