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Providing therapy, companionship and dedicated, compassionate care can go a long way, but the “Fatal Four” can destroy any foundation you work to build. Dehydration, constipation, aspiration and seizures make up the “Fatal Four.” These conditions have the potential to severely undermine any interventions and rehabilitative efforts you undertake and, in some cases, can be deadly. They seem easy to understand, but you need to take a closer look at how they impact people with intellectual disability or developmental disabilities (IDD).
In a recent story reported by CNN, the father of a 14-year-old boy with autism, a type of developmental disability, struggled for years to keep his son hydrated. The problem stemmed from the son’s unwillingness to drink from any container other than a specific blue cup. Unfortunately, the manufacturer stopped selling the cup years ago, and the father struggled with repeated hospitalizations of his son because of dehydration.
Think about this report: The son began suffering severe medical problems, and he could have lost his life. Fortunately, the cup’s manufacturer stepped in, providing a lifetime supply of the specific cups for this child. However, this is a once-in-a-lifetime scenario, and dealing with dehydration among those you serve requires a bit more insight.
Dehydration can cause many serious problems with bodily functions, ranging from decreased cognitive ability to cardiovascular stress. Most people suffer from dehydration at some point in their lives. A variety of factors can cause dehydration, reports Healthline, which include the following:
- Viral or bacterial infections
- Decreased fluid intake
- Excessive perspiration
Dehydration tends to occur more frequently in children and young adults, reflecting behavioral rationale for not staying hydrated. For example, a sick child may not understand why he needs to drink more fluids than usual, or he may refuse to drink any fluids when his needs are not being met.
This concept remains evident among children and youth with intellectual disability as well. Meanwhile, those with developmental disabilities, such as fetal alcohol syndrome (FAS) or Down syndrome (DS), may suffer from a physical inability to drink fluids on their own. More importantly, dehydration decreases cognitive and physical functions, further exacerbating the problem. This means the prevalence of dehydration in this group may be significantly higher than among the general population.
How to Recognize the Signs of Dehydration
Increased thirst is the obvious sign of possible dehydration. When you crave water or other fluids, your body is sending a message that it needs more fluids. Yet, people with intellectual disability may not be able to express thirst, especially if they have mobility or other physical limitations. Therefore, you need to learn to recognize the other warning signs of dehydration, explains the Mayo Clinic, which
- Dry mouth
- Tiredness or lethargy
- Dry skin
- Swollen tongue
- Decreased urine output
- Trouble concentrating
Notice that constipation, one of the “Fatal Four” health concerns for people with intellectual disability, is included as a symptom of dehydration.
Tips to Prevent Dehydration
“Push fluids.” This is the most universal of any medical instructions after seeing a physician for dehydration. It is almost an archetype, but how do you prevent this situation from ending up in the doctor’s office? The answer lies in preventing dehydration and addressing it once any of its warning signs appear. Consider using these tips, as explained by WebMD, to help prevent dehydration among those you serve.
1. Monitor Intake and Output.
The intake and output of urine and bowel movements should be similar. If a person drinks 500 mL of fluids, a similar volume of urine should be expected. But, if diarrhea occurs, the output of fluids through stool will be higher. However, the cause of diarrhea should be treated appropriately because it contributes to dehydration.
2. Encourage “Nontraditional Fluid Consumption.”
This tip is more of a trick. Rather than focusing on encouraging people to drink more water, think outside of the box. Encourage people to eat a popsicle, or you might try creating a frozen-fruit smoothie. This increases fluid intake without adding the excess sugar found in carbonated beverages. In fact, there are many low-sugar treats with a high-water volume available today.
3. Use Thickener If Needed.
Sometimes, people with developmental disabilities may have trouble swallowing thin liquids. Consider using a thickener to increase the viscosity of the fluids. This may encourage someone who has trouble swallowing to increase fluid consumption, and thickeners can be added to any beverage without altering the flavor.
4. Reduce Consumption of Caffeine and Salt.
5. Watch for the Signs of Dehydration.
Any of the symptoms or warning signs of dehydration should be documented and counteracted with these tips. With the exception to dietary restrictions, these tips do not generally require a physician’s order, so you can act immediately.
Ensure Your Staff Understands the Dangers of Dehydration.
Dehydration should not be taken lightly. By making your staff members aware of its risks, prevalence among people with intellectual and developmental disabilities, and how to address it when it begins, you can help to reduce possible complications. Ultimately, recognizing the signs of dehydration and implementing prevention strategies today could prevent a hospitalization tomorrow.