Year-Round Hydration Tips for the Whole Family

Summer may be around the corner, but hydration is an important part of your family’s health year-round. Keep in mind these easy hydration tips to ensure your family gets the fluid intake they need.

What is dehydration?

Dehydration is a condition that occurs when someone loses more fluids than he or she takes in. Infants and children are especially vulnerable because of their relatively small body weights and high turnover of water and electrolytes. They’re also the group most likely to experience diarrhea, a common cause of dehydration. Vomiting, fever, excessive heat/sweating, and increased urination can also lead to dehydration.

Symptoms of dehydration include:

  • Dry, sticky mouth
  • Sleepiness or tiredness- children are likely to be less active than usual
  • Thirst
  • Decreased urine output
  • No wet diapers for three hours for infants
  • Few or no tears when crying
  • Dry skin
  • Headache
  • Constipation
  • Dizziness or lightheadedness

What does proper hydration look like?

Staying healthy means staying hydrated, since our bodies depend on water to survive. Every cell, tissue and organ in your body needs water in order to work correctly. For example, your body uses water to maintain its temperature, remove waste and lubricate joints. Water is needed for good overall health.

Some of the top beverages I recommended to my patients for hydration include: water, low-fat or fat-free milk, and 100 percent fruit juice.

Keep in mind these tips for choosing healthy beverages:

  • Avoid drinking your calories
  • Avoid drinks that are high in sugar, such as soda, fruit drinks, punch, sweet tea, etc.
  • Choose beverages that have low or no added sugar
  • Remember that water is the source for hydration
  • Read nutrition labels and choose a beverage with less than 6 grams of sugar per serving
  • Be sure to double-check the serving size and number of servings in a bottle.

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Beat the Heat this Labor Day Weekend

With temperatures expected to reach the 90s this Labor Day weekend, please ensure your family stays cool and hydrated to avoid the risk of heat related illness. Check out the following tips for a fun and safe holiday:

• Drink plenty of water. Don’t wait until you’re thirsty. By the time you or your child are thirsty, you may already be dehydrated.

• For those who participate in sports, drink extra fluids before the activity begins. Take frequent rest and refreshment breaks. Avoid strenuous activities if possible, especially if you are outside.

• Never leave children, elderly people or pets unattended in vehicles.

• Stay cool indoors. If your home is not air conditioned, visit public facilities such as shopping malls.

• Avoid unnecessary sun exposure. Wear light, loose-fitting clothing, a hat, and use sunscreen. Remember to reapply sunscreen often when swimming or perspiring.

• Take frequent rest and refreshment breaks in a shaded area.

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FAQ: Hydration for Young Athletes

By Shonda Brown, RD, CNSC, CSP, CHOC Children’s sports dietitian

Water is the most essential nutrient for athletes, yet it’s often forgotten when discussing adequate nutrition for physical activity and improving sports performance.

Adequate fluid intake provides multiple advantages to an athlete, including decreased perceived effort, decreased heart rate, decreased core temperature and increased performance.

Check out some answers to frequently asked questions about sports hydration:

Q: What should athletes drink to optimize hydration?

A: Water is an appropriate beverage choice for children and adolescents who participate in recreational activities or low intensity sports.  However, for young athletes who engage in prolonged and/or vigorous physical activity, a sports electrolyte drink is recommended.

Carbohydrate-containing beverages aid the absorption of water, and provide a fuel source for intense activity. The sodium content in these beverages helps replace what is lost in sweat. This becomes very important for those athletes exercising for more than two hours or for those who are heavy, salty sweaters.

Increased sodium loss without proper replacement may cause hyponatremia, or low sodium blood level, muscle cramps and increased risk of heat-related problems. Athletes may also consume solid food that contains carbohydrate and sodium with plain water during prolonged exercise if better tolerated than a spokids_hydration3rts electrolyte drink.

Q: What’s the difference between energy drinks and sports drinks?

A: Varying widely in their nutrient content, energy drinks may contain zero grams of carbohydrates or up to 160 percent of the recommended concentration of carbohydrates for proper rehydration. High concentration of carbohydrates can lead to slow gastric emptying and therefore impede hydration during exercise.

Energy drinks are not regulated by the Food and Drug Administration. Also, the content and purity of energy drinks have no guarantee and the American Academy of Pediatrics, as well as the National Federation of State High School Association, discourage their use in youth.

