Diarrhoea in Children: Home Care, ORS, Zinc and Danger Signs

Diarrhoea in Children: Home Care, ORS and When to Go to Hospital

Loose motions in a child are one of the most common worries for parents in Bangladesh. Diarrhoea can happen throughout the year—not just in hot weather or during the monsoon. Rotavirus is a common cause of childhood diarrhoea during winter in Bangladesh. Most cases are caused by a stomach bug and get better within days. But children can lose water and salts quickly, and dehydration can make diarrhoea dangerous.

The WHO identifies diarrhoeal disease as the third leading cause of death worldwide in children aged 1–59 months, while emphasising that it is both preventable and treatable. This guide explains what parents can do at home and when to get help.

What Counts as Diarrhoea?

The WHO defines diarrhoea as 3 or more loose or liquid stools per day, or loose stools occurring more frequently than is normal for the child.

Keep in mind:

• Frequent formed stools are not diarrhoea.
• Loose, pasty stools in breastfed babies can be normal. Soft stools alone do not necessarily mean a baby has diarrhoea.

Types of diarrhoea

1. Acute watery diarrhoea — lasts hours or days; includes cholera.
2. Acute bloody diarrhoea — also called dysentery.
3. Persistent diarrhoea — lasts 14 days or longer.

Bloody and persistent diarrhoea need medical assessment. Do not wait for diarrhoea to become persistent if your child has danger signs.

What Causes Diarrhoea in Children?

Diarrhoea is usually caused by an infection in the gut involving bacteria, viruses or parasites. These germs can spread through:

• Contaminated food or drinking water.
• Person-to-person contact, particularly when hands are not washed properly.

Rotavirus during winter

Rotavirus is a common cause of childhood diarrhoea during winter in Bangladesh. Surveillance and research in Bangladesh have found higher rotavirus activity during the winter months. However, rotavirus infections can also occur at other times of the year.

Do not assume diarrhoea is harmless because it happens in winter. Children can still lose significant amounts of water and salts. Give ORS, continue feeding and watch for signs of dehydration.

Children who are malnourished or have weakened immunity are at greater risk of severe illness.

The Two Key Treatments: ORS and Zinc

Oral rehydration solution (ORS) replaces water and salts lost during diarrhoea. It does not immediately stop loose stools; its purpose is to prevent and treat dehydration.

Zinc is also used as part of treatment. The WHO's diarrhoeal disease fact sheet describes a 10–14 day course of zinc. Confirm the appropriate dose and duration for your child with a doctor or pharmacist.

1. ORS

• Use packet ORS where possible.
• Mix the full packet with exactly the amount of safe water stated on the packet. Different packets may require different amounts of water.
• Give small, frequent sips using a cup or spoon.
• If your child vomits, wait 5–10 minutes, then start again more slowly.
• Follow the packet's instructions on how long prepared ORS can be kept. Discard any remaining solution after that time and prepare a fresh batch.
• Do not add extra sugar, salt, milk or juice.

If your child cannot drink, becomes very weak or still has signs of dehydration despite ORS, seek urgent medical care.

2. Zinc

• Complete the course recommended by your child's doctor, even if diarrhoea stops sooner.
• Ask a doctor or pharmacist to confirm the correct dose and duration.
• Zinc does not replace ORS. Continue giving ORS while your child is taking zinc.

Common mistakes

• Mixing ORS with too little water.
• Giving soft drinks, packaged juice or glucose drinks instead of ORS.
• Stopping feeding.
• Stopping zinc before the prescribed course is complete.
• Continuing home treatment despite signs that the child is getting worse.

Feeding During Diarrhoea

• Continue breastfeeding. If your baby vomits, offer smaller feeds more often.
• Continue formula at its usual strength. Do not dilute it.
• Continue age-appropriate foods, offering small amounts more frequently.
• Let your child eat when they feel able. Avoiding very fatty or spicy foods may help.
• Do not rely on plain water alone to replace diarrhoeal losses; give ORS.

