Can I make ORS at home if I don't have a sachet?

WHO-formulated ORS sachets are the most reliable option and are widely available at health posts and pharmacies in Nepal at very low cost. If a sachet is genuinely not available, a health worker can guide you on a home preparation. However, homemade solutions are more prone to measurement errors, so getting a sachet is worth the effort whenever possible. Sports drinks, fruit juice, and sugary water are not substitutes — their electrolyte and sugar concentrations are not suited to a sick child and may worsen fluid loss.

My child keeps vomiting the ORS back up. What should I do?

Vomiting during diarrhoea is common and does not mean ORS cannot work. Wait about 10 minutes after a vomiting episode, then restart with very small amounts — a few millilitres at a time from a spoon, every few minutes. Even small amounts absorbed between vomits add up. If the child cannot keep any fluid down at all over several hours, that is worth a visit to your health post.

Should I give my child an antibiotic or anti-diarrhoeal medicine?

For most childhood diarrhoea, neither is needed or recommended. Anti-diarrhoeal medicines (such as loperamide) are not appropriate for children under five and do not address the fluid loss that causes harm. Antibiotics are only indicated in specific cases — such as confirmed cholera, bloody diarrhoea (dysentery), or significant illness in a very young infant — and should be prescribed by a health worker after assessment, not given routinely. Routine antibiotic use contributes to resistance without helping most diarrhoea cases.

When can my child go back to their normal diet?

There is no need to wait. Offer age-appropriate foods as soon as your child shows interest — continuing to eat actually helps the gut lining recover and shortens the illness. There is no evidence that a special 'bland diet' is necessary beyond what your child finds comfortable. For breastfed infants, breastfeeding on demand should continue throughout and never be paused.

My child's rotavirus vaccines are due. Does the diarrhoea illness change the schedule?

Mild diarrhoea is generally not a reason to postpone vaccination, but your health worker will confirm this at the visit. Nepal's National Immunisation Programme provides the Rotarix vaccine free at 6 weeks and 10 weeks of age, alongside the pentavalent doses. If your child has missed these doses, your local health post can advise on catch-up. Rotavirus accounts for roughly one quarter to one third of severe diarrhoea cases in children under five in Nepal, so completing the schedule is a meaningful protective step.

Prevention

Diarrhoea in Children: ORS, Zinc, and Stopping Dehydration

The simple, proven steps that prevent the biggest risk of diarrhoea.

6 min read · Reviewed against official sources

Diarrhoea is one of the most common illnesses a young child will experience. In Nepal, every child is expected to have at least one episode before their fifth birthday, and globally nearly 1.7 billion cases occur in children each year. Most cases resolve on their own — but some become more serious, and the reason is almost always the same: the body loses more fluid and salts than it takes in. Understanding that one fact, and knowing how to respond to it, puts a powerful tool in every parent's hands.

Why fluid loss is the real concern

Diarrhoea is defined as three or more loose or liquid stools in a day. The illness itself — whether caused by a virus, bacteria, or parasite — is something the body's immune system can usually clear. What it cannot do on its own is replace the water and electrolytes (sodium, potassium, chloride, and bicarbonate) that pour out with every loose stool, and also leave through vomit, sweat, and breathing. When those losses outpace what a child is drinking, dehydration begins.

Infants and young children become dehydrated more quickly than adults, and the risk is higher still in children who are underweight. This is why prompt, calm action at home — not waiting to see how things go — makes such a difference.

~525,000Under-5 deaths that could be prevented each year with ORS and zinc

Oral rehydration solution: what it is and how to give it

Oral rehydration solution (ORS) is a precise mixture of clean water, salt, and sugar. It works because the small intestine absorbs glucose and sodium together, and water follows — this mechanism restores fluid to the body even when diarrhoea is still ongoing. A sachet of ORS costs a few cents and is available at health posts, pharmacies, and community health workers across Nepal.

Since 2003, WHO and UNICEF have recommended a reduced-osmolarity ORS (245 mmol/L total osmolarity), which replaced the older standard formula. The lower concentration reduces the duration of diarrhoea, the volume of stools, and the total amount of ORS a child needs compared with the older version.

How much ORS to give

For a child with minimal dehydration (under 10 kg): the WHO/CDC guidance is to offer 60–120 mL of ORS after each loose stool.
For a child with minimal dehydration (over 10 kg): offer 120–240 mL after each loose stool.
For a child with some dehydration: the recommended amount is roughly 75 mL per kilogram of body weight over 4 hours — your health worker can calculate the exact amount for your child.
Give it slowly. Use a small cup or spoon. If the child vomits, wait 10 minutes and try again more slowly — small sips every few minutes.
Continue between stools too. ORS is not only for immediately after a stool; keep offering it throughout the day.

