This week a story about inadequate hydration in US youth has gotten a fair amount of press. As a pediatric kidney doctor, I end up seeing these kids in my clinic, most often for stones. Getting these kids to drink enough liquid to keep calcium from getting together with other stuff to form crystals and rocks is tough. The biggest barriers come from the schools!
The first problem is lack of access to fluid. There are water fountains in the halls, but kids often do not like to drink from them. Also, a mouthful of water every hour or two is far less than most of these children need. We have a stock letter we send to schools allowing our patients to carry water bottles to class.
The next issue involves bathrooms. Carmines' law of physiology states, "You drink, you pee, you don't, you die." Our stock school note also asks schools to let our patients use the bathroom when they need to go. Too many schools have really short transition times between classes that do not give students time to use the restroom. Teachers can also be reluctant to allow their pupils to wander about the school unsupervised, even when pursuing a noble activity like urination.
My final issue also involves bathrooms. Too many students tell me that they do not want to go to the bathroom at school. They are often dirty, unpleasant, and sometimes unsafe. If we want our kids to drink enough fluid, then we need facilities where they can "recycle" that liquid. These facilities should be ones we would use ourselves, and not just in an emergency situation.
We evolved on the savannah where access to liquid was often unpredictable, so our kidneys can conserve water well, without immediate damage. Long-term effects of concentrating urine may occur, but kidney stones are a clear, early result. This is more than a matter of telling our offspring to drink more. It's a matter of making them able and willing to pee more.