For children who already eat solid foods, suitable options include rice, khichuri, soft dal, mashed banana, boiled potato, yoghurt and eggs—foods the child normally eats and tolerates.

What to Avoid

• Do not give fruit juice or fizzy drinks—they can make diarrhoea worse.
• Do not give children under 12 medicines to stop diarrhoea, such as loperamide.
• Do not give aspirin to children under 16 unless prescribed by a doctor.
• Do not give antibiotics without medical advice.

Most childhood diarrhoea does not need antibiotics. A doctor may prescribe them for certain infections, such as dysentery or cholera, when appropriate.

How Long Does It Last?

According to the NHS:

• Diarrhoea usually stops within 5–7 days.
• Vomiting usually stops within 1–2 days.

Do not wait this long to seek help if your child has dehydration or other danger signs.

Keep your child home from school or nursery until at least 48 hours after the last episode of diarrhoea or vomiting.

Signs of Dehydration

Watch for:

• Fewer wet nappies or passing less urine.
• Dark, strong-smelling urine.
• Dry mouth and lips.
• Sunken eyes.
• Fewer or no tears when crying.
• In babies, a sunken soft spot on the head.
• Being unusually sleepy, floppy or irritable.

If your child is difficult to wake, is not responding normally or cannot drink, go to hospital immediately.

An illustrative example

Tasnim is 18 months old and has had 6 watery stools since morning. She is still breastfeeding and taking ORS by spoon, and her nappies are wet. Her father keeps a note of each stool and how much ORS she takes.

By evening, she becomes unusually sleepy and her nappy has been dry for several hours. These may be signs of dehydration, so he takes her to hospital without waiting.

When to Get Medical Advice Urgently

Seek urgent medical advice if:

• You are worried about a baby under 12 months with diarrhoea.
• Your child stops breastfeeding or taking formula while ill.
• Your child has signs of dehydration, particularly if they are under 5.
• Your child still has signs of dehydration after ORS.
• Your child keeps vomiting and cannot keep fluids down.
• There is blood in the stool or bleeding from the bottom.
• Diarrhoea lasts more than 7 days or vomiting lasts more than 2 days.

Emergency: Go to Hospital

Go to the nearest hospital emergency department immediately if your child:

• Is very floppy, difficult to wake or not responding normally.
• Cannot drink, particularly if there are other signs of dehydration.
• Vomits blood or material that looks like ground coffee.
• Has yellow-green or green vomit.
• May have swallowed something poisonous.
• Has a stiff neck and pain when looking at bright lights.
• Has a sudden severe headache or severe abdominal pain.
• Has blue, grey, very pale or blotchy skin, lips or tongue. Changes may be easier to see on the palms and soles in children with brown skin.
• Has severe difficulty breathing or takes very fast, short breaths.

Also seek urgent hospital care for large amounts of rice-water-like stool. This can suggest cholera and can lead to rapid dehydration.

Preventing Diarrhoea

Many cases of diarrhoeal disease can be prevented through safe drinking water, sanitation and hygiene.

• Wash hands with soap after using the toilet, after changing nappies, and before preparing food or feeding a child.
• Use safe drinking water. Where necessary, boil and cool water or use an appropriate water-treatment method.
• Exclusively breastfeed for the first 6 months. If a baby develops diarrhoea, ORS and medically indicated treatment should still be given when needed.
• Keep food covered and serve it freshly cooked.
• Use a sanitary latrine.
• Keep your child's routine vaccinations up to date through the EPI programme.

Wash clothing and bedding soiled with stool or vomit separately. Clean toilet seats, taps and door handles regularly, and avoid sharing towels.

Rotavirus vaccination

Rotavirus vaccines help protect children against severe diarrhoea caused by rotavirus. Two recognised vaccine brands are Rotarix and RotaTeq. Both are given by mouth, not by injection.

