Diarrhoea in Children: ORS, Zinc & Warning Signs

Diarrhoea is very common in young children, and most episodes can be looked after at home. It can also be dangerous. WHO says it is the third leading cause of death in children aged 1 to 59 months, with about 443,832 children under five dying from it each year. Much of this harm comes from losing too much fluid, which simple treatment can prevent.

What counts as diarrhoea?

WHO defines diarrhoea as passing 3 or more loose or watery stools in a day, or passing stools more often than is normal for that child. In most children it stops within 5 to 7 days.

What is ORS and how should you give it?

ORS (oral rehydration salts) is a mix of clean water, salt and sugar that replaces the fluid and salts lost through diarrhoea. It costs very little. WHO and UNICEF found that the current low-osmolarity ORS reduced stool output by about 20% and vomiting by about 30%, and cut the need for unplanned drip treatment by 33%.

• Start giving extra fluids and ORS as soon as the diarrhoea begins.
• Prepare ORS with clean water.
• Give small amounts often. For a baby on formula, offer small sips of water between feeds too.
• Keep a few ORS packets at home so you are ready.

Why is zinc recommended?

WHO and UNICEF recommend zinc alongside ORS for every episode of diarrhoea in young children. It is given once a day for 10 to 14 days. According to WHO, zinc shortens a bout of diarrhoea by about 25% and reduces stool volume by about 30%. It also means fewer episodes in the 2 to 3 months after the course.

The amount depends on the child's age, and babies under six months get a smaller amount than older children. Ask a health worker or pharmacist how much to give, and keep going for the full course.

Should you keep feeding a child with diarrhoea?

Yes. Keep feeding your child and, if you breastfeed, breastfeed more often. Babies on formula can have smaller, more frequent feeds. Offer nourishing food once your child feels ready, and avoid fatty or spicy food. After the diarrhoea is over, give extra food to help your child recover.

How can you prevent diarrhoea?

• Use safe drinking water.
• Use a proper toilet and keep the home clean.
• Wash hands with soap, especially before food and after the toilet.
• Breastfeed only (no other food or drink) for the first 6 months.
• Prepare and store food hygienically.
• Make sure your child gets the rotavirus vaccine.

When to see a doctor

Take your child to a doctor or health worker if they have:

• signs of some dehydration, such as restlessness or irritability, sunken eyes, or drinking eagerly because they are very thirsty
• fewer wet nappies, or dark and strong-smelling urine
• blood in the stool
• trouble keeping fluids down
• vomiting for more than 2 days, or diarrhoea for more than 7 days

Emergency signs

Get emergency help at once if a child with diarrhoea:

• is very sleepy, floppy or unconscious
• has sunken eyes and cannot drink, or drinks very poorly
• has skin that goes back very slowly (2 seconds or more) when gently pinched
• vomits green or yellow-green fluid, or has severe tummy pain
• has pale or blotchy skin

Go to the nearest hospital or call Rescue 1122 for an ambulance.