Hydration and Water Intake Among Children and Parents*

Background Studies show 80% of children in the United States do not meet the dietary guidelines for water intake, and 65% have elevated urine osmolality (UOsm), indicative of underhydration. Objectives To examine the relationship between parental-child hydration habits and identify parental factors associated with children’s water intake and hydration. Methods A cross-sectional study was conducted in 729 parent-child pairs (children 3-13 y) from Northwest Arkansas and Phoenix, Arizona. Participants completed a food and fluid diary and collected a 24-h urine sample for hydration assessment. Associations between parental and child hydration indicators, including TWI, plain water intake (PWI), sugar-sweetened beverage (SSB) intake, and UOsm, were assessed using linear regression and multivariable models. Results Children’s fluid intake habits were significantly associated with those of their parents. Positive associations were observed between parent and child TWI (β=0.12, P <0.001), PWI (β=0.159, P <0.001), SSB intake (β=6.251, P <0.001), and 24-h UOsm (β=0.177, P < 0.001). Children whose parents were underhydrated (UOsm >500 mmol·kg- 1 ) had 1.54 times greater odds of also presenting with UOsm >500 mmol·kg -1 (95% CI: 1.05–2.26, P = 0.03). Multivariable analysis revealed that higher parental PWI and water intake from food were associated with greater TWI in children. Child-specific factors, including older age, male sex, higher BMI, physical activity, and energy/protein intake, also predicted higher TWI. Conclusion Parental fluid intake habits are strongly associated with children’s hydration status and habits. These findings underscore the importance of parental role modeling in promoting healthy hydration practices in children and highlight the need for family-centered interventions to improve hydration outcomes. This trial was registered at clinicaltrials.gov as NCT02937038. This trial was registered at clinicaltrials.gov as NCT02937038.