Diarrhoea in children: ORS and zinc, step by step

Diarrhoea is one of the main causes of death in children under five in India, but almost every death can be prevented. The two most important medicines are cheap and simple: ORS to replace the water and salts the body loses, and zinc to make the illness shorter and less severe. As an ASHA, you can teach every mother to use them correctly.

What counts as diarrhoea

Diarrhoea means three or more loose or watery stools in one day. Frequent soft stools in a breastfed baby who is feeding well and gaining weight are normal and are not diarrhoea.

How to prepare ORS

1. Wash your hands with soap and water.
2. Take one litre of clean drinking water (boil and cool it if you are not sure it is safe).
3. Empty one full packet of ORS into the water and stir until it dissolves. Do not add sugar or salt.
4. Use this solution within 24 hours. Make a fresh one the next day.

How much ORS to give

• Child under 2 years: about 50 to 100 ml (a quarter to half a cup) after each loose stool.
• Child 2 years and older: about 100 to 200 ml (half to one cup) after each loose stool.
• Give slowly with a cup and spoon. If the child vomits, wait 10 minutes and then continue more slowly.
• Keep giving ORS until the diarrhoea stops.

Zinc for 14 days

• Child 2 to 6 months: half tablet (10 mg) once a day.
• Child 6 months to 5 years: one tablet (20 mg) once a day.
• Dissolve the tablet in a little breast milk, ORS or clean water.
• Give zinc for the full 14 days, even if the diarrhoea stops earlier.

Zinc shortens the illness and protects the child from diarrhoea in the next two to three months. Explain this to the mother so she completes the course.

Keep feeding the child

Never stop food or breastfeeding during diarrhoea. Breastfeed more often. Give soft home foods and extra fluids such as rice water, dal water, buttermilk or soup. After the diarrhoea stops, give one extra meal every day for two weeks so the child regains strength.

Look for dehydration and danger signs

Check the child at the start and again the next day. Refer at once to a facility if the child:

• is very sleepy, unconscious or not able to drink
• has sunken eyes, or the skin pinch on the belly goes back very slowly
• has blood in the stool
• has had diarrhoea for 14 days or more
• is vomiting everything, or has fits
• is under 2 months old with diarrhoea

On the way to the facility, the mother should keep giving ORS in small sips and continue breastfeeding.

Prevent the next episode

• Wash hands with soap after using the toilet, after cleaning the child, before cooking, before eating and before feeding the child.
• Use safe drinking water and keep it covered.
• Use a toilet and dispose of the child's stool safely.
• Exclusive breastfeeding for six months.
• Complete the child's vaccines, including the rotavirus vaccine at 6, 10 and 14 weeks.

During the Stop Diarrhoea Campaign, ASHAs give ORS packets in advance to families with children under five and teach them how to use them. Keep a few ORS packets and zinc strips with you at all times.

Common questions

Can homemade sugar-salt solution be used instead of ORS?

ORS packets are best because the amounts are exact. If ORS is not available, give home fluids and get ORS as soon as possible from you or the sub-centre.

The child vomits the zinc tablet. What should we do?

Give it again after some time, dissolved in a little breast milk. Giving it after a feed often helps.

Why give zinc after the diarrhoea has stopped?

The 14-day course rebuilds the gut and lowers the chance of diarrhoea in the coming months.