Sport drinks are formulated to replace fluid and electrolytes lost through sweat during exercise. They often contain carbohydrate, sodium and other electrolytes. Sports electrolyte drinks should contain 14 to 19 grams of carbohydrates and 110 to 165 milligrams of sodium per 8 fluid ounces.

Q: How much fluid is recommended for young athletes?

A: Athletes have varying sweat rates and therefore require different fluid and electrolyte intakes to optimize hydration and sports performance. Environmental factors, clothing and equipment, training adaptations and age all affect an athlete’s sweat rate.

Athletes should not rely on thirst as an indicator of when to drink fluids, as thirst is not stimulated until dehydration has already occurred.

Some general recommendations are to consume

  • 16 to 20 fluid ounces of fluid two to three hours before exercise
  • An additional 5 to 10 fluid ounces of water or a sports drink 10 to 20 minutes prior to exercise
  • 5 to 10 fluid ounces of water or sports drink every 15 to 20 minutes during exercise
  • 16 to 24 fluid ounces of a sports drink or water (with a salty snack) for each pound of weight lost during exercise

Q: How does an athlete know if they are appropriately hydrated?

A: Check the color of urine during an athlete’s first morning void. If the color looks like lemonade, then the athlete is appropriately hydrated. If it appears more like apple juice, the athlete is not consuming adequate amounts of fluid during the day. Also, try weighing the athlete right before and after exercise. The change in weight is due to fluid loss. More than 1 percent weight loss can negatively affect sports performance.

Q: Can an athlete consume too much fluid?

A: An athlete can over-hydrate or consume high amounts of water without proper sodium replacement, which puts the body at risk for hyponatremia. If an athlete weighs more after exercise than before, then the athlete is consuming too much fluid.

Hydration Tips

  •  Pack a water bottle to school
  • Consume fluids throughout the day to produce a light-colored (lemonade color) urine prior to exercise
  • One gulp equals approximately 1 ounce of fluid. Train children to take five gulps during a water break
  • Consume a salty snack after a workout. This not only helps retain fluid consumed but also promotes thirst and drives athletes to drink more fluid
  • Infuse water with lemon, herbs or fruit to make drinking water throughout the day fun and enjoyable
  • Weigh a child before and after exercise to see if she is consuming adequate fluid
  • Parents should provide sports electrolyte drinks for young children who are exercising outside on a very hot day or are engaged in prolonged activity

Meet with a CHOC sports dietitian to develop an individualized hydration regimen. Call 714-509-4572 or email sportsnutrition@choc.org to schedule an appointment.

Learn more about CHOC’s Clinical Nutrition and Lactation Services.

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Kids and Dehydration

CHOC_08-27-2013_dehydration_half

READY FOR ACTION?

When temperatures heat up, the risk of children becoming dehydrated intensifies. “Dehydration occurs when an athlete has less body fluid than they need,” says Dr. Koutures. “That can be from not getting enough fluid at the start of practice or excessive sweating or vomiting.” If your child plays sports, there are rules coaches and caregivers can enforce to keep them hydrated, healthy and in tiptop performance shape.

TIME OUT

When dehydration sets in, “you’re going to see kids not be as energetic,” explains Koutures.

Some tell-tale thirsty signs:

  • Decreased attention
  • Stomach ache complaints
  • Vomiting
  • Dropping to one knee

Time out tip: get child in the shade, make sure they are alert, cool them down with ice packs; have them sip small amounts of fluid, if they can.

HAVE A GAME PLAN

Preventing dehydration is all about preparation. “In the days before a sports practice or activity, make sure kids get plenty of fluids and water-rich fruits and veggies, like watermelon and berries,”
explains Dr. Koutures. Coaches should also keep an eye on kids who may be at higher dehydration risk, including those who may have just gotten over a cold or are overweight.

Is H20 Good Enough?

Some kids simply don’t like the taste of water. If your child won’t drink it, flavored beverages are acceptable. “My favorite recovery drink is chocolate milk,” says Dr. Koutures. “It has carbohydrates, protein, vitamin D and calcium.” For kids younger than 5, water is best, but drinks like Pedialyte are good, too.