The role of zinc

Since 2004, WHO and UNICEF have jointly recommended that zinc be given alongside ORS for every episode of diarrhoea in children. Zinc is a micronutrient essential for immune function, cell repair, and the normal transport of water and electrolytes across the intestinal wall. During diarrhoea, zinc is depleted rapidly, and restoring it helps the gut heal.

25%Reduction in diarrhoea duration with zinc

30%Reduction in stool volume with zinc

The WHO/UNICEF-recommended course is 20 mg per day for children over six months, or 10 mg per day for infants under six months, given for 10 to 14 days — even after the diarrhoea has resolved. Your paediatrician or health worker will confirm the right dose and form for your child. That extended course matters: it provides protection against re-infection for the following two to three months. Zinc comes in dispersible tablet or syrup form and is well tolerated by children. It is effective regardless of whether the zinc salt used is sulfate, acetate, or gluconate.

Keep feeding — do not stop food

A common instinct is to rest the gut by withholding food. Current evidence points the other way: continuing to feed a child during diarrhoea shortens the illness and helps the intestinal lining recover. Withholding food for more than 24 hours is not recommended.

Breastfed infants should continue feeding on demand throughout the illness, including during the oral rehydration phase. Breastmilk provides both fluid and immune protection. Exclusive breastfeeding in the first six months is associated with a much lower risk of dying from diarrhoea compared with no breastfeeding.
Older children should be offered their usual foods as soon as they show interest — soft, easily digestible foods are fine. There is no need for a special 'bland diet' beyond what the child tolerates.
Breastfeeding should not be paused to give ORS — both can continue together.

Recognising dehydration: what to watch for

Most children with diarrhoea have little or no dehydration and do well at home with ORS and continued feeding. Knowing the signs of dehydration helps you identify when it is worth seeking a health worker's assessment.

Signs of some dehydration (two or more present)

Restless or unusually irritable
Eyes appear sunken
Child is clearly thirsty and drinks eagerly
Skin pinched at the abdomen goes back slowly (more than one second)

Signs of more significant dehydration (two or more present)

Very lethargic or difficult to rouse
Markedly sunken eyes
Unable to drink or drinking very poorly
Skin pinch goes back very slowly (more than two seconds)
Decreased blood pressure, rapid heart rate, dry mouth, or marked listlessness

Prevention: the steps that reduce risk most

Diarrhoea is largely preventable, and the measures that work are practical and within reach for most families. Nearly 90% of all deaths from diarrhoea are linked to unsafe water and inadequate sanitation — meaning that improvements in these areas have an outsized effect on child health.

Handwashing with soap at key moments — before preparing food, before feeding a child, and after using the toilet or changing a nappy — can reduce diarrhoea incidence by up to 47%.
Safe drinking water. Treat or boil water when the source is uncertain. Store water in clean, covered containers.
Sanitation. Use a latrine or toilet; safely dispose of children's stools.
Breastfeeding. Exclusive breastfeeding for the first six months prevents roughly half of all diarrhoea episodes and 72% of hospital admissions for diarrhoea in infants.
Rotavirus vaccine. Nepal introduced the Rotarix vaccine into its National Immunisation Programme in July 2020. It is given free in two doses — at 6 weeks and 10 weeks — alongside the first and second pentavalent vaccine doses. Rotavirus causes one quarter to one third of severe diarrhoea cases in Nepali children under five. If your child has not yet received these doses, your local health post can advise.

Up to 47%Reduction in diarrhoea from handwashing with soap

A home diarrhoea action plan

When diarrhoea starts, the steps are straightforward and can begin immediately.

Start ORS right away. Mix one sachet in the correct volume of clean water (read the packet label). Begin offering small sips as soon as the first loose stools appear — do not wait to see if it gets worse.
Keep breastfeeding or offering food. Continue on demand for infants; offer usual foods to older children.
Give zinc daily for 10–14 days. Even once stools return to normal, complete the course your health worker recommends.
Watch for dehydration signs. Check the child's eyes, skin turgor, and alertness at each nappy change or toilet visit.
Wash hands. After every nappy change and before handling food or drink.
Seek care if needed. Use the signs listed above as your guide for when to visit a health post or hospital.

