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In theory, the degree of dehydration can help guide management and interventions. Ideally, the degree of dehydration is determined by comparing a child’s current weight with the pre-illness weight. Because infants have a higher total body water (70%-80%) compared to older children (total body water of 60%), they must lose more weight to reach the same degree of dehydration as an older child.$^{24}$ Parents very rarely know this information, so physical signs such as tear production, mucous membrane appearance, skin turgor, capillary refill, activity level, etc, are more clinically useful. There are many different dehydration scores available, such as the World Health Organization (WHO) scale for dehydration, the Clinical Dehydration Scale (CDS), and the Gorelick scale for dehydration. The WHO scale for dehydration is a 4-point scale that evaluates the patient’s general condition, eyes, thirst, and the feel of the patient’s skin.$^{25}$ The CDS is also a 4-point scale; it includes rating the patient’s general appearance, eyes, mucous membranes, and degree of tears.$^{26,27}$ The Gorelick scale can be used in either a 4-point format or a 10-point format, with the first 4 characteristics being those in the 4-point scale.$^{28,29}$ (See Table 2.) A meta-analysis of these scales showed that no single scoring system is best.$^{30}$ A more recent study comparing the CDS, Gorelick, and WHO scales found that the CDS was very limited in its ability to diagnose dehydration, and neither the Gorelick nor the WHO scale was highly accurate.$^{31}$ In general, these scoring systems can identify children with severe dehydration, but often miss children with mild dehydration and fail to adequately differentiate between children with mild and moderate dehydration.$^{32}$ Since the recommended treatment for mild and moderate dehydration is the same—oral rehydration solution (ORS) only—and most clinicians can recognize severe dehydration, the use of these complex scoring systems (some have 12 different clinical findings) are perhaps not routinely needed.$^{23}$

Used under Creative Commons Attribution 4.0 International (CC BY 4.0). Adapted from: Kimberly Pringle, Sachita P Shah, Irenee Umulisa, et al. Comparing the accuracy of the three popular clinical dehydration scales in children with diarrhea. Int J Emerg Med. 2011;4:58. Licensee Springer 2011.