The two things that do the most for a child with diarrhoea are oral rehydration solution (ORS) and zinc, given while you keep feeding as usual. Most tummy bugs settle on their own within a week, so your job at home is to stop dehydration and know the signs that mean the child needs a doctor today.
Below is what the World Health Organization (WHO) and other health services actually advise, what to keep away from, and the red flags that shouldn’t wait.
What counts as diarrhoea in a child?
The WHO defines diarrhoea as three or more loose or watery stools in a day. Frequent but formed stools aren’t diarrhoea, and the soft, pasty poo of a breastfed baby is normal.
Most cases in children are caused by infections picked up from contaminated water, food or hands. The NHS says diarrhoea from a stomach bug usually stops within 5 to 7 days, and vomiting within 1 or 2 days. The WHO estimates it still kills around 443,000 children under five every year, and dehydration is the danger you can do most about at home. (Teething, by the way, doesn’t cause diarrhoea. Our teething guide explains why loose stools in a teething baby should still be taken seriously.)
ORS: the first thing to reach for
ORS is a measured mix of salts and sugar that helps the gut absorb water. Plain water doesn’t replace the salts a child loses, and plain glucose water has no salts at all. Buy WHO-formula ORS sachets from any chemist, or ask your ASHA worker or Anganwadi centre. India’s national STOP Diarrhoea Campaign pre-positions ORS packets with zinc for children under five.
How to give it
- Mix one sachet in exactly the amount of clean (boiled and cooled) water the packet says. Too little water makes it too salty.
- Give it slowly with a spoon or small cup, not in big gulps.
- If the child vomits, the WHO manual says to wait 5 to 10 minutes and start again more slowly, for example a spoonful every 2 to 3 minutes.
How much after each loose stool
As a guide, the WHO’s Treatment of Diarrhoea manual suggests giving this much fluid after every loose stool, on top of usual drinks:
| Age | Fluid after each loose stool |
|---|---|
| Under 2 years | 50 to 100 ml (a quarter to half a large cup) |
| 2 to 10 years | 100 to 200 ml (half to one large cup) |
| Older children | As much as they want |
The general rule in the same manual is simple: give as much fluid as the child wants until the diarrhoea stops.
Zinc for 10 to 14 days
Zinc is the part many parents skip. The WHO says a 10 to 14 day course of zinc cuts the length of an episode by about 25%. The joint WHO and UNICEF statement recommends 20 mg a day for children and 10 mg a day for babies under six months, usually as a dispersible tablet dissolved in a little water or breast milk, or as a syrup.
Keep going for the full 10 to 14 days even after the stools improve. The WHO manual says finishing the course replaces the zinc lost and lowers the chance of another bout in the next 2 to 3 months. Your doctor, pharmacist or health worker will confirm the right product and dose for your child’s age.
Keep feeding, don’t starve the gut
An old belief says a child with loose motions should be kept hungry so the gut can “rest”. The WHO says the opposite: food should never be withheld and breastfeeding should always continue.
- Breastfed babies: feed more often than usual. ORS goes in addition, not instead.
- Formula-fed babies: the NHS says to make formula at its usual strength, not watered down.
- Older babies and children: offer small, frequent meals of their usual food. Soft khichdi, dal rice, curd rice, idli, mashed banana or boiled potato are easy to start with.
- After recovery: the WHO suggests one extra meal a day for at least two weeks to help the child regain lost weight.
Safe home fluids, if ORS runs short, listed in the WHO manual include rice water (kanji), salted or plain yoghurt drinks such as chaas, soup, plain water and tender coconut water. They help, but they aren’t a substitute for ORS once a child is losing a lot of fluid.
What not to give
Some common home choices make diarrhoea worse or hide danger signs:
- Medicines to stop diarrhoea. The NHS says not to give children under 12 medicine to stop diarrhoea, such as loperamide. The WHO manual says “antidiarrhoeal” drugs have no practical benefit for children and don’t prevent dehydration.
- Antibiotics without a doctor. Most childhood diarrhoea is viral. The WHO says antibiotics should not be used routinely, and are reliably useful mainly for bloody diarrhoea, suspected cholera with severe dehydration, or another serious infection.
- Sugary drinks. Packaged fruit juice, cola and other fizzy drinks, and sweetened tea pull water into the gut. The WHO lists these as fluids to avoid. MedlinePlus adds that full-strength fruit juices can loosen stools.
- Glucose powder in water. It has sugar but no salts, so it doesn’t correct the salt loss. Use ORS.
- Coffee and “purging” herbal mixtures. The WHO manual warns against fluids with stimulant, diuretic or purgative effects, which includes some medicinal teas and infusions.
If your child also has repeated vomiting, our guide to nausea and vomiting has tips on giving fluids in small sips.
Signs of dehydration to watch for
Check your child every few hours. The NHS lists these signs of dehydration in babies and children:
- Fewer wet nappies than usual, or peeing much less
- Dark yellow pee
- Few or no tears when crying
- Sunken eyes
- A sunken soft spot (fontanelle) on top of a baby’s head
- Being drowsy or irritable
- Fast breathing or a fast heartbeat
MedlinePlus advises calling a doctor if a child hasn’t urinated for 6 hours, or has a dry, sticky mouth.
When to see a doctor
The WHO manual tells parents to take a child to a health worker if the child:
- Starts passing many watery stools
- Has repeated vomiting
- Becomes very thirsty
- Is eating or drinking poorly
- Develops a fever
- Has blood in the stool
- Isn’t getting better in three days
See a doctor the same day if your baby is under 12 months and you’re worried, or if a child stops breast or bottle feeding while ill.
Go to hospital now or call 112 if your child:
- Is very sleepy, floppy or hard to wake
- Has blue, grey, pale or blotchy skin, lips or tongue, or feels cold to touch
- Is breathing very fast or struggling to breathe
- Seems confused
- Has green or yellow-green vomit
- Can’t keep down any ORS at all
These are the NHS’s emergency signs for dehydration and diarrhoea and vomiting. A severely dehydrated child may need fluids through a drip, which only a hospital can give.
Preventing the next bout
The WHO’s list of what prevents diarrhoea is practical:
- Safe drinking water: boiled, filtered or from a safe source
- Handwashing with soap after the toilet, after changing nappies and before preparing food or feeding a child
- Exclusive breastfeeding for the first six months
- Clean food handling and storage
- Rotavirus vaccination, which India added to its routine immunisation schedule in 2016
For other causes of loose stools in older children and adults, see our guide to common causes of diarrhoea.
Frequently asked questions
Can I make ORS at home?
Packet ORS is safer because the amounts are measured. Home sugar-salt mixes are easy to get wrong, and too much salt is harmful for a small child. Keep a few sachets at home, especially through the monsoon.
Should I stop milk if my child has diarrhoea?
No. Keep breastfeeding, and keep formula at its usual strength. Children already on solids should carry on eating their normal foods in smaller, more frequent meals.
Is zinc safe to give with ORS?
Yes. The WHO recommends both together: ORS for fluids and zinc for 10 to 14 days. Ask your pharmacist or doctor for the right dose for your child’s age.
Is coconut water better than ORS?
Tender coconut water is a fine home fluid, but it doesn’t have the balance of salts in ORS. Use it alongside ORS, not instead of it, once diarrhoea is frequent.
When can my child go back to school?
The NHS advises staying home until there has been no diarrhoea or vomiting for at least 2 days, so the infection doesn’t spread to other children.
This article is for general information and is not a substitute for advice from a doctor. If you have symptoms or a health condition, please consult a qualified healthcare professional.
