By Nicole Bando, APD & IBCLC, 17th September 2019

Water is vital for all of our body’s basic functions, such as carrying nutrients to cells, regulating body temperature and ensuring healthy bowel motions. I am often asked, how much fluid do children need?
The answer depends on their age, body weight and other factors, such as illness, environment & physical activity levels. My advice is based on a healthy population.

0-6 month old babies need 150mls of fluid per kg per day. Many parents of breastfed babies worry that they can’t quantify how much milk their baby is receiving. There are many ways to tell if a baby is well hydrated, remember that what goes in must come out.

At least 5 heavy wet nappies and multiple soft stools per day are a good indicator that baby is well hydrated. Please note that after about 6 weeks, a breastfed baby poo only once per day. it is also normal for a breastfed baby to last 7-10 days without a bowel motion, this is quite normal if baby is otherwise gaining weight and well. Bottle fed babies may only poo once every 2 or 3 days.

Baby’s skin tone, colouring and alertness is also a good indicator of hydration. Diarrhoea or vomiting increase fluid requirements and increase risk of dehydration at any age, which can be life threatening in children. If your child ever becomes listless, has a depressed fontanelle (soft area on baby’s forehead prior to the bones closing), won’t drink breast milk or formula or becomes unresponsive, seek emergency medical attention.

Both breastfed and formula fed babies are likely to need extra feeds offered in hot weather. A formula fed baby may need additional sterile water, it is best to discuss this with your GP. Breastfed babies do not require additional water, and instead may be offered extra breastfeeds.

Children 6-12 months require 120mls fluid per kilogram per day (e.g. a 9kg baby requires just over 1000mls per day). This includes water consumed from sippy cups, breastmilk, formula, as well as water found in foods.

Basic fluid requirements per day beyond 12 months (+fluid from diet) are listed below:
1-3 years: 1000mls
4-8 years:1200mls
9-13 years: Boys 1600mls, Girls 1400mls
4-18 years: Boys 1900mls, Girls 1600mls

Fluid is defined as anything liquid at room temperature (milk, jelly, yoghurt, custard), it also comes from high water content foods, such as fruit and vegetables. These are difficult to quantify, but they do count towards total fluid intake (in adults up to 20% of total intake). Beyond 12 months, cow’s milk (or alternative) and water are the best drinks for children. Specialised toddler formulae are not required in healthy children. Juices, diet and sugary soft drinks are not recommended to be part of a child’s diet. Many schools now only allow water in the classroom and children are encouraged to drink throughout the day.

If your child is straining, passing hard pellet like stools, or passing urine that is dark and offensive, this can be a sign of inadequate hydration, which can contribute to constipation and other medical concerns. See your GP if you have any concerns and seek help from a Paediatric Dietitian for specialised dietary help if you feel constipation or diet may be an issue.

As a Melbourne based Paediatric Dietitian, I discuss this very emotional topic with parents frequently. I like to to use positive language and practical strategies to encourage my families towards healthy change. Here are my tips for addressing the hard topic of nutrition and children’s bodies:

– Take action: it may be time to change family eating & lifestyle habits. Offer balanced meals and snacks based on the core food groups. Avoid having too many treat foods in the home. Be active together. Change as a family creates a positive environment for learning and avoids focus on an individual, which can create pressure, anxiety and fuel risk of disordered eating and negative body image.

– Talk about body image concerns: what we can do and the sort of people we are is more important than looks or weight. This is a great podcast: https://www.abc.net.au/…/teaching-your-kids…/12625036

– Avoid making negative comments about your body or your child’s body. As an adult, avoid crash diets as this role models unhealthy eating behaviours. Say positive things about your own body.

– Avoid blaming or shaming the child for their food choices or preferences. Remember that young children will eat what is on offer in their immediate environment and parents can change this.

– Talk about feelings of hunger and fullness. Children are excellent at reading their own cues. Remember it can take 20 minutes after eating for the hormones (chemical messengers) to send a message to the brain that the stomach is full. Encourage everyone in the family to recognise these signals, this can help to avoid 2nd portions when they may not be needed.

– Depending on the child’s age – use phrases such as: ‘eating fresh and colourful foods help us to grow strong & concentrate at school’ or talk about what they love. If your child loves soccer, then ‘eating ‘grow’ foods like meat, chicken and eggs makes our muscles strong to kick the ball’ and ‘go-go foods like bananas and Weet-bix give us the energy to play soccer or swing on the monkey bars.’

– Primary school aged children: don’t talk about weight, take action that involves changing the family habits

– Make changes gradually, growth occurs over time and small changes make a big difference

– Work with a paediatrician and paediatric dietitian for expert guidance.

A note about older children who may be feeling conscious about their bodies. Talk openly, answer their questions and understand why and how they are feeling this way. Social media has an incredible impact on our children’s body image & perception of self. Seek advice if you are concerned. Focus on health and growth, rather than ‘weight’. If children are overweight, it is recommended they maintain their weight, whilst their height catches up.

– Avoid demonising foods. Treat foods have their place and should be enjoyed in small portions, occasionally