Water Works: Dehydration, Regulation and Behaviour

There’s so many factors that contribute to regulation, regulation development, and behaviour that sometimes it can be hard to know where to start. The Regulation Rocket is the perfect tool to help remind us to approach regulation and behaviour functionally and holistically. Sometimes we can overlook the most retrospectively obvious things in our search to support the individuals in our lives. One area of the Regulation Rocket that can frequently be overlooked (or incorrectly assumed) is Basic Needs. And a component of this area which we will explore today is water intake and the impact of dehydration on regulation and behaviour. 

What is dehydration?

 As I’m sure you remember from school (or trivia nights!), the body is made up of primarily water. While you may recall a particular percentage of water that your science teacher assured you is the number every body contains, the reality is that how much of your body is water depends on a few factors. Age, sex, and fat levels all contribute to the exact percentage of water in your body, but as a general rule infants are the most water dense (about 78% water!), children over the age of one have approximately 65% water, and adults range from about 55-60%. 

We lose water constantly throughout the day by sweating, excreting waste (urine or faeces), and even breathing. Vomiting, diarrhea, or blood loss increases how much water our body loses. Dehydration occurs when the amount of water our body loses is not replaced, causing the percentage of water in our body to drop. Losing 1-2% of total body water is classified as mild dehydration, 2-5% as moderate dehydration, and anything over 5% as severe.  

Why does dehydration occur? 

Dehydration can occur due to lack of replacing fluids, high temperature or humid environments, consumption of diuretics (substances that increase urine production) or participation in exercise. 

Fluids may not be replaced due to a lack of thirst recognition, poor thirst mechanisms, dissatisfaction in drinking water, or lack of access to water. Individuals who have introception difficulties (problems recognising the internal state of their body) may not process or respond to the signals their body is sending re: thirst. Fluid regulation is also a complex process involving various parts of the brain, sensors in the blood vessels, hormones, and the kidneys. A breakdown in the communication or coordination of these processes can result in a lack of feeling thirsty. Not liking water, or not having the access to water are two other ways that contribute to an individual not adequately replacing the fluids lost throughout the day.

High temperature or humid environments and exercise both increase fluid loss rates due to an increase in perspiration (sweating) and also increased breathing rate (causing the body to expel more water vapour). Diuretics such as caffine, alcohol, or some medications cause an increase in urine production, accelerating the rate of water leaving the body. 

How does dehydration affect us? 

Dehydration has long been known to impact physical performance due to many, many studies and experiments (usually with athletes). More recently, researchers have turned their sights on understanding the impact dehydration has on cognitive performance as well. For me, this is fascinating to read into as cognition plays a massive role in regulating thoughts, feelings, and behaviour.

Besides physical and cognitive performance, dehydration also has a physiological impact on the body (physiology is a component of biology, another regulation factor!). The following occurs when moderate dehydration (2%+ body water loss) is present:

• Difficulties with short term memory (such as remembering verbal instructions) 
• Impaired performance of pyschomotor tasks involving visuomotor or hand eye coordination (ie using the eyes and body together to produce a movement pattern). 
• Decreased visual attention 
• Decreased perceptual speed (ability to focus attention and process/compare information)
• Increased production of stress hormones such as cortisol
• Increased tiredness, fatigue and drowsiness 
• Reduced alertness
• Reduced concentration 
• Increased headaches
• Decreased feelings of happiness and well being
• Decreased ability to regulate body temperature via sweating
• Increased blood pressure 
• Increased likelihood of constipation and kidney problems 

That’s quite a list! As you can see, being dehydrated both directly and indirectly impacts on many of the factors that contribute to an individual’s regulation and their behaviour. 

What are the recommendations for daily water intake? 

While there are no hard and fast recommendations for water intake (due to differences in environment, physical activity and individual metabolisms), the Australian National Health and Medical Research Council has released “Adequate Intake” values. These serve as a guide of how much water (including that gained from foods) should be ingested daily.

Remember exercise, environment and individual differences play a role, and intake should be adjusted accordingly. When in doubt, check for physical signs like dry lips, darker coloured urine, less urine output, dry and cool skin, or unexplained tiredness or drowsiness. 

How can I support an individual to drink/consume more water? 

Water is found in a lot of foods (such as meat, eggs, fruits and vegetables) as well as drinks such as formula, juice, milk, and sports drinks. Approximately 20% of daily water intake comes from the food we eat (as shown in the tables above). Juice and sports drinks often contain high levels of sugar, and as water has no calories/kilojoules (and it’s free!), it is recommended as the primary fluid intake (excluding babies).

But what if you are struggling to encourage an individual to consume an adequate amount of water? Check out the tips below! 

• Build drinking water into daily routines: making drinking a habit and the norm supports individuals who may not voluntarily drink water to do so. Start the day with a glass of water and have set times throughout the day when everyone drinks

• Lead by example: demonstrate drinking water yourself (and encourage other adult supporters, peers, and siblings to do the same). Seeing people in our life perform an action makes us more likely to imitate and do it to. This is particularly true for children and adolescents!

• Make water fun! Choose fun bottles, glasses, cups, or straws to intice your child to engage in drinking. Let them choose their own bottle, or use stickers to spice up a pre-existing bottle.

• Monitor consumption: when possible, use vessels that allow you to see how much water is consumed at a particular time. See through bottles (or ones with a strip to see water level) make this much easier. You can also use the visual water levels to set clear expectations for your child (eg getting them to drink to a certain line, or empty the glass/cup).

• Make it accessible: not only is water crucial for rehydration, the act of drinking can be a great sensory regulator! Having it easily accessible (eg on a child’s desk, next to them during play, on the table when eating) allows them to not only drink it when needed, but helps them to self regulate as it is a tool they can access without adult support or permission. 

• Change the taste: do you have a child who is “addicted” to juice or sports drinks? Or who flat out refuses water aa it’s “yucky”? Help your child grow accustomed to the taste of water by diluting juice/sports drinks with water, or my adding fresh fruit to water to give it some added taste. Lemons, limes, oranges, and berries are all great additions, as is some fresh mint!

• Encourage your child to consume more water dense foods such as watermelon, strawberries, rockmelon/cantelope, peaches, celery, cucumber, lettuce, tomatoes or yoghurt. Unlike fruit juices, fresh fruit contains fibre and lower levels of fructose per serving, making them a great alternative for sweet tooths! 

• Don’t forget ice: ice is literally water… that’s frozen! Do you have a child who loves oral input? Who constantly sucks on or mouths objects or clothing? Ice is a fantastic substitute, that also provides them with much needed hydration! Just like water, you can spice up ice by adding fruit to it before freezing. Everyone loves a good popsicle, especially in summer! Please note that ice should be sucked on and not chewed to protect the teeth. If your child tends to chew or crunch ice, consider offering shaved or finely crushed ice instead. 

• Play around with temperature: ice may be a bit too cold for some, but cold water (from the fridge or cooled with ice blocks) may be more appealing than water which is room temperature. Alternatively, warmer water might be preferred, particularly in colder months.

If you are concerned about your child’s water intake, or suspect it may be impacting their regulation/behaviour, please speak to your doctor, speech pathologist, occupational therapist and/or educators. It’s important that your child is supported across all their environments, and that their health and basic needs are addressed.