American Children and Adolescents Are Dehydrated

American Children and Adolescents Are Dehydrated

Pamela A. Popper, President

Wellness Forum Health


According to a recent study, American children and teens do not consume enough water, which affects both their physical and mental health status. Harvard researchers analyzed data from 4,134 children and adolescents between ages 6 and 19 participating in the National Health and Nutrition Examination Survey (NHANES). About half the  children were not taking in enough fluids of any type. Dehydration was 76.0% higher in boys than girls, and 34.0% higher in blacks than whites. Almost 25.0% of the kids reported drinking no water at all.

The bad news is that so many children are dehydrated. The good news is that this could be an easier problem to solve than many diet-related issues with children, since there is likely to be less controversy and argument about getting kids to drink more water. Here are a few ways in which kids could be helped to do better with minimal expense and disruption at school. 

First, all children could be given water bottles at school. This would cost a small amount of money, but if budgets are so tight that schools cannot spend $1.00 per child to make sure water intake is adequate, perhaps the PTA could step in to help.

Second, children could be allowed to drink water during the school day. It is appalling to me the number of children of members of Wellness Forum Health who are forbidden to drink water during the school day, and also forbidden to use the restroom except at specified breaks like recess (I assume that the reason water drinking is prohibited is to lessen the number of times children need to use the restroom during the day). While there are many reasons to keep kids from running around the school building during the school day, stopping them from using the restroom is not one of them.

Third, water could be served with meals at school. While it would be great if water replaced milk, the milk lobby won’t let that happen anytime soon, so water in addition to milk would be a step in the right direction.

Fourth, water could replace caloric beverages like milk, soft drinks, and sports drinks in the vending machines.  Some schools have already made this change. While schools have become reliant on revenue from vending machines, this does not mean that junk foods, including caloric beverages, need to be offered for sale. 

Last but not least, coaches could encourage kids to drink more water and require water bottles at practice. While many coaches push protein and sports drinks, most coaches would agree that kids need to drink more water and that water drinking is a good habit to form.

The result of this focus on water would most likely carry over to home. Kids who become used to drinking water at school would most likely also do so at home, which might encourage parents to drink more water too.

Kenney E, Long M, Cradlock A, Gortmaker S. “Prevalence of Inadequate Hydration Among US Children and Disparities by Gender and Race/Ethnicity: National Health and Nutrition Examination Survey, 2009–2012.”  Am J Public Health. 2015 Aug;105(8):e113-118

Preventing and Treating UTIs

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Preventing and Treating UTIs

Pamela A. Popper, President., Wellness Forum Health

Over half of all women will have at least one bladder infection, referred to as uncomplicated cystitis, during their lifetime, and those who have one are highly likely to develop more of them. Symptoms include a strong, persistent urge to urinate, a burning sensation during urination, passing small amounts of urine, blood in the urine, and pelvic pain. In addition to the bladder, other parts of the urinary tract can be affected, such as the urethra and kidneys.

About 27% of women will have another recurrence of cystitis within 6 months,[1] and for women who have had a previous urinary tract infection (UTI), between 44% and 70% will have a recurrence within a year.[2] Risk factors for recurrence include recent sexual intercourse, use of a diaphragm with spermicide, and history of recurrent UTIs.[3]

UTIs are generally treated with antibiotics, and about 15% of all antibiotic prescriptions are written for this condition. As a result, antibiotic resistance is increasing and is as high as 45% for ampicillin for women who have been given antibiotics for UTI.[4]

There are numerous ways to prevent cystitis, including not delaying urination, urinating shortly after sexual intercourse, and better pelvic hygiene.[5]  Both oral and intravaginal suppositories of probiotics are effective for prevention, and cranberry products have been shown to decrease recurrence of UTIs by 30-40% in premenopausal women.[6]

One of the simplest and most effective prevention strategies is hydration, because drinking enough water flushes out the bacteria in the urinary tract.[7] A new study included women who had at least 3 symptomatic episodes of cystitis during the previous year and who reported drinking less than 1.5 liters of fluid daily. They were randomized to either add 1.5 liters of water to the daily intake or no additional fluids for a year. Women who drank no additional fluids had an almost two times greater risk of cystitis than women who drank additional water.[8]

Cranberries, cranberry capsules, and cranberry juice are also inexpensive and effective tools for prevention. Cranberries contain proanthocyanadins (PACs) which prevent bacteria from attaching to the lining of the urinary tract. A study that compared the use of antibiotics to cranberry capsules showed that antibiotics were initially more effective for preventing infections. But women eventually developed resistance to trimethoprim sulfa, amoxicillin, and ciprofloxacin. On the other hand, resistance did not develop to the cranberry capsules. In other words, while the antibiotics were more effective in the short-term, cranberry was more effective in the long term.[9] Another advantage is that cranberry does not destroy beneficial bacteria, while antibiotics do.

Low-tech and inexpensive prevention tools such as probiotics[10] and better hydration have been shown to be safe and effective for prevention of UTI.

Women who develop cystitis or UTIs should avoid antibiotic treatment if possible. In many instances, the drugs can be avoided by using several strategies:

  • Drink 8 ounces of cranberry juice (not from concentrate) sweetened with raw honey 3-4 times per day. Raw honey has been proven to have antibiotic properties.[11]
  • Drink at least 64 ounces of water daily
  • Discuss the use of plant antimicrobials with a competent healthcare provider. Many are as effective as antibiotics and do not have negative side effects.

[1] Foxman B. “Recurring urinary tract infection: incidence and risk factors.” Am J Public Health 1990 Mar;80(3):331-333

[2] Ikaheimo R, Siitoenen A, Heiskanen T et al. “Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women.” Clin Infect Dis 1996 Jan;22(1):91-99

[3] Hooten TM, Scholes D, Hughes JP et al. “A prospective study of risk factors for symptomatic urinary tract infection in young women.” NEJM 1996 Aug;335(7):468-474

[4] Mazzulli T. “Resistance trends in urinary tract pathogens and impact on management.” J Urol 2002 Oct;168(4 Pt 2):1720-1722

[5] Nosseir SB, Lind LR, Winkler HA. “Recurrent uncomplicated urinary tract infections in women: a review.” J Women’s Health (Larchmt) 2012 Mar;21(3):347-354

[6] Beerepoot M, Geerlings S. “Non-Antibiotic Prophylaxis for Urinary Tract Infections” Pathogens 2016 Apr;5(2):pii:E36

[7] Beetz R. “Mild dehydration: a risk factor of urinary tract infection?” Eur J Clin Nutr 2003 Dec;57 Suppl2:S52-S58

[8] Hooten TM, Vecchio M, Iroz A et al. “Water intake in Premenopausal Women With Urinary Tract Infections. A Randomized Controlled Trial.” JAMA Intern Med 2018;178(11):1509-1515.

[9] Beerepoot MA, ter Riet G, Nys S, et al. “Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women.” Arch Intern Med. 2011;171:1270-1278.

[10] Stapleton AE, An-Yeung M, Hooton TM et al. “Randomized, Placebo-Controlled Phase 2 Trial of a Lactobacillus crispatus Probiotic Given Intravaginally for Prevention of Recurrent Urinary Tract Infection.” Clin Infect Dis 2011 May;52(10):1212-1217

[11] Kwakman P, te Velde A, de Boer L, et al. “How honey kills bacteria.” FASEB J  2010 Jul;24(7):2576-82.