Oral Fluid Intake Chart
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1Oral fluid intake chart
Medical Clinic Name:
Physician Name:
Child’s Name:
Date:
/
/
Age:
Weight (lbs):
Your child should drink
fl oz every 15 minutes
Please give your child:
Fluid replacement table
Hydralyte
(solution or powder)
™
Child’s age
Volume every
Total volume
Frequent breast feeds
15 minutes
in first 6 hours
Encourage your child to drink small sips at regular
intervals – this is more effective than large amounts
Up to 12 months
0.5 fl oz
7–14 fl oz
less often.
1–3 years
0.8 fl oz
14–20 fl oz
Every 15 minutes write down how much fluid your
child has taken, this information will be useful for
3–6 years
1 fl oz
20–30 fl oz
your physician.
6–12 years
1.5 fl oz
30–50 fl oz
Please tick the relevant column if your child
vomits, has diarrhea or passes urine during
12–Adult
2.5 fl oz
50–68 fl oz
that 15 minute period.
Time
Type of fluid
Amount of fluid
Vomited?
Diarrhea?
Urine?
taken (fl oz)
0.5
e.g
Use under Medical Supervision.
Reference: Paediatric Handbook 2003. 7th Edition. Blackwell Science. Chapter 24 Gastrointestinal Conditions. P 370-373.
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