As my 18 month old daughter recovers from a particularly nasty bout of roseola, I wanted to use my article this week to share a fact I learned from my experience – that an actively breastfeeding baby can still become dehydrated. Roseola is a particularly insidious little virus. Severity of this illness can, I've been told, vary from child to child, but is generally found in babies 6 months to about 3 years.
In our family, this illness hit both my daughters right around 18 months and manifested as 5 days of relentless high fevers. We were up nights administering acetaminophen and ibuprophen alternately, which only succeeded in bringing the fever down to a "reasonable" 102 degrees or so. We had her in and out of baths, trying to avoid an ER visit. The most annoying thing about roseola is that you have no proof of what it is until after the illness is essentially over, when the fever breaks and they develop a telltale rash. But since most pediatricians will want to examine them and then test for bacterial infection after 3-4 days of fever, you have to torture their little bodies with a blood test and urine collection, only to get the results back right about the time your find out, "Oh, it's only roseola after all…"
As a seasoned second-time mom, my instincts told me that it was roseola right from the start, and I resolved not to put my baby through that testing. But my resolve was tested after 4 days of high fevers and the attendant worry that I was putting her through all of this when there was an obvious bacterial infection that I should be treating – and I gave in and took her in for an exam. Oh, and I probably should mention that this whole four days, she had been on the breast nursing for what I'd have to estimate at 18-20 out of each 24 hours – no exaggeration.
All of this is prelude to explaining that when I went into the pediatrician proclaiming that I was sure it was roseola (which did turn out to be right!), but just wanted to rule out the other possibilities, I also mentioned that because she had been nursing so much, at least I knew she wasn't dehydrated. But on this count, it's a good thing that I went it, because it turned out that I was very wrong.
Now I'm not sure how this would go with a younger baby, who probably generates a more robust and more quickly responsive milk supply than an "extended" nurser like mine, but I guess by 18 months, despite how long she nurses, there's just only so much milk available on "short notice."
She had been a bit lethargic the previous 24 hours, but given all the fever, I thought it wasn't beyond reason. But the pediatrician told me that she was borderline dehydrated and if we couldn’t get her fluids up, she'd need to receive treatment. I was completely shocked. My first was already basically done nursing during this illness, and so she was drinking other liquids throughout and it wasn't an issue. I had thought that nursing would sustain her. But apparently high fevers really burn up all that liquid.
So, I pass on my "wisdom" and some tips and tricks I picked up from the pediatrician for nursing through illness and avoiding dehydration:
• First, breastfeeding babies, at least older ones, can become dehydrated, even when nursing around the clock, so don't ignore this factor when evaluating this over a prolonged or fluid-losing illness (like diarrhea or vomiting).
• If doing this again, I'd be offering my baby some water and/or electrolyte drinks earlier on, before the dehydration level reaches that point where they aren't thirsty. Thank goodness my little one was nursing for comfort, so she was at least getting what I could provide.
• If your baby is nursing often like mine, whip out the galactogogues to try and increase supply temporarily to meet her needs. Do be careful… after the first day, even without any help, my supply did respond a little bit and I got a plugged duct, which was one more thing to deal with. Lack of sleep and stress associated with a sick baby can contribute to this as well – so be sure to stay on top of your own health as well. See my articles on "Increasing Low Milk Supply" and "Plugged Ducts and Mastitis" (listed below in "related links") for more details on these topics.
• Have electrolyte drinks handy. To be honest, I've never been a bit fan of these drinks, but my pediatrician shared that the salts in them, as opposed to just water, can help them hang on longer to the liquids they do drink. He also said that slightly salty bland foods, like salted rice cakes or bland crackers can help with this function as well. A different doctor told me once that after about age 2, when they've had exposure to more foods, you may not have much luck with infant electrolytes, as they aren't very sweet – even though there is more sugar in a Gatorade-type drink, you may have more luck actually getting them to drink it.
• Watch for signs of early dehydration – no more tears when they cry and increased lethargy (we failed to recognize these). Also, he taught us a neat trick… press their heel gently causing the area to blanch (turn white). If it takes close to or especially longer than about 2 seconds for the color to return, that's a sign of decreased fluid in the body. This is not a substitute for medical care, and a quicker response is not guarantee hydration is fine, but it is a nifty little tool to use at home.
In short, my advice to you is don't lose sight of dehydration when dealing with other issues. I'll definitely never make that mistake again. When dealing with fever, lack of sleep, constant breastfeeding, and irritability (mine and hers), this definitely got lost in the shuffle. But the biggest culprit in my daughter's near-dehydration, was my misconception that with all that breastfeeding that is just couldn't happen. So be warned from my experience and watch out for this silent little complication when your child is ill.
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