Despite how common diarrhoea is, deaths from it have dropped by 63% globally since 2000 — a result that came largely from wider use of ORS and zinc. Yet globally, 56% of children with diarrhoea still do not receive ORS, and 93% do not receive zinc. Knowing these two treatments and having them at home is one of the most direct ways a parent can protect a young child.

Key takeaways

The real concern in childhood diarrhoea is dehydration — the loss of water and electrolytes — not the loose stools themselves.
ORS (oral rehydration solution) replaces the exact salts and fluid the body loses; it should be started as soon as diarrhoea begins, before any dehydration develops.
Zinc (WHO/UNICEF recommend 20 mg/day for children over 6 months; 10 mg/day under 6 months) is given for 10–14 days alongside ORS — completing the full course protects against re-infection for the following 2–3 months. Your health worker confirms the dose.
Continue breastfeeding and food throughout the illness; withholding food for more than 24 hours is not recommended and slows recovery.
Handwashing with soap, safe water, sanitation, and the rotavirus vaccine (given free in Nepal at 6 and 10 weeks) together form the strongest prevention layer.
Signs of significant dehydration — very sunken eyes, very poor drinking, marked lethargy, or skin that returns very slowly when pinched — are a reason to visit a health facility promptly.

Questions parents ask

Can I make ORS at home if I don't have a sachet?: WHO-formulated ORS sachets are the most reliable option and are widely available at health posts and pharmacies in Nepal at very low cost. If a sachet is genuinely not available, a health worker can guide you on a home preparation. However, homemade solutions are more prone to measurement errors, so getting a sachet is worth the effort whenever possible. Sports drinks, fruit juice, and sugary water are not substitutes — their electrolyte and sugar concentrations are not suited to a sick child and may worsen fluid loss.
My child keeps vomiting the ORS back up. What should I do?: Vomiting during diarrhoea is common and does not mean ORS cannot work. Wait about 10 minutes after a vomiting episode, then restart with very small amounts — a few millilitres at a time from a spoon, every few minutes. Even small amounts absorbed between vomits add up. If the child cannot keep any fluid down at all over several hours, that is worth a visit to your health post.
Should I give my child an antibiotic or anti-diarrhoeal medicine?: For most childhood diarrhoea, neither is needed or recommended. Anti-diarrhoeal medicines (such as loperamide) are not appropriate for children under five and do not address the fluid loss that causes harm. Antibiotics are only indicated in specific cases — such as confirmed cholera, bloody diarrhoea (dysentery), or significant illness in a very young infant — and should be prescribed by a health worker after assessment, not given routinely. Routine antibiotic use contributes to resistance without helping most diarrhoea cases.
When can my child go back to their normal diet?: There is no need to wait. Offer age-appropriate foods as soon as your child shows interest — continuing to eat actually helps the gut lining recover and shortens the illness. There is no evidence that a special 'bland diet' is necessary beyond what your child finds comfortable. For breastfed infants, breastfeeding on demand should continue throughout and never be paused.
My child's rotavirus vaccines are due. Does the diarrhoea illness change the schedule?: Mild diarrhoea is generally not a reason to postpone vaccination, but your health worker will confirm this at the visit. Nepal's National Immunisation Programme provides the Rotarix vaccine free at 6 weeks and 10 weeks of age, alongside the pentavalent doses. If your child has missed these doses, your local health post can advise on catch-up. Rotavirus accounts for roughly one quarter to one third of severe diarrhoea cases in children under five in Nepal, so completing the schedule is a meaningful protective step.

Sources

WHO — Diarrhoeal disease — Fact Sheet (2024)
WHO — Zinc supplementation in the management of diarrhoea — WHO ELENA (2022)
WHO/UNICEF — Clinical management of acute diarrhoea — WHO/UNICEF Joint Statement (2004)
WHO — Oral rehydration salts (WHO/FCH/CAH/06.1) (2006)
WHO — Water, sanitation and hygiene interventions and the prevention of diarrhoea — WHO ELENA (2023)
WHO — Exclusive breastfeeding for optimal growth, development and health of infants — WHO ELENA (2023)
WHO Nepal — Nepal introduces Rota virus vaccine against diarrhoea in children: National Immunization Programme achieves new milestone (2020)
UNICEF — Diarrhoea — UNICEF DATA (2023)
WHO — Integrated Management of Childhood Illness (IMCI) Chart Booklet (2014)
CDC — Managing Acute Gastroenteritis Among Children: Oral Rehydration, Maintenance, and Nutritional Therapy — MMWR (2003)
WHO — The Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers (4th revision) (2005)

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