According to the latest published WHO information for Bangladesh, rotavirus vaccination is not included in Bangladesh's routine EPI immunisation schedule. Completing routine EPI vaccinations therefore does not necessarily mean your child has received a rotavirus vaccine. Check your child's vaccination record and discuss it with a doctor or vaccination centre.

• Rotavirus vaccination can begin from 6 weeks of age.
• The number of doses and vaccination schedule differ between products.
• There are age limits for starting and completing vaccination, so discuss it during your baby's early vaccination visits.
• Ask a doctor or vaccination centre which vaccine is suitable for your child and where it is available.

Rotavirus vaccines do not prevent every type of diarrhoea and do not treat an existing episode. Even after vaccination, a child with diarrhoea still needs ORS, continued feeding and monitoring for dehydration.

Related reading: If your child also has a high temperature, see fever in children: when to worry. For older children with prolonged fever and stomach upset, read about typhoid symptoms. Learn why antibiotics are not routinely needed in our article on antibiotic resistance.

Frequently Asked Questions

How much ORS should I give my child?

Give small, frequent sips after every loose stool. A doctor can advise the amount based on your child's age, weight and level of dehydration. If your child cannot drink or becomes very weak or unusually drowsy, go to hospital.

Is zinc necessary for diarrhoea?

Zinc is used alongside ORS in the treatment of childhood diarrhoea. The WHO's diarrhoeal disease fact sheet describes a 10–14 day course. Confirm the appropriate dose and duration with your child's doctor.

Can I give my child loperamide?

No. The NHS advises against giving children under 12 medicines such as loperamide to stop diarrhoea.

Should I stop milk during diarrhoea?

No. Continue breastfeeding or formula at its usual strength. Do not dilute formula.

When is diarrhoea in a baby an emergency?

Go to hospital immediately if your baby is very floppy, difficult to wake, not responding normally, unable to drink or has green vomit. Reduced urination, blood in the stool or repeated vomiting also require urgent medical assessment.

Can teething cause diarrhoea?

Do not assume teething is the cause of diarrhoea. Give ORS, watch for dehydration and seek medical advice when needed.

Can children get diarrhoea during winter?

Yes. Rotavirus is a common cause of childhood diarrhoea during winter in Bangladesh. Winter diarrhoea can still cause dehydration.

Does completing EPI vaccinations mean my child has received a rotavirus vaccine?

No. According to the latest published WHO information for Bangladesh, rotavirus vaccination is not included in the routine EPI schedule. Check your child's vaccination record and ask a doctor or vaccination centre.

What are the names of rotavirus vaccines?

Two recognised brands are Rotarix and RotaTeq. Both are given by mouth. The schedule depends on the vaccine and your child's age, so discuss vaccination during your baby's early vaccination visits.

Can my child still get diarrhoea after rotavirus vaccination?

Yes. Vaccination helps reduce the risk of severe rotavirus diarrhoea, but it does not prevent all causes of diarrhoea. Safe water, hygiene and appropriate care during illness remain important.

Get Advice From a Paediatric Doctor on ShifaMate

If your child has mild diarrhoea without danger signs, you can browse verified doctors on ShifaMate, including doctors providing paediatric care, and consult through the app.

Tell the doctor:

• Your child's age and weight.
• How long the diarrhoea has lasted and how many loose stools occur each day.
• Whether there is blood in the stool.
• Whether your child has fever or vomiting.
• How much breast milk, food and ORS your child is taking.
• How often nappies are wet or whether urine output has decreased.

See the full list of ShifaMate doctors.

If your child shows signs of dehydration or any emergency sign, seek in-person medical care without waiting for an online consultation.

References

• World Health Organization. Diarrhoeal disease
• NHS. Diarrhoea and vomiting
• NHS. High temperature (fever) in children — dehydration signs
• IEDCR. Surveillance Report, 2024 — rotavirus seasonality in Bangladesh
• World Health Organization. Rotavirus — disease and vaccination information
• World Health Organization. Introduction of rotavirus vaccine for Bangladesh

This article is for general information and does not replace advice from a qualified doctor.