Diabetes insipidus in infants can be particularly difficult to diagnose. Because the two main symptoms of this disorder are an increased level of thirst and an excessive amount of urine, it can be difficult to distinguish normal developing behaviors or symptoms of this disorder. Infants tend to be always hungry and have a large amount of wet diapers in the early days of life as it is, so it becomes important to look at some specific symptoms that do not seem to go away to determine if a medical appointment is necessary.
Infants May Have These Symptoms With Diabetes Insipidus
Infants will always have wet diapers, but when diabetes insipidus is involved, the diapers are unusually wet. There may be enough urine passed in one session that the diaper may begin to leak because of the excessive amount of fluids. If an infant has a dry diaper that becomes so unusually wet that it leaks and this happens more than once per day, then a medical provider should be consulted about this specific symptom.
There will also be a difference in the urine that has been produced. Because excessive fluids are being removed from the body, the infant’s urine is not going to be concentrated at all. Instead of a yellow color being in the diaper after it becomes wet, the diaper may look like it has absorbed plain water instead. If the urine is consistently this color, then this may also indicate the presence of diabetes insipidus.
Infants also tend to be more fussy than normal when diabetes insipidus is present. They will be inconsolable. This can create a lot of frustration for parents because the infant will not begin to sooth themselves. It is important in the early days of infancy to recognize the difference between crying because of diabetes insipidus and other crying.
Purple Crying vs Diabetes Insipidus Crying
The period that is known as purple crying is the time in an infant’s life when they will cry and fuss more than any other time in their life. Sometimes this period of time is referred to as being colicky, but it is a normal developmental aspect of infants. This crying can begin as early as 2 weeks of age and continue on up until the child is 4 months old. Every child goes through this period and parents often think their infant is in pain or needs something beyond soothing.
There are certain attributes of purple crying that are different from the crying that may result because of the presence of diabetes insipidus. Look for these specific attributes of purple crying to determine if it is the cause of the issue.
It is long lasting.
Infants in their purple crying period will cry for as much as 5 hours per day. In comparison, crying because of diabetes insipidus is typically because of hunger or thirst, so the crying stops once the need the infant has is met.
There is no soothing.
Infants will refuse to be soothed when they are in their period of purple crying. In comparison, infants with diabetes insipidus will be soothed once their thirst or hunger needs have been met.
It looks like painful crying.
This is the most difficult of the symptoms to distinguish. Infants with diabetes insipidus may be bothered by hunger or thirst pains and actually be in discomfort as they cry and show it on their face. Infants in their purple crying period also tend to have a pained expression on their face.
Infants in their purple crying period also tend to escalate their behaviors during the evening hours when parents tend to be more exhausted. This may make it seem like the symptoms being displayed are more severe than they really happen to be.
The bottom line is this: trust your gut as a parent. If you believe your infant is struggling with fluid retention and the crying seems excessive, then schedule a medical appointment to discuss your concerns. The worst thing that can happen is that the doctor will say that the infant is fine.
What Causes Diabetes Insipidus In Infants?
Most infants are diagnosed with central diabetes insipidus if this disorder is present. This means that there is a lack of a hormone called vasopressin in their body that helps the kidneys regulate how much fluid is retained. It may be caused by an injury, a developmental disorder, a tumor, or a number of other reasons. The issue is either related to the hypothalamus or the pituitary gland as not enough of the needed hormone is created or released.
It may also be caused by the presence of an intracranial lesion. There may be just one lesion or several that are discovered during an examination.
Infants have a higher than normal risk of being diagnosed with nephrogenic diabetes insipidus as well. This is usually caused by a genetic issue when discovered so early on in life. It means that the kidneys are unable to respond to the hormones that are present, telling the organs to stop taking water out of the body. Adding more hormones isn’t beneficial in this circumstance because the kidneys aren’t responding to the hormone in the first place.
How to Treat Diabetes Insipidus in Infants
Most medical providers will recommend an inpatient treatment setting if diabetes insipidus is discovered in an infant. This is because there is a severe risk of dehydration developing because of the condition that cannot always be properly managed at home. If infants have a lesion that is causing their diabetes insipidus, then inpatient care is 100% mandated. It may also mean that the infant will need to have surgery to correct the issue.
For infants that have the nephrogenic version of diabetes insipidus that does not have a lesion associated with it, the typical treatment plan involved providing infants with breast milk or higher levels of formula to offset the fluids that are being lost. Protein and sodium levels are recommended to be reduced by many medical providers as well, which make affect the diet of the mother if the infant is breastfeeding.
Some infants may respond well to the presence of desmopressin. This care will still typically happen during an inpatient setting to make sure the proper levels of this hormone are distributed on a daily basis. With central diabetes insipidus, there will be varying levels of hormones within the infant’s body that must be accounted for with desmopressin dosing. Too much of the hormone could create fluid retention that leads to other dangerous situations, such as water toxicity.
Some sites recommend aspirin therapy for children, but do not follow this advice. Regular aspirin use by children has been linked to Reye’s syndrome, which can create seizures, confusion, and even a loss of consciousness. These symptoms can be life-threatening if early diagnosis and treatment is not received.
As the diabetes insipidus becomes stabilized, the outpatient visits may begin and this will slowly transition into an at-home treatment option as the infant ages. It will continue to be important to eliminate restrictions to water as the child ages to prevent dehydration, especially for those who get into sports.
Some infants may also respond well to a class of diuretics that have an opposite response when given during nephrogenic diabetes insipidus episodes. Researchers have noted that infants receiving the diuretic therapies when desmopressin isn’t an available treatment option may see urine levels reduce by up to 75%. As a result, more fluids are retained and urination patterns will eventually come back to a fairly normal state.
What Is the Expected Outcome of Diabetes Insipidus in Infants?
Most infants respond well to treatment, especially those who are diagnosed with central diabetes insipidus. Once the right balance of desmopressin is achieved on a regular basis, the infant’s growth and developmental curves will begin to restore themselves to normal. Although this may require regular medical appointments for some time, the outlook is very positive.
There is also a positive outlook for nephrogenic diabetes insipidus in infants, even when the cause is genetic in nature. With lower sodium levels and increased fluids throughout their early months, their developmental curve can stay on track. It is very challenging to manage this version of diabetes insipidus in an infant, but as long as there are sufficient fluids available to the child, the long-term outlook remains positive.
Diabetes insipidus in infants may be difficult to spot during the period of purple crying. It may be difficult to treat if an infant is refusing to latch on or take a bottle. With inpatient medical care and early treatments, however, infants have a chance to live a happy, fulfilling life even with the presence of this disorder. Use this guide to ask questions of your medical provider if you suspect this disorder with your infant and schedule an appointment immediately.
Maybe you will be told that you’re being overly cautions. There’s nothing wrong with that. It’s better to be overly cautious than to allow diabetes insipidus to remain untreated in an infant.