Fluid Restriction in Children with Heart Disease

Why is Fluid Intake Limit advised?

Children with significant heart diseases are prone to develop heart failure.  Heart failure will result in fluid retention which would further overload the heart and aggravate symptoms of heart failure. Fluid restriction is an important measure to control heart failure, in addition to drug treatment. 

Fluid restriction is also necessary for patients after open heart surgery because the kidney and heart function has not yet recovered.  Therefore fluid restriction is usually more strict in the first few days after an open heart surgery.

How to Limit Fluid Intake?

Based on the patient’s condition and body weight doctors can calculate the daily upper limit of fluid intake.  In accordance with the limit, parents can derive a balanced feeding schedule based on patient’s feeding habit and food preference.

Calculation of Fluid Amount

Fluid includes plain water, milk, juice and soup.  The amount is expressed in millilitres (ml).

Calculation of Semi-liquid

Semi-liquid food includes congee, cereal, porridge, ice-ream, jelly etc.  The amount of milk/water added to prepare the cereal is taken as the amount of liquid to be calculated.

Water Content of Fruits

For fruit with high water content, it is better to prepare fruit juice and calculate the amount for ease of calculation.

Things to Note during Fluid Restriction

Body Fluid Output

Total fluid output includes urine, vomitus, and the amount of sweating.  In most cases, urine output constitutes the majority of fluid output. During hospital stay, use of measuring cups or weighing of diapers would give good estimation of the urine output.

Low Salt Diet

It is recommended to take food with low salt content to avoid excessive salt accumulation and thus fluid retention.

Warning Signs of Fluid Retention

• Significant increase in body weight
• Puffiness of eyelids
• Shortness of breath
• Limbs swelling
• Poor appetite
• Decreased urine output

Dehydration may occur in children when fluid is restricted in addition to diuretics therapy.

Warning Signs of Dehydration

• Decreased urine output
• Dry and cracked lips
• Sunken eyeballs

Daily weighing of body weight at home is recommended to assess the hydration state. Whenever there are signs of fluid retention or dehydration, arrange an earlier follow-up.