FAST FACTS

  • Temperature of high fever and possible reaction to dehydration: 104 degrees
  • The maximum number of minutes between water breaks during practice: 15
  • Fluid recommended before sports activity: 12-18 ounces

 Learn more about CHOC’s sports medicine program

Dr. Koutures
Dr. Chris G. Koutures
Pediatric and Sports Medicine Specialist

PHYSICIAN FOCUS: DR. CHRIS KOUTURES

Dr. Koutures is a member of the American Academy of Pediatrics Executive Committee on Sports Medicine and Fitness. He operates a Pediatric and Sports Medicine practice in Anaheim Hills and also practices at CHOC. Dr. Koutures has held several U.S. Olympic appointments, including working with the U.S. Men’s and Women’s National Volleyball Teams, and participating in the 2008 Beijing Summer Olympics. He’s currently the team physician for Cal State Fullerton Athletics.

Dr. Koutures’ philosophy of care: “I strongly believe taking time to educate patients and families and communicating with other medical professionals best provides a comprehensive, patient-specific approach to managing injuries and illnesses.”

EDUCATION:
University of Wisconsin-Madison School
of Medicine

BOARD CERTIFICATION:
General Pediatrics and Sports Medicine

More about Dr. Koutures

This article was featured in the Orange County Register on August 27, 2013 and was written by Shaleek Wilson.

View the full feature on Kids and Dehydration

Protect Your Kids’ Kidneys and Bladder This Summer With Lots of H20

If May’s unseasonable heat wave was any indication of the hot temperatures Orange County could face this summer, you’d better get your water bottle ready.

Children are especially vulnerable to dehydration during the summer. Kids who are active outdoors – whether they play sports or hit the beaches – need to remember that drinking plenty of water is critical to maintaining good health during the hot months.

The CHOC Children’s Urology Center treats many kids during summertime who suffer from urologic conditions related to poor water drinking, said Dr. Antoine Khoury, a pediatric urologist and the center’s medical director.

“It is remarkable how frequently children and their families forget to drink water. The fluid they take in is juice, soda and milk, and not water,” Dr. Khoury said.

A good way to tell if a child is hasn’t been drinking enough is to check the color of his urine. If it’s dark yellow, the urine is concentrated and the child needs to drink more. The urine should be pale in color or better still clear, this provides the child with immediate feedback to drink more water any time the urine is not clear. And, “Any time the child is thirsty he is already dehydrated,” Dr. Khoury said.

Drinking liquids other than water is not as effective in keeping the body hydrated, Dr. Khoury explained. Our bodies require “free water,” or water that is available to the kidneys so they can do their job filtering blood and extracting waste through urine. Giving the kidneys extra water helps them do their job.

Dehydrated children can face several serious urological problems. They include:

1) Kidney stones. Due to a lack of water intake, the urine becomes concentrated and overly rich in salts and crystals. Crystals can be a nidus for kidney stones formation. This can be a very painful condition.

2) Bladder infections. If a child’s body doesn’t make enough urine, the urine becomes concentrated. Children who don’t produce enough urine will not get the urge to urinate and tend to hold it in. Holding in urine for several hours accelerates bacteria growth and may cause a bladder infection.

3) Constipation and incontinence. The more water the colon absorbs from the food due to lack of water in the body, the harder and smaller the stool is. Children who don’t drink enough water can become constipated. The dysfunctional emptying of the bladder associated with constipation promotes incontinence and infections.

4) Urgent and frequent urination. A child’s urine can become so concentrated and loaded with crystals and salts that the bladder becomes irritated. This may lead to urgent and frequent urination.

Drinking Water Guidelines

Dr. Antoine Khoury, Medical Director of the CHOC Children’s Urology Center, recommends that children drink an 8-ounce cup of water daily for every year of age, up to the age of 8. (So a four-year-old should drink at least four cups of water daily). Kids over 8 and adults should drink 8 cups of water daily. This recommended water intake is in addition to any other fluids consumed. Finally, sports drinks are not a substitute for water!

If your child experiences a urological problem, call the CHOC Children’s Urology Center at 714-512-3919.

Related articles:

  • Year-Round Hydration Tips for the Whole Family
    Hydration is an important part of your family’s health year-round. Keep in mind these easy hydration tips to ensure your family gets the fluid intake they need.
  • Beat the Heat this Labor Day Weekend
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  • FAQ: Hydration for Young Athletes
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