Childhood Diarrhoea in India: The ORS Debate Every Parent Should Know

ByRiddhi Roy
Updated: 3 Nov 2025, 1:02 pm
Medical Reviewed by Dr. Savitha Shetty

Childhood diarrhoea, a significant health concern in India, is at the centre of a heated debate over the misuse, misleading labelling, and underuse of the lifesaving treatment, Oral Rehydration Solution (ORS). This article aims to simplify this urgent debate, enlighten parents on what they need to know, and outline the correct usage of ORS for children.

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Diarrhoea in children under five, a top cause of illness and death in India, is largely preventable. Each episode, if not appropriately managed, can lead to dangerous dehydration, nutrient loss, and long-term growth setbacks.
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The good news is that a very low-cost solution exists: ORS with zinc therapy. But despite this, many children do not receive this treatment in time or at all.

What is ORS and Why It Works

Oral rehydration salts (ORS) are a scientifically formulated solution of glucose and electrolytes designed to replace what the body loses during diarrhoea.
Because children lose water, sodium, and other salts rapidly during episodes of diarrhoea, giving ORS early can prevent dehydration, avoid hospitalisation, and substantially reduce the risk of death.

The ORS Debate in India: What’s Going On

Over recent years, several worrying trends have emerged:
  • Many children do not receive ORS or zinc when they have diarrhoea. A study showed that only about 61% received ORS in 2021 in India, and use varied widely across districts.
  • Doctors and caregivers sometimes favour antibiotics, anti-diarrhoeal “strong” medicines, or sugar-laden “hydration” drinks instead of the recommended ORS + zinc.
  • More recently, there has been a fight against misleading products: flavoured drinks falsely marketed as “ORS” but high in sugar and lacking the right electrolyte balance. The Food Safety and Standards Authority of India (FSSAI) has banned the use of the term “ORS” on such products.
  • This “doctor fight” stems from the concern that misuse of the term ORS or wrong treatments delays correct care and increases risk for children.

Why ORS Use Is Still Low

There are several reasons this lifesaving treatment is not always used:
  • Lack of awareness among caregivers and private practitioners about ORS + zinc guidelines.
  • Belief that parents expect tablets or injections rather than a simple liquid solution.
  • Misleading marketing and the availability of sugar-rich “hydration drinks” confuse caregivers.
  • Supply issues or cost barriers in some regions.

What Parents Must Know and Do

  • Recognising diarrhoea early is crucial. Look out for loose stools, frequent passing of watery stools, and possibly vomiting. Look for dehydration symptoms such as fewer wet nappies, sunken eyes, dry mouth, and lethargy.
  • Begin ORS at home: At the first sign of diarrhoea, begin giving ORS. Use a clean cup/spoon, and prepare the solution exactly as per instructions. Avoid substituting sugary drinks; users should only drink plain water. ([medicalguidelines.msf.org][9])
  • Continue feeding and breastfeeding: Keeping the child fed – including breast milk or age-appropriate food – during diarrhoea helps prevent malnutrition.
  • Give zinc supplementation: The combined ORS + zinc treatment is recommended for children with diarrhoea. An essential mineral called Zinc plays a crucial role in the immune system and can help shorten the duration of diarrhoea and prevent its recurrence.
  • Watch for danger signs: High fever, blood in stools, persistent vomiting, signs of dehydration, lethargy or convulsions. Seek medical care immediately.
  • Avoid misleading “hydration” drinks: Know that not all “sports drinks”, “sugar drinks” or flavoured liquids are suitable. The recent ban on improper ORSlabelling in India makes this even more critical.

The Doctor’s Perspective:

  • ORS is cost-effective, safe, and should be the first-line treatment for childhood diarrhoea.
  • Every doctor should prescribe ORS first, not antibiotics or anti-diarrhoeals unnecessarily.
  • Private and public sectors must adopt the guideline uniformly — doctor bias, private clinic incentives or assumptions about what parents expect should not replace science.
  • Misuse of the term ORS or incorrect formulas undermines trust in the system and delays appropriate care.

When and Why to Seek Medical Help

While most simple diarrhoea cases can be managed at home with ORS + zinc, you must go to a paediatrician/hospital if:
  • Dehydration signs are worsening despite ORS.
  • The child’s condition does not improve in 24-48 hours.
  • There are underlying conditions: malnutrition, immunodeficiency, or severe vomiting.
  • There is blood in stool, high persistent fever, or suspected cholera/typhoid.

The Short-Term and Long-Term Impact

Prompt treatment with ORS + zinc can reduce child mortality due to diarrhoea by up to 90%. In contrast, poor management leads to nutrient loss, growth faltering, recurrent illness, and increased health risks.

Your Role as a Parent

  • Keep a sachet of WHO-approved ORS in your home first-aid kit.
  • Always measure and mix correctly.
  • Continue feeding your child.
  • Stay calm, follow the correct advice, and don’t succumb to pressure to take “strong medicine.”
  • Ensure your child’s vaccinations (including rotavirus) are up to date.
Good hygiene practices, such as regular handwashing with soap and clean water, can significantly reduce the risk of diarrhoea. Additionally, ensuring safe drinking water and proper food handling can also help prevent the spread of diarrhoeal diseases.
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FAQs on Childhood Diarrhoea in India: The ORS Debate Every Parent Should Know

  1. Can I use plain water instead of ORS when my child has diarrhoea?
    No. Plain water does not replace lost salts and electrolytes. ORS is formulated explicitly for diarrhoea-related dehydration.
  2. Why did the doctor give antibiotics instead of ORS?
    In most simple cases, antibiotics are not needed. Doctors may misjudge parental expectations or skip ORS due to habit. Ask for ORS + zinc clearly.
  3. How often should I give ORS to my child?
    Give small, frequent sips after each loose stool; follow the instructions on the packet or those from your doctor for age-appropriate amounts.
  4. Is breastfeeding safe during diarrhoea?
    Yes. Continue breastfeeding – it supports nutrition, immunity and recovery.
  5. What happens if I delay giving ORS?
    Delay increases the risk of dehydration, hospitalisation and long-term health consequences.
  6. Are all ORS packets the same?
    No. Only those conforming to the HO low-osmolarity ORS formulation are recommended. Avoid questionable products claiming to be “ORS”.
  7. When should I go to the hospital?
    It's critical to get medical help right away if you see symptoms of severe dehydration, such as intense thirst, dry mouth, sunken eyes, fast breathing, or a weak pulse, or if your child is having trouble keeping the ORS down.
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