To the Editor—Editor—I read with interest the article “Translating evidence into practice: Hong Kong Reference Framework for Preventive Care for Children in Primary Care Settings” by Siu et al in the June 2015 issue of the Hong Kong Medical Journal.1 There is one aspect worth mentioning. Compared with adults, children excrete more water in the form of urine. Also, in relation to their body mass, children have a larger body surface area than adults. This means that children can lose a larger quantity of fluid via the surface of the skin. Thus, in relation to their body size, children have a substantially higher need for fluid intake than adults. Children are also more sensitive to lack of water caused by heat, exercise, or other factors.

Increased water intake is to be considered a health-promoting measure. Primary care physicians should, in my view, incorporate increased water intake into the two-page summary of the Hong Kong reference framework or preventive care checklist as, in China too, many children and adolescents consume less than the recommended daily water intake (1200 mL/day).2 3 In addition, it has been shown that drinking water can have beneficial effects on weight reduction in children.4 In our school programmes, we repeatedly find that every other primary school child starts the school day in a state of mild dehydration, which can affect a child’s powers of concentration and attentiveness in the course of the classes.5 Therefore, a desire for adequate water intake on a daily basis should be encouraged in our society as a whole (eg by ‘nudging’ and ‘choice architecture’ strategies).

1. Siu NP, Too LC, Tsang CS, Young BW. Translating evidence into practice: Hong Kong Reference Framework for Preventive Care for Children in Primary Care Settings. Hong Kong Med J 2015;21:261-8. Crossref

2. Wang Z, Shi A, Chen Y, et al. Water intake and its influencing factors of children and adolescents in Shanghai [in Chinese]. Wei Sheng Yan Jiu 2014;43:66-9.

3. Guelinckx I, Iglesia I, Bottin JH, et al. Intake of water and beverages of children and adolescents in 13 countries. Eur J Nutr 2015;54 Suppl 2:69-79. Crossref

4. Stookey JD, Del Toro R, Hamer J, et al. Qualitative and/or quantitative drinking water recommendations for pediatric obesity treatment. J Obes Weight Loss Ther 2014;4:232. Crossref

5. Khan NA, Raine LB, Drollette ES, et al. The relationship between total water intake and cognitive control among prepubertal children. Ann Nutr Metab 2015;66 Suppl 3:38-41. Crossref