Hydrating and Feeding Babies and Toddlers When They are Sick
Thank you to guest author, Joana Fraser, MD, a pediatrician and founder of Littlemore, a women-owned and led company making the snacks you always wished existed for your kids. She lives in Massachusetts with her husband, 3 children and cavalier king charles spaniel.
How do you keep babies and toddlers hydrated and fed when they are sick?
Sometimes it starts with a sniffle, other times it comes in like a freight train with a 103°F fever or vomiting from out of nowhere….
Either way, having a sick little one at home is no fun for anyone. One of the biggest concerns from parents during bouts of illness is what, and how much, to give babies and toddlers to eat and drink.
Here, I’ll break it down by age, since this helps determine what types of liquids and foods they are able to eat and drink. However, no matter what the illness, the same general principles apply. And if you are ever worried, it’s always a good idea to call your doctor, but I’ll also outline some specific scenarios where this is necessary.
Three main principles:
Focus first on hydration
Offer small amounts of liquid frequently
Follow your little one’s lead when it comes to food
Hydrating and Feeding Babies 0-6 Months During Illness
At this age, babies are only drinking breast milk, formula or a combination of both. Water is not recommended before 6 months of age as their kidneys are still too underdeveloped to handle this.
If your baby will still take their normal amount of milk, great! However, they often need to have smaller, more frequent feedings. If they are vomiting, sometimes only 0.5-1oz at a time is enough for their sensitive tummies. For babies who just can’t seem to keep anything down the “5 every 5” technique is best.
Take a 5ml syringe, fill it with milk, and slowly empty it into their mouth (aim for where their lower molars will be one day, rather than straight back), as if you were giving them medication.
Wait 5 minutes later, and do this again
Repeat!
After 1oz (6 syringes) take a break for 20-30 minutes and then start again
This sounds (and is!) time and labor-intensive, but it really works. Even the most sensitive tummies can handle these small amounts and have time to absorb the liquid. And, if they do throw up, it will just be stomach liquids and they will still have absorbed the milk.
And remember, if they do throw up, it ALWAYS looks worse than it is. A small amount of liquid looks like a lot more than it actually is (if you don’t believe me then spill a tablespoon of water on your countertop and see what it looks like!)
Other tricks for getting fluids in:
Freeze breast milk or formula into small popsicle molds and let them suck on this
If your baby won’t take milk, you can give an electrolyte solution such as Pedialyte. An alternative to this which has no artificial colors, flavors or sweeteners is Kinderlyte. This can also be frozen into popsicle molds
If baby has started solids and is still interested in them, some good, high water content, choices are:
Pureed fruits or vegetables, especially melon, berries, carrots and peas which all have a lot of sweetness and are often better tolerated
And remember, NEVER water down breast milk or formula.
Hydrating and Feeding Babies 6-12 Months During Illness
In this age range, little ones are usually eating more solid foods on a more regular basis. However, just like us when we are sick, their appetite for solid foods can drastically reduce when they are feeling under the weather.
Don’t panic! Yes, they might not eat “real” food for a few days, and they might even lose a little weight but they will more than make up for it when they are feeling better.
Remember principle #1- hydration is our goal. Food is a bonus and if it doesn’t happen for a short period of time, that’s ok.
Some wonderful foods that help keep babies this age hydrated include:
Watermelon- cut into one inch wide sticks
Mango- you can let them hold and gnaw on the stone, or cut the flesh into large wedges or small (<½”) cubes
Applesauce, or any other fruit purees
Frozen breastmilk or formula popsicles
If offering foods, start with blander flavors such as toast (cut into 1” wide sticks, with butter or thinly spread nut/seed butter), oatmeal (mixed with breastmilk or formula) or plain crackers.
If they seem hungry, you can definitely offer a wider selection of foods but the same idea applies as with fluids- only give a small amount, give them a break, then offer more.
At this age babies can also drink water, but it’s a good idea to also try and give them fluids that contain electrolytes. Electrolytes are the salts and sugars our bodies need for energy and all our vital functions so it’s important to get these when we are sick, either from food or fluids.
They might be very thirsty but don’t let them get carried away, especially if they have been vomiting. Allow them an ounce or two at a time, then give them a 10-15 minute break before offering more.
Hydrating and Feeding Toddlers During Illness, Age 12+ Months
By this age, your little one will be in the process of transitioning away from breast milk and/or formula. They may have started drinking cow’s milk or a plant-based milk. Or, they may have stopped drinking any kind of milk altogether! Their diet will be expanding and they will be eating three solid meals and likely 2-3 snacks each day.
Just like the younger ages, the most important principle when they are sick is hydration. They can drink water, an electrolyte solution and another option can be a diluted fruit juice (use ½ fruit juice and ½ water).
All food options are on the table, but as with the younger ages, stick with fruits that have a higher water content and bland solid foods. If these are well tolerated and your little one still seems hungry you can branch out to other table foods, continuing to give them little amounts only at a time.
How do I know if my baby is hydrated enough?
It’s not uncommon to get a little dehydrated when we are sick, but we want to avoid dehydration in babies and kids as best we can. If your child is wetting diapers every 3-4 hours, that is a good sign, even if they aren’t quite as wet as normal.
If it has been more than 4 hours since a wet diaper, and especially if they are having difficulty drinking fluids or keeping them down, reach out to your healthcare clinician.
What about dairy?
Sometimes there are concerns about giving dairy when your little one is under the weather. Does it make them more ‘mucusy’? Will it upset their tummy more?
The short answer is…probably not. I’d recommend starting with non-dairy liquids but if milk (breastmilk, formula or cow’s/non-dairy milk) is the only thing they will drink then, again, hydration matters most! Sometimes after a stomach bug with vomiting and diarrhea, the gastrointestinal system can remain a little out of sorts for 1-3 weeks. The microbiome needs to build itself back up, and some of the enzymes used to break down dairy might need to be replenished. So, if you find that dairy is less well tolerated after an illness like this, it’s a good idea to build it back into their diet gradually.
Is coconut water good for dehydrated babies?
Coconut water is often hailed as “hydrating.” In reality, it has not been proven to be more hydrating than regular water. It is not recommended as an alternative to standard electrolyte replacement drinks (such as Pedialyte or Kinderlyte) as the ratios of electrolytes are not right for children. When you consider what their bodies need, there is too much potassium relative to how much sodium is in coconut water. In addition, there is less sugar (glucose) in coconut water. While this might seem like a good thing, when kids are sick and not eating as much, they need sugar in easily available forms to help maintain blood sugar levels.
In the end, if this is the ONLY fluid your little one will take, it’s definitely better than nothing but the first recommendation would be Pedialyte or Kinderlyte, especially if they are not eating much food.
When to call the doctor
These reasons apply to any age and please note, this list is not exhaustive. Please never hesitate to call your doctor if you are worried about your little one.
Not keeping anything down, even when you trying giving small amounts with breaks in between
No wet diapers for more than 4 hours, especially if they are vomiting or having a hard time keeping fluids down
Unusually drowsy or difficult to wake up. Your little one will definitely be tired, but they should still wake enough to drink something before going back to sleep again.
Inconsolable or you feel you are unable to comfort them
For children who are vomiting: if vomit is green (we’re talking Kermit the Frog green, NOT yellow which is the color of regular stomach liquids) or if there is blood in it
For children with diarrhea: if there is blood (this can be bright red or black in color)
If your parental instincts tell you something is wrong!
