Diarrhoea in Children: ORS, Zinc and When to See a Doctor

Loose motions in a child are one of the most worrying things for a parent, especially in the hot, humid months when stomach infections spread fast. Most cases of diarrhoea in children are caused by a virus, get better by themselves within a few days, and are managed at home. The real danger is not the diarrhoea itself but the loss of body water, which can become serious quickly in babies and small children. Knowing how to replace fluids, and when to go to a doctor, protects your child.

What causes diarrhoea in children?

• Viruses, especially rotavirus, the commonest cause in young children
• Bacteria from contaminated food and water, such as Salmonella, E. coli and Shigella
• Parasites such as Giardia, and worms
• Unclean bottles, unwashed hands and flies on food
• Food intolerance, and sometimes antibiotics

Diarrhoea means three or more loose or watery stools in a day, and often comes with vomiting, stomach cramps and fever. In babies, a sudden change from their usual pattern is more important than a fixed number.

The most important treatment: ORS

Oral rehydration solution (ORS) replaces the water, salts and sugar the body is losing. It is the single most effective treatment, and it saves lives.

• Start ORS from the first loose stool. Do not wait for signs of dehydration.
• Give small, frequent sips with a spoon or cup, especially if the child is vomiting. Wait ten minutes after a vomit, then carry on slowly. Vomiting is not a reason to stop.
• The amount depends on age and weight, so follow the instructions on the packet or your doctor’s advice.
• Always mix ORS exactly as the packet says, using clean, boiled and cooled water. Do not add extra water, sugar or salt.
• If no packet is available, a home mix is six level teaspoons of sugar and half a level teaspoon of salt in one litre of clean water, as a short-term measure until you can get ORS.
• Throw away any made-up ORS after 24 hours.

Keep feeding your child

• Continue breastfeeding, and feed more often if possible.
• Do not starve a child with diarrhoea. Give normal food in small, frequent portions: khichdi, rice, banana, dahi, boiled potato, daal water, soft roti and soup.
• Avoid sweet drinks, packaged juices, soft drinks, and fried and very spicy food, which can make diarrhoea worse.

Zinc, probiotics and other medicines

• Zinc: a zinc supplement given for 10 to 14 days shortens the illness and lowers the chance of another episode in the next two to three months. The dose is based on age, so check with your doctor or pharmacist.
• Probiotics such as Saccharomyces boulardii may slightly shorten the illness in some children.
• Racecadotril is sometimes prescribed to reduce the volume of watery stools in young children.
• Paracetamol can be used for fever or discomfort, in the dose for your child’s weight.
• Antibiotics are not needed for most diarrhoea, since it is usually viral. They are used only when a doctor finds a specific cause, such as blood in the stool or certain infections.
• Do not give loperamide (an anti-motility medicine) to children, and do not use home or herbal medicines, opium-based syrups or leftover antibiotics.

Signs of dehydration

Go to a doctor or hospital the same day if you see any of these:

• Dry mouth and tongue, no tears when crying
• Sunken eyes, or a sunken soft spot on a baby’s head
• No wet nappy for 6 to 8 hours, or very little, dark urine
• Unusual sleepiness, floppiness, irritability or very fast breathing
• Skin that goes back slowly when gently pinched
• Intense thirst, or refusing to drink

When to see a doctor urgently

• A baby under 6 months with diarrhoea
• Blood or mucus in the stool, or black stools
• Fever of 39°C or above, or fever lasting more than 2 to 3 days
• Repeated vomiting so that ORS cannot be kept down
• Severe or constant stomach pain
• Diarrhoea lasting more than 7 days
• A child with a long-term illness or poor nutrition

How to prevent diarrhoea

• Wash hands with soap after the toilet, after changing nappies, before preparing food and before eating.
• Give boiled or filtered water, and wash and sterilise feeding bottles. Breastfeed for as long as possible, and exclusively for the first six months.
• Cover food, keep flies away and avoid street food and cut fruit left out in the open.
• Keep toilets clean and dispose of nappies safely.
• Get the rotavirus vaccine and other vaccines on the national schedule, in time. Typhoid, see typhoid fever, can also begin with stomach upsets.

Key takeaways

• Dehydration is the danger in childhood diarrhoea, and ORS is the treatment.
• Keep feeding and breastfeeding, and add zinc for 10 to 14 days as advised.
• Do not give loperamide, herbal syrups or unprescribed antibiotics.
• Blood in the stool, high fever, signs of dehydration or any illness in a young baby need a doctor.

Related medicines on Medimart

These are commonly used for diarrhoea in children. Please check the dose for your child’s age and weight with a doctor or pharmacist.

• Oral rehydration salts (ORS): replace fluid and salts lost in diarrhoea
• Zinc sulphate: shortens diarrhoea in children
• Saccharomyces boulardii: a probiotic for diarrhoea
• Racecadotril: reduces watery stools, on a doctor’s advice
• Paracetamol: for fever and discomfort

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse diarrhoea and dysentery medicines on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. If your child shows signs of dehydration, please seek medical care.