Water and Hydration

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It is Summer time now and we enjoy basking in the warmth!  As lovely as it is for the brain injured child to experience the warmth of the Sun on his or her skin and to be outside without extra clothing – this time of year can present even extra challenges if the parents are not attentive!

The post below is not only important in the Summer but it may be one of the most important piece of information that you need for the optimal care of your CP child.  It can be immediately implemented as well.

The parents of thousands of children with brain damage have told us:  The child does not like to drink – and especially not water.

For the ABR Accessors who do the children’s evaluations – this is not a surprise.  Moreover the “song and dance” routines that some mothers and fathers have thought out in order to try to get their children to drink anything at all can be very amusing to hear – but it is not the main proportion of the parents who have developed these hydration routines with success. Unfortunately most parents will tend settle at the thirst level of the child.

The main thing that parents of a brain injured child need to keep in mind, is that once the child’s body is dehydrated, he or she does not feel thirst. So it is incredibly important that in respect to water intake and hydration, the parents do not feel inclined to “follow the child”!  Most parents will simply do this – and this is of course natural.  These children have so many problems and the refusal to drink seems to be rather small one in respect to the other difficulties on hand.  But especially in the case of hydration, the parent has to know that he or she knows best – and much better than the child!  Only the parent can regulate the intake of water for a child and especially for one who is certainly already dehydrated.

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Water is the foundation for all life and it possesses dynamic qualities!

The parent needs to know and remember that water and liquid flow is the basis for all of the life processes taking part in the child.  At the same time, even a slight dehydration has an enormous cascade effect upon the entire bodily system!

  • When dehydration occurs and the overall water volume in the body is reduced: this then results in a reduction in the central blood volume and, therefore also in skin blood flow!
  • The decrease in the blood volume then causes a compensatory increase in the heart rate, which is then again followed by a decrease in stroke volume. This is due to the increased heart rate and decreased filling time for the heart!
  • Remember that the heart beat rate increases! Many children with CP have tachycardia. Before giving the child pharmaceutical drugs for this condition – try to bring up the hydration level!

Water is essential for all of the life processes.  It is important to realize that the flow of the fluids within the tissues together with the capillary flow is the essential tissue stimulation required for all tissue regeneration and tissue renewal.  This fluid exchange movement known as “liquid shear” has a positive remodelling effect upon the tissues.  When the tissues dry out and the pathways for the more capillary located blood flow decrease, then the tissues will of necessity be locked into a process of slow and steady degeneration.  For a children with movement disorders the systemic reduction of tissue fluids is one of the leading factors which reduces the child’s general performance.  It is also responsible for an increase in joint stiffness and spasticity!

Enough written about the importance of water intake!   We could continue with many more aspects but the parents and caretakers should be able to see the connections between sufficient water intake and their own child’s health and development.

Some of the signs of dehydration that are easy to recognize are as follows:

  • The colour of the urine is the most significant sign. Instead of being a light greenish yellow, it becomes bright orange yellow or worse yet dark yellowish amber brown.  When the colour of the urine is in this range it is a sign that the child has much too little to drink.  If the child is using disposable nappies, it may be difficult to discern the colour.  Here also the parent needs to be creative and perhaps use a cloth nappy in order to see the colour.
  • Odour of the urine – if it smells this is a sign of dehydration
  • If the child smells badly (and many children with CP have a bad smell) – this is also not a good sign! Healthy hydrated children do not smell.
  • Dizziness and headaches. Most children will not be able to express anything about this, but they may certainly being having these symptoms.
  • Confusion
  • Dry skin, brittle skin or paper thin skin where one can easily see the bluish colour of veins

On the other hand, if one can achieve some diligence in getting the child to drink, the success of what may seem like a bagatelle can be shown in an interesting example of a child from Hungary.  The parents came with the child to a long pre-assessment where we found out that the child drank almost nothing at all.  In addition the girl had problems with:

  • sleeplessness
  • chewing and swallowing – it took half the day to give the child her meals
  • drinking
  • seizures
  • mood swings
  • restlessness
  • attentiveness problems

Six weeks later we met for a further assessment before the family started with the ABR training.  At this meeting we found out that the mother had taken the recommendations we had given her to take the drinking seriously and had tried to increase the water intake up to at least one liter per day for a child of her small size.  The mother was fortunately able to get the girl to drink consistently.  Most amazing however was the long list of improvements that the parents told us about that had came about spontaneously during these short weeks simply through increasing the water intake!

  • The child started sleeping through the nights.
  • Constipation was relieved.
  • She was much less restless during the day as well.
  • The child began to be able to swallow and to chew almost normally!. The time taken for the meals was down to a normal time for a meal so that the child is now finished eating together with the parents.
  • The seizure level decreased significantly and seizures almost disappeared.
  • Motor function improvements
  • Sound production
  • Communication efforts

This story illustrates the extreme importance of good hydration for children with cerebral palsy.

The parents need to be encouraged to pay attention to hydration at all times!  Not one day should go by when the child has too little to drink.

If the child has been dehydrated for a long time – and this is the case of most children with brain injury – then it cannot be expected that thirst will simply be present.  The cells within the body have been used to a minimal liquid exchange.  It will take time for the introduced water to begin to move consistently through the system – but do not give up!

You need to be consistent and will also need to develop a strategy.

Some of the methods that work are:

  1. Offer the liquids at least once each half an hour.  In this way the child will become used to having liquids in his body.
  2. If there are issues with getting the fluids into the child’s mouth, try using a variety of cups, bottles, syringes or even spray bottles at first.
  3. If the child refuses to drink, try using a syringe and find out where to bring the water into the mouth so that the child does not choke but can swallow it. Or use even a spray bottle and simply spray the water into the child’s mouth.
  4. Make a realistic goal for increasing the liquid intake on a week-to-week basis. Increase by ca. 100 ml each week until one achieves the wished for daily water intake.
  5. Taste can be important. If the water has some taste then the stomach will automatically react in such a way as to facilitate swallowing.  If the child simply refuses the water, then add a bit of non-sweetened juice or some soup broth.  Taste can be important assistant in swallowing and it may be necessary in the beginning to add something that has some taste.
  6. There are several healthy foods that can be used as thickeners if all else fails to work. This helps the child who has much difficulty with the swallowing of water to be able to manage the liquids when they enter the mouth.  Agar, psyllium fiber or chia seeds can all be used as a thickener agent for water. Arrowroot can also be tried.  Xanthan gum is not to be recommended, as it is a more or less engineered food additive. ( read here:  https://draxe.com/what-is-xanthan-gum/)

 

Diane Vincentz
Director
ABR Denmark Aps

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