Water Intake for Health and Well Being
An Excerpt from Gastrointestinal Health and the Child with Feeding Problems, Part 1
Reprinted with permission. See www.new-vis.com for the full document text.
Suzanne Evans Morris
It is commonly believed that the body requires a specific level of liquid intake — rather than a specific level of water intake — for health and well being (Batmangheilidj 1995). Since children on feeding tubes receive their entire nutrition in liquid form, it often is assumed that they do not need additional water (other than that used to flush the tube). It is also assumed that water will fill them up and reduce their desire and tolerance for the formula. Thus, fear of reduced caloric intake also contributes to the failure to give needed water. Formula is a food —which like most milks, fruits, and vegetables —has a high percentage of water. However, this does not replace the body’s cellular need for clear water to provide optimum function of all cells and systems. The digestive system is heavily dependent upon water for efficient function. The chronic “subclinical” dehydration experienced by children and adults who lack adequate water intake, can contribute to reflux and other gastrointestinal problems (Batmangheilidj 1995). A child should receive water intake equivalent to two-thirds of the body weight. Thus, a child weighing 30 lbs. should be given 20 ounces of water throughout the day (Batmangheilidj 1996). No physician would advise the parents of a typically developing child to drink only milk and juice. Water is recommended for all children and adults.
Lack of adequate water can affect the function of all systems of the body -- especially the gastrointestinal system, which needs water for digestion. Increased water can reduce gastroesophageal reflux, improve digestion, reduce constipation, and cleanse the body through removing toxins. The optimum amount of water varies with the age-range and weight of the person. Doctors recommend that infants under the age of 6 to 9 months should not receive added water or have their formulas diluted with water. This is because the baby's kidneys have not developed the ability to retain extra fluid efficiently. As a result of the increased water intake there is a risk that the infant's body will release too much urine containing sodium. This can result in a condition known as hyponatremia or water intoxication that can lead to seizures and brain damage. Adding water according to specific weight and age guidelines does not create a risk for older infants and children who are on a formula diet because their kidneys are more mature and can retain and regulate the release of urine and sodium. However, water must be added carefully to the diet of any individual. This is definitely not a case where more is better! Children need the number of ounces equivalent to two-thirds of their body weight (Batmangheilidj 1996). A child weighing 36 lbs. needs 24 ounces of water. When children reach the age of 10 to 12 years, their water needs approach that of adults. They need the number of ounces equivalent to half of their body weight (i.e. a child weighing 60 lbs. needs 30 ounces of water). It is commonly stated that adults need a minimum of 6 to 8 eight-ounce glasses of water per day. Juice, milk, tea, and soda do not count toward the daily allotment of water. The body needs clear fluid that is not a food requiring digestion (Batmangheilidj 1995).
Water should be introduced very slowly and the total daily amount should be divided into small portions and given approximately 30 minutes prior to each tube-feeding or oral meal. This may be offered by feeding pump, a syringe or gravity bolus feeding, or orally. It is important to begin with an amount and a rate that is comfortable for the child. This can be very gradually increased over a period of weeks or months. Increments should be very small. For example, if the child is comfortable with 30 cc of water (i.e. 1 ounce), the next increase should be 45 cc (i.e. 1.5 ounces). Monitor the amount of urine output in diapers or trips to the bathroom. As water intake increases, urination should also increase. If there is a history of urinary tract dysfunction or a cardiac problem resulting in water retention, the child’s physician should be consulted before fluid intake is increased.
Thirst signals are often unclear to children and adults who are chronically dehydrated. A dry mouth is often the last signal of thirst. A body can suffer from dehydration even though the mouth is moist. Gastrointestinal pain and discomfort can be a major signal that the body is not getting enough water (Batmangheilidj 1995).
In his book, Your Body’s Many Cries for Water, F. Batmanghelidj, MD makes a strong case for gastroesophageal reflux (heartburn) as a symptom of inadequate water intake. Copious amounts of water are needed in the stomach for digestion. When we drink a glass of water, it rapidly passes through the stomach and is absorbed in the intestine. Thirty minutes later the stomach secretes the same amount of water through the glandular layer in the mucosa. The water in the stomach is now ready to mix with stomach acids and enzymes and assist with digestion.
The cells in the small intestine would be damaged by acid from the stomach if the pancreas did not secrete a watery bicarbonate solution that changes the environment to a strongly alkaline solution. Once the bicarbonate solution has been released, the pyloric valve opens to allow stomach contents to pass into the small intestine. These acid contents are then neutralized by the alkaline solution secreted by the pancreas. The manufacturing of the watery bicarbonate solution requires a great deal of water from the body’s circulation. When inadequate water is present due to chronic dehydration there is often inadequate production and release of the bicarbonate solution. The pyloric valve does not receive the signals to open and release the stomach’s acidic contents into the intestines. This is a self-protective response since the walls of the intestines lack the protective layer against acid that is present in the stomach. The pyloric valve constricts more tightly and the lower esophageal sphincter relaxes. This results in the “anti-peristalsis” that reverses the contractions and sends stomach contents upward into the esophagus (Batmangheilidj 1995, p.37-38)
One of the functions of the neurotransmitter histamine is regulation of water distribution to the cells (Batmangheilidj 1990, Batmangheilidj 1995). When there is inadequate water for all of the cells, the brain secretes more histamine. Histamine redistributes more water to areas such as the brain whose cells have a high need for hydration, drawing water from cells that have a less critical need. The greater the body’s need for water, the more histamine it secretes to try to solve the problem.
Increased production of histamine is one of the major problems in asthma and allergy. This is the reason that the most common medications for these problems are antihistamines. Salt is also a natural antihistamine which can be added to the diet in small amounts to prevent excess histamine production. Sodium (salt) regulates the amount of water that is held outside the cell wall. Through a special filtration system, water can be directed into the cell itself. When we don’t drink enough water, the body will retain sodium so that additional water isn’t lost. Giving diuretics for water retention just makes dehydration worse. Water itself is an excellent natural diuretic when the body is getting enough.
Problems with thick mucous in the body are also related to chronic dehydration. Batmangheilidj states that “Sodium is a natural mucus breaker, and it is normally secreted to make mucous disposable. That is why phlegm is salty when it comes in contact with the tongue. Salt is needed to break up the mucous in the lungs and render it water for its expulsion from the airways.” When there is chronic dehydration, the body doesn’t want to give up salt to loosen the mucous (Batmangheilidj 1995, p. 120).
Constipation is also related directly to inadequate water intake. “One of the main functions of the large intestine is the process of taking water out of the excrements so that too much of it is not lost in the waste matter after food digestion. When there is dehydration, the residue is naturally devoid of the normal amount of water necessary for its easier passage. Also, by slowing down the flow and further squeezing the content, even the final drops of water will be drawn away from the solid residue in the large gut. Thus, constipation will become a complication of dehydration in the body.” ((Batmangheilidj 1995, p. 34).
Reflux, thick mucous, and constipation are major issues for children with feeding problems. Is it possible to eliminate these problems, by something as simple as increasing their water intake? q
Suzanne Evans Morris, Ph.D is a speech-language pathologist with more than 40 years of clinical experience. She is nationally and internationally known for her work in identifying and treating young children with feeding and swallowing disorders. Dr. Morris maintains a practice which includes direct clinical work, continuing education workshops, development of clinical materials, and clinical research. She is the director of New Visions near Charlottesville VA, which sponsors the Mealtime Partners Program a series of family-oriented workshops and clinical services that focuses on mealtime and feeding skills.
Fereydoon Batmangheilidj. Your Body’s Many Cries for Water, 1995. Global Health Solutions, Falls Church, VA.