Diarrhoea in babies and children: ORS, zinc, and the signs that mean hospital

The two-part treatment that saves lives

ORS plus zinc. That is the national protocol, it is what every PHC and Anganwadi stocks free, and it is what prevents the dehydration that makes diarrhoea dangerous. ORS replaces the water and salts pouring out; zinc (14 days, dose by age, from your doctor or the health centre) shortens the episode and reduces the next one.

Mix one ORS sachet in exactly one litre of clean boiled-and-cooled water — not half a litre to 'make it stronger', which makes it dangerous. Give small sips constantly: a spoonful every one to two minutes for a small child, more for an older one, and after every loose stool. Slow and steady beats a big glass that comes straight back up.

Keep feeding. Breastfeeding continues throughout and more often, not less. Older children keep eating — khichdi, curd rice, banana, dal-rice, whatever they accept. The old advice to starve the gut is wrong and leaves a weakened child; food speeds recovery.

Spotting dehydration before it gets dangerous

Watch the output and the eyes. Fewer wet nappies or no urine for six to eight hours, a dry mouth and tongue, no tears when crying, sunken eyes, a sunken soft spot in a baby, and skin that is slow to spring back when pinched — these are the signs, roughly in the order they appear.

Then watch the behaviour, which matters more than any single sign: a child who is unusually sleepy, floppy, irritable beyond consoling, or refusing to drink is dehydrating regardless of what the nappy count says.

Weigh where possible — the Anganwadi or ASHA worker can help. Rapid weight loss during an illness is the most objective dehydration measure there is.

What never to give

No anti-diarrhoeal medicines for children — the loperamide-type drugs sold freely across counters are unsafe in young children and can cause serious complications. Antibiotics are for specific situations only, on prescription (bloody diarrhoea, cholera-type illness), not for routine loose motions, most of which are viral.

No cold drinks, packaged fruit juices or sugary 'energy' drinks — their sugar load pulls more water into the gut and worsens things. Home-made lemon-salt-sugar water is a fallback if ORS is genuinely unavailable, but ORS is cheap and correct — buy it.

And nothing self-prescribed from the last illness's leftover strip. If a child needs a medicine beyond ORS and zinc, it needs a doctor who has looked at the child.

Preventing the next episode

Handwashing with soap — after the toilet, after cleaning a baby's bottom, before cooking and eating — is the single biggest preventive, and the habit has to belong to the adults first. Nail-cutting and a soap by the tap do more than any tonic.

Water and food: drink boiled or filtered water, especially in the monsoon and during travel; eat freshly cooked hot food; skip cut fruit, chutneys and juices from street stalls for small children; refrigerate leftovers promptly and reheat properly; wash vegetables well.

Vaccination pulls real weight here: rotavirus vaccine, part of the national schedule at 6, 10 and 14 weeks, prevents the severe infant diarrhoea that fills paediatric wards every year. Also exclusive breastfeeding for six months — the single most protective feeding decision of infancy.

When to see a doctor

Go the same day, or straight to hospital (108 for an ambulance) if: the child is under six months; there is blood or mucus in the stool; vomiting stops fluids going in; there is high fever; the child is drowsy, floppy, or unusually irritable; no urine for six to eight hours; sunken eyes and dry mouth; the tummy is swollen and painful; or the diarrhoea has continued beyond two to three days without improving.

Under-three-month rule stands: any fever in a baby that young is a same-day hospital matter, diarrhoea or not.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: My baby is exclusively breastfed and passes several loose yellow stools a day — is that diarrhoea? — Usually not. Breastfed newborns often pass a stool at almost every feed, loose and seedy — that is normal. Diarrhoea is a clear change from your baby's pattern: suddenly more frequent, more watery, sometimes with a different smell or colour.

Q: Can I make ORS at home? — In an emergency: six level teaspoons of sugar and half a teaspoon of salt in one litre of clean boiled-and-cooled water. But packet ORS is correctly balanced, costs almost nothing, and is free at government facilities — home-made is the backup, not the plan.

Q: My child refuses ORS because of the taste — what now? — Chill it, give it in a spoon or a familiar sipper rather than a glass, and alternate with breastmilk, plain water and thin dal water or rice kanji. Some flavoured ORS variants exist. What matters is small amounts continuously; refusing all fluids is itself a reason to go to hospital.

Q: Should I stop milk during diarrhoea? — Breastmilk never stops. Formula continues at normal strength. For older children, curd and buttermilk are usually well tolerated and helpful; only if your doctor specifically diagnoses a temporary lactose problem would milk be paused, and then briefly.