Wow, what a difference a few years can make. You may be aware that nutritionists, diabetologists, endocrinologists, toxicologists and every type of ologist you can think of have been waging war on apple juice, for decades. Back in the 80’s there was concern from the ologists that apple juice caused malnutrition in toddlers, in the 90’s it was concern about the chemical Alar that was used to enhance the growth of apples, and today, according to some, apple juice and other sweetened beverages are at the heart of the obesity epidemic. All this attention and bad news about apple juice! Knowing all this background, it was with great interest that I read a recent article in a well respected pediatric journal touting how apple juice, diluted with water, can be a great mixture to orally rehydrate a dehydrated children who is having vomiting and diarrhea. So today, I thought I would tell you about this new research and talk a little about dehydration in children.
I haven’t taken my listeners down science lane in a while so why don’t we take a few moments to talk about the science of water balance in a child. We are probably all aware that a child’s body needs a balance of water in and water out to stay healthy, maintain their blood pressure, and rid their bodies of wastes. Water in, comes from food and drink while water out is the sum of water lost in urine and feces as well as what is called insensible water, that is, the water in our breath and that lost to evaporation from the child’s skin. As I said, water in and water out has to balance all the time but when a child is sick, their intake may go down drastically. They can only tolerate poor intake of water for a short span of time, about two days before their bodies start very serious dehydration. The most common condition where a child becomes dehydrated is during a vomiting and diarrhea illness. You can see that while this is going on, water in has stopped entirely during the vomiting phase and not only that, they are losing water extremely rapidly in the form of diarrhea, sweat, and through their breath. Fortunately, children usually have fantastic kidneys that, even during a water crisis like a febrile diarrheal illness, can keep a child close to water balance by drastically decreasing water lost in the form of urine. But water, sugar, and salt intake are vitally important to a child with diarrhea; maintaining intake of these substances is literally keeping the child alive until the illness passes.
Best Rehydration fluid?
So, what is the best rehydration fluid for a child you ask? Pediatric literature is replete with cases of children being given various drinks during a diarrheal illness and developing various life threatening water and salt imbalances. Unless a child’s kidneys are given the right amount of water, sugar, and salt during rehydration, things can go very badly. A lot of effort has gone into figuring out what that exact correct amount of water, sugar, and salt are. That’s where Pedialyte and other electrolyte drinks came from. They are the gold standard for rehydration… until now. Remember that study I told you about, well, the authors of this study compared an oral electrolyte solution like pedialyte to diluted apple juice as a rehydration fluid. The two study groups were compared to see if one had a greater failure rate for oral rehydration. AND… it turns out that the diluted apple juice group had fewer children progressing to more serious dehydration. (apple juice group 17% versus 25% electrolyte group) Presumably, the kids drank more of the diluted apple juice since it tasted better than the electrolyte solution. To me, Pedialyte tastes a lot like sweat so I think the kids just were more willing to drink the apple juice. I don’t think hospitals have switched to diluted apple juice for oral rehydration yet, but expect that they may. Certainly, I think if a parent wanted to try diluting pasteurized apple juice 1:1 with water and using this as a rehydration fluid for a child 6 months or older with gastroenteritis, I think this reasonable. But don’t forget, apple juice or no apple juice, if your child goes 8 hours without urine, looks weak, has a dry mouth, doesn’t make tears when crying, has cold hands and feet, or just looks very ill, get some help right away. Your child may be dehydrated!
Well, hopefully you know a little more about water balance and dehydration in children after listening to that discussion. For more on dehydration, don’t miss a previous pedcast I did on the subject http://www.docsmo.com/the-physiology-of-dehydration-a-parents-guide/. If you enjoy learning and thinking about child health issues with pedcasts, go ahead and subscribe to my blog at www.docsmo/com or on iTunes. And remember, you can share any post on my site with relatives and friends as you wish. It’s free and easy. Go ahead and get your free pediatric education. This is Doc Smo, broadcasting from the famous studio 1E, reminding you to stay alert, if your child develops the squirts. Until next time.
Best Juice for oral rehydration of children with diarrhea.