Diarrhoea remains a leading cause of childhood death worldwide, and almost all of those deaths are from dehydration rather than the infection itself. Oral rehydration solution is one of the most effective and cheapest treatments in all of medicine.
Knowing how to assess a child's hydration and how to give ORS correctly is genuinely life saving knowledge.
Assessing Dehydration at Home
You can judge severity reliably from a few observations, and this determines whether home treatment is safe.
No or mild dehydration: alert, drinking normally, normal urine output, moist mouth, tears present when crying.
Some dehydration: restless or irritable, thirsty and drinking eagerly, reduced urine, dry mouth, sunken eyes, skin returning slowly when pinched.
Severe dehydration: lethargic or unconscious, unable to drink or drinking poorly, no urine for many hours, very sunken eyes, skin pinch returning very slowly, cold hands and feet, fast weak pulse.
Severe dehydration is an emergency requiring intravenous fluids. Do not attempt home management. Our paediatric emergency service treats this urgently.
Getting ORS Right
ORS works because glucose and sodium together are absorbed by the gut even when it is inflamed, and water follows. The proportions matter, which is why homemade approximations can be harmful.
- Use one full ORS sachet in exactly one litre of clean water
- Do not use half a sachet in half a litre by guessing, measure it
- Do not add sugar, salt or flavouring
- Discard any solution not used within twenty four hours
- Give small amounts frequently, a teaspoon every one to two minutes for a small child
- If the child vomits, wait ten minutes then resume more slowly
Too concentrated a solution draws water into the bowel and worsens diarrhoea. This is the specific danger of homemade salt and sugar mixtures.
How Much to Give
Volume is guided by the degree of dehydration and by ongoing losses.
- No dehydration: after each loose stool, give 50 to 100 ml for children under two and 100 to 200 ml for older children
- Some dehydration: roughly 75 ml per kilogram over four hours, then continue replacing losses
- Severe dehydration: intravenous fluids in hospital, with ORS resumed once the child can drink
Continue breastfeeding throughout, in addition to ORS. Breast milk is not a reason to withhold ORS, and ORS is not a reason to stop breastfeeding.
Zinc Is the Overlooked Half of Treatment
Zinc supplementation for ten to fourteen days reduces the duration and severity of the current episode and reduces the likelihood of further episodes over the following months.
The standard dose is 10 mg daily for infants under six months and 20 mg daily for older children, given for ten to fourteen days even after the diarrhoea stops.
Zinc is inexpensive and effective, and it is frequently omitted. Ask for it specifically if it has not been prescribed.
What Not to Give
Several commonly used remedies are ineffective or harmful in children.
- Anti motility drugs such as loperamide should not be given to young children. They trap infection in the bowel and can cause serious complications
- Antibiotics are not indicated for most diarrhoea, which is viral. They are reserved for dysentery with blood, cholera and specific infections
- Fizzy drinks, fruit juice and sports drinks contain too much sugar and too little sodium, and worsen diarrhoea
- Withholding food prolongs recovery. Feeding should continue throughout
- Plain water alone does not replace the salts being lost
The practice of stopping milk and giving only water or rice water is common and counterproductive.
Feeding During and After
Continued feeding shortens the illness and prevents the weight loss that follows repeated episodes.
- Continue breastfeeding, more frequently than usual
- Continue the child's normal diet, in smaller more frequent portions
- Offer easily digested foods: rice, curd, banana, khichdi, boiled potato
- Curd is helpful and does not need avoiding
- Avoid very fatty or heavily spiced food temporarily
- Give an extra meal daily for two weeks after recovery to regain lost weight
Routine lactose free formula is not needed for most children. It is occasionally useful in prolonged diarrhoea, on medical advice.
When to Go to Hospital
Take the child in without delay for any of these.
- Signs of severe dehydration, particularly lethargy or inability to drink
- Blood in the stool
- Persistent vomiting preventing any oral intake
- High fever, particularly in an infant
- Diarrhoea lasting more than fourteen days
- Any diarrhoea in a baby under three months
- Severe abdominal pain or a swollen abdomen
- Not passing urine for eight hours or more
- Convulsions
An infant becomes dehydrated far faster than an older child. The threshold for review under one year should be low.
Prevention
Most childhood diarrhoea is preventable, and the measures are simple.
- Rotavirus vaccination, which prevents the most common severe diarrhoea in infants and is part of the immunisation schedule
- Hand washing with soap after using the toilet and before preparing food
- Safe drinking water, boiled or properly filtered
- Exclusive breastfeeding for the first six months
- Careful handling of weaning foods, freshly prepared rather than stored
- Avoiding cut fruit and uncovered food from roadside vendors
Rotavirus vaccination alone has substantially reduced severe diarrhoea admissions where coverage is good.
The message is short: ORS in the correct concentration, zinc for two weeks, continued feeding, and no anti motility drugs. Watch alertness, drinking and urine output, and go to hospital if the child is lethargic or cannot drink.
Our paediatrics department at T. Nagar treats childhood diarrhoea and dehydration around the clock.
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