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This is a life-threatening emergency. Call 911 immediately, then follow these steps while waiting for help.

Severe Dehydration in Infants and Toddlers

Content reviewed against published AAP, WHO, CDC guidelines

Editorial policy

Last reviewed:

Severe dehydration in babies is a life-threatening emergency. Babies dehydrate much faster than adults due to their small body size and higher fluid turnover. Common causes include vomiting, diarrhea, fever, and refusal to feed. Severe dehydration requires IV fluids — do not try to manage it at home.

Immediate actions

  • Call 911 immediately
  • Look for signs of severe dehydration: sunken fontanelle, no tears when crying, no wet diapers for 6+ hours, sunken eyes, extreme lethargy
  • DO NOT: Do NOT give plain water to babies under 6 months — it can cause dangerous electrolyte imbalances

Step-by-Step Response

1

Assess dehydration level

Mild: slightly dry mouth, fewer wet diapers. Moderate: sunken fontanelle, no tears, dry mouth, fewer than 3 wet diapers in 24 hours. Severe: no wet diapers 6+ hours, sunken eyes, lethargy, mottled skin, weak cry.

2

Check the fontanelle

In babies under 18 months, gently feel the soft spot on top of the head. A sunken fontanelle (dips inward) is a reliable sign of moderate-to-severe dehydration.

3

Skin turgor test

Gently pinch the skin on baby's hand or abdomen. In a hydrated baby, skin snaps back immediately. If skin stays "tented" or takes more than 2 seconds to return, baby is significantly dehydrated.

4

Begin oral rehydration (if mild-moderate)

For breastfed babies: nurse frequently (every 1-2 hours). For formula-fed babies: offer Pedialyte in small amounts — 1 teaspoon every 5 minutes using a syringe if needed. Gradually increase as tolerated.

5

Track wet diapers

Keep a written log of wet diapers, vomiting episodes, and fluid intake. Newborns should have 6+ wet diapers daily. Fewer than 3 in 24 hours is concerning.

6

Go to ER if severe

If baby shows signs of severe dehydration (no tears, sunken fontanelle, lethargy, mottled skin, no wet diapers 6-8+ hours), go to the ER immediately. Baby will likely need IV fluids.

7

Monitor for worsening

Even with mild dehydration, watch closely. If baby cannot keep any fluids down for 4-6 hours, becomes increasingly lethargic, or stops producing wet diapers, escalate to ER immediately.

8

Continue feeding

Do not stop feeding during illness. Continue breast milk or formula. Offer solids if baby is eating them (bananas, rice, applesauce, toast — BRAT diet). Resume normal diet as soon as possible.

What NOT to Do

  • ✕Do NOT give plain water to babies under 6 months — it can cause dangerous electrolyte imbalances
  • ✕Do NOT give fruit juice, soda, or sports drinks — the sugar can worsen diarrhea
  • ✕Do NOT force large amounts of fluid at once — this can trigger vomiting
  • ✕Do NOT withhold breastfeeding during illness — continue nursing frequently
  • ✕Do NOT assume dehydration will resolve on its own if baby is refusing fluids
  • ✕Do NOT wait until the next morning if baby has not had a wet diaper in 8+ hours at night

When to Seek Help

Call 911 if:

  • Baby is unresponsive or extremely difficult to wake
  • Baby has mottled, gray, or blotchy skin
  • Baby is breathing very fast or irregularly
  • Baby has not urinated in over 12 hours
  • Baby had a seizure (can occur with severe dehydration)
  • Baby's eyes are severely sunken and they are not producing tears

Go to ER if:

  • No wet diapers for 6-8 hours in an infant or 8-12 hours in a toddler
  • Sunken fontanelle with other signs of dehydration
  • Baby is too lethargic to feed or refuses all fluids
  • Vomiting everything — cannot keep any fluids down for 4-6 hours
  • Blood in vomit or stool (along with dehydration signs)
  • Baby under 3 months with any vomiting and diarrhea — low threshold for ER at this age
  • Skin turgor test shows slow return (skin stays tented)

Call your doctor if:

  • Baby has diarrhea or vomiting and you want guidance on rehydration
  • Baby has had fewer wet diapers than normal but is still alert and feeding
  • Vomiting has lasted more than 24 hours
  • Diarrhea has lasted more than 3 days
  • Baby has fever along with vomiting or diarrhea
  • You are unsure if baby is dehydrated

Age-Specific Guidance

0-3 months

Newborns dehydrate extremely quickly. They should have 6-8 wet diapers per day. Any decrease in wet diapers, combined with poor feeding or lethargy, warrants immediate medical attention. Do not give water — only breast milk, formula, or Pedialyte as directed by a doctor.

3-12 months

Babies at this age are at high risk during gastroenteritis (stomach bugs). The rotavirus vaccine greatly reduces risk. Offer breast milk/formula frequently. Pedialyte can be given between feeds. Watch for sunken fontanelle and decreased tears.

1-3 years

Toddlers may refuse to drink when ill. Try popsicles (Pedialyte freezer pops), small sips with a straw, or a medicine syringe. Toddlers should have at least 4-6 wet diapers/pull-ups per day. They can handle diluted clear fluids in addition to ORS.

Prevention

  • Offer frequent feeds during illness — small amounts more often is better than large amounts
  • Keep Pedialyte or generic oral rehydration solution at home before you need it
  • Learn to recognize early signs of dehydration: dry lips, fewer wet diapers, darker urine
  • Continue breastfeeding through illness — breast milk is the best rehydration for breastfed infants
  • Keep baby cool during fever to reduce fluid loss from sweating
  • Wash hands to prevent gastroenteritis (stomach bugs) from spreading
  • Get rotavirus vaccine at 2 and 4 months — this prevents the most common cause of severe infant diarrhea
  • In hot weather, offer extra feeds to prevent heat-related dehydration

Frequently asked questions

Should I call 911 for severe dehydration in infants and toddlers?
Yes. Baby is unresponsive or extremely difficult to wake
What should I do first?
Look for signs of severe dehydration: sunken fontanelle, no tears when crying, no wet diapers for 6+ hours, sunken eyes, extreme lethargy. If baby is lethargic, unresponsive, or has very dry mouth with no wet diapers — go to ER immediately. Offer small, frequent sips of oral rehydration solution (Pedialyte) if baby is alert enough to drink. Do NOT give plain water to infants under 6 months — use breast milk, formula, or Pedialyte. Call 911 if baby is unresponsive or has mottled/gray skin
What should I NOT do?
Do NOT give plain water to babies under 6 months — it can cause dangerous electrolyte imbalances. Do NOT give fruit juice, soda, or sports drinks — the sugar can worsen diarrhea. Do NOT force large amounts of fluid at once — this can trigger vomiting. Do NOT withhold breastfeeding during illness — continue nursing frequently. Do NOT assume dehydration will resolve on its own if baby is refusing fluids. Do NOT wait until the next morning if baby has not had a wet diaper in 8+ hours at night
How can I prevent this?
Offer frequent feeds during illness — small amounts more often is better than large amounts. Keep Pedialyte or generic oral rehydration solution at home before you need it. Learn to recognize early signs of dehydration: dry lips, fewer wet diapers, darker urine

Sources

AAPWHOCDC

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources

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Bottom line

This is a serious emergency. Always call 911 first, then follow the steps above while help is on the way.

You are doing the right thing by learning what to do in an emergency. Being prepared is one of the best things you can do for your child.