If a child is unable to drink enough fluids or is losing too much fluid because of illness, they may need fluids given through a drip (intravenous fluids) to help them stay hydrated and healthy. The amount and type of fluids depend on the child’s weight, age, and condition.
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How much fluid does a child need each day?
The total daily fluid a child needs is calculated based on their weight:
- For the first 10 kilograms of weight, they need 100 millilitres per kilogram each day
- For the next 10 kilograms, add 50 millilitres per kilogram
- For any additional kilograms, add 25 millilitres per kilogram
If the child has a fever or is losing fluids (for example through vomiting or diarrhoea), they will need about 10% more fluids for every degree Celsius of fever.
What about newborn babies (neonates)?
- Mothers are encouraged to breastfeed frequently. If the baby cannot breastfeed, expressed breast milk can be given through a feeding tube (nasogastric tube).
- Oral feeding should be stopped if the baby has a bowel blockage, severe infection in the intestines, or is vomiting everything.
- If the baby is very sick, unconscious, or having many convulsions, oral feeding is also stopped temporarily.
- The amount of fluids given through an IV on the first day is about 60 ml per kilogram, increasing gradually over the next days as the baby improves.
Managing shock in children who are not malnourished
Shock is a dangerous condition where the body’s blood flow is too low to keep organs working well. It needs urgent treatment with fluids.
- Ringer’s lactate or normal saline (types of IV fluids) are given quickly, 20 ml per kilogram of the child’s weight.
- If the child does not improve, repeat the fluids in 10 to 20 ml per kilogram doses.
- If the child is bleeding, blood transfusion is given at 20 ml per kilogram.
- If still no improvement, shock due to infection (sepsis) is suspected and medicines such as adrenaline or dopamine may be needed.
- When the child improves, fluids are continued at a slower rate over several hours.
Managing shock in malnourished children
Children who are malnourished need fluids given more slowly and carefully:
- They receive 15 ml per kilogram over one hour, using special fluids that include sugar (glucose) and lower salt levels.
- Fluids may be repeated once.
- If the child improves, they switch to special oral fluids called ReSoMal given slowly through a feeding tube or by mouth.
- If no improvement, maintenance fluids are given more slowly, blood transfusion may be needed, and antibiotics are started.
Common IV fluids used in children and when they are given
| Fluid Name | Main Components | When it is used |
|---|---|---|
| Sodium Chloride 0.9% (Normal saline) | Sodium 154 mmol/L, Chloride 154 mmol/L | For shock and dehydration in children and adults, also maintenance fluid in adults |
| Dextrose (Glucose) 5% | Glucose 25 g in 500 ml | Maintenance fluid in adults |
| Dextrose (Glucose) 10% | Glucose 50 g in 500 ml | Treatment of low blood sugar in children and adults, maintenance fluid in newborns on day 1 and 2 |
| Dextrose 50% | Glucose 50 g in 100 ml | Treatment of low blood sugar in adults |
| Ringer’s lactate | Sodium 130 mmol/L, Potassium 5.4 mmol/L, Calcium 1.8 mmol/L | For shock and dehydration in children and adults, maintenance fluid in adults |
| Half-strength Darrow’s solution with 5% glucose | Sodium 61 mmol/L, Potassium 17 mmol/L, Glucose 25 g in 500 ml | For shock and dehydration in malnourished children |
| Half normal saline (0.45% NaCl) with 5% dextrose | Sodium 77 mmol/L, Chloride 77 mmol/L, Glucose 25 g in 500 ml | Maintenance fluid in children, shock and dehydration in malnourished children |
| Normal saline or Ringer’s lactate with 5% dextrose | Sodium 154/130 mmol/L, Potassium 0/5.4 mmol/L, Glucose 25 g in 500 ml | Maintenance fluid in children |
Notes on preparing fluids
- Some fluids like Dextrose 10% and half normal saline with dextrose need to be prepared by mixing other fluids immediately before use and cannot be stored.
- Normal sterile technique must be used to avoid infections.
- Fluids should always be given under medical supervision to watch for side effects such as swelling or too fast infusion.
