How do I know if my child's diarrhoea needs hospital care or can be managed at home?

For most cases, starting ORS at home and monitoring closely is appropriate. The signs that suggest your child should be seen promptly include sunken eyes, a skin pinch that returns to normal very slowly, inability to drink or keep fluids down, and unusual sleepiness or difficulty waking. If you notice any of these, visit a health facility the same day — intravenous fluids may be needed. For milder diarrhoea without these signs, ORS with careful fluid-intake monitoring, plus zinc supplementation as advised by your doctor, is the WHO-recommended approach.

My child had dengue fever and the fever has just broken — is the worst over?

Not necessarily. The days immediately after the fever drops (typically three to seven days after onset) are when close monitoring is most important. Some children develop more serious complications during this window, even though they seem better. Continue watching for severe abdominal discomfort, persistent vomiting, rapid or difficult breathing, unusual tiredness, bleeding from the gums or nose, or pale and cold skin. If any of these appear, visit a health facility promptly.

Are there mosquito repellents that are safe for my young child?

Yes. DEET-based repellents are considered safe for children older than two months; the concentration should not exceed 30% on children. Do not apply to their hands, face, or broken skin, and wash it off with soap and water when they come indoors. Picaridin (20%) is a well-studied alternative offering eight to twelve hours of protection. Products containing oil of lemon eucalyptus should not be used in children under three years. For infants under two months, physical barriers — nets, full-coverage clothing, and removing standing water — are the recommended approach.

My child's vaccinations are up to date for the standard schedule. Is there anything extra to check before monsoon?

The main vaccines to confirm for monsoon season are: rotavirus (in Nepal's national programme), typhoid conjugate vaccine (TCV, from six months), Japanese encephalitis (given at 12 months — especially important for families in the Terai and Hill regions), and pneumococcal (PCV10, given at six weeks, ten weeks, and nine months). If you are unsure whether any of these were given, your local health post can check the immunisation record and catch up any missed doses.

How quickly can food become unsafe during the monsoon?

In hot, humid conditions, cooked food left at room temperature can reach unsafe bacterial levels within two hours. This applies to re-heated rice, dal, curries, and especially street food. The safest approach is to refrigerate leftovers soon after cooking, reheat thoroughly before serving, and avoid food that has been sitting at ambient temperature for more than two hours. Washing all raw fruits and vegetables under clean water is also more important during the monsoon than in drier months.

Prevention

Monsoon Season Health: Protecting Children from Seasonal Illness

Water-borne, mosquito-borne, and respiratory risks, and how to prevent them.

7 min read · Reviewed against official sources

When the rains arrive in Nepal each June, they bring welcome relief from the heat — and a well-documented shift in the illnesses that affect children. Flooding contaminates water sources, warm stagnant puddles become mosquito nurseries, and humidity speeds up bacterial growth in food. None of this is inevitable. Understanding what changes during the monsoon, and acting on a handful of practical habits, puts most of these risks firmly within a family's control.

The monsoon is not simply wet weather — it is a combination of conditions that each favour different pathogens. Rising temperatures matter as much as rainfall: an ecological study across all 77 districts of Nepal found that diarrhoeal disease incidence in children under five increased by 4.4% for every 1°C rise in mean temperature, and by 0.28% for every additional centimetre of rainfall. Summer months showed about 11.6% higher incidence than winter. Floodwater overwhelms drainage and mixes with sewage, contaminating wells, taps, and open water sources. Stagnant water collects in containers, tyres, and low-lying ground — ideal breeding habitat for the Aedes mosquito that carries dengue. Indoors, people cluster together with windows closed against the rain, making it easier for respiratory viruses to spread. Each of these mechanisms drives a different category of illness, but the prevention strategies overlap considerably.

Waterborne diseases are among the most common monsoon-season illnesses in children. Globally, around 1.7 billion childhood episodes of diarrhoea occur every year, and diarrhoeal disease remains the third leading cause of death in children aged one to 59 months. In Nepal, an estimated 25–33% of severe diarrhoea cases in children under five are caused by rotavirus — which Nepal now vaccinates against in the national immunisation programme, introduced in 2020. Typhoid fever, caused by Salmonella Typhi spreading through contaminated water or food, affects an estimated nine million people globally each year. Hepatitis A follows the same faecal-oral route; in settings with limited sanitation, most children — around 90% — are exposed before age ten, often without obvious symptoms.

The single most impactful household action is consistent water treatment and safe storage. WHO evidence shows that household water treatment and safe storage — when used correctly and consistently — can reduce diarrhoeal disease by up to 45%. Handwashing with soap reduces diarrhoea incidence by 47% and acute respiratory infection in children under five by up to 50%. These numbers are remarkable for measures that cost almost nothing.

Boil or treat drinking water consistently during the monsoon, even from tap sources that seem fine in dry months.
Store treated water in a covered, clean container — do not dip hands or cups directly in; use a ladle.
Wash hands with soap before preparing food, before feeding children, after using the toilet, and after handling raw food.
Ask your child's doctor about the typhoid conjugate vaccine (TCV), recommended from six months of age, and confirm rotavirus vaccination is up to date.
Wash fruits and vegetables thoroughly under clean running water; avoid raw salads from uncertain sources during the monsoon.

If a young child does develop diarrhoea, begin oral rehydration solution (ORS) promptly. Use pre-packaged WHO-formulation ORS sachets mixed with the exact measured amount of clean water — too little water makes the solution too concentrated and can worsen dehydration. WHO also recommends zinc supplementation alongside ORS, typically for a 10–14 day course — continued even after the diarrhoea has settled, because it helps protect against further episodes over the following two to three months. Zinc has been shown to reduce episode duration by about 25% and stool volume by about 30%. Ask your child's doctor about the right zinc product and amount for your child's age, and complete the full course as advised even if your child seems well sooner.

54,000+Dengue cases reported across all 77 districts of Nepal in 2022 — the country's largest outbreak on record, with cases peaking in September after the monsoon.

Dengue is now an annual reality in Nepal. The monsoon months of June to August create ideal breeding conditions for Aedes mosquitoes, and the dengue season follows closely, with the majority of cases appearing from September through November. In 2022, Nepal recorded over 54,000 cases and 88 deaths — Kathmandu district alone accounting for 9,528 cases. The South-East Asia region as a whole carries more than half the global dengue burden, with cases in the region rising 46% between 2015 and 2019. Japanese encephalitis (JE) follows a similar monsoon-linked pattern in Nepal, peaking in late August and early September, with over 60% of JE mortality in Nepal occurring in children under 15. The JE vaccine, part of Nepal's national schedule at 12 months, provides more than 95% protective efficacy from a single dose — it is one of the most straightforward protections available.

Aedes mosquitoes — the dengue vector — do not need a pond or stream. They breed in small water-holding containers around the home: storage tanks, flower pots, discarded bottles, blocked gutters, and even a bottle-cap of stagnant water. Covering a container is not always enough, because Aedes eggs can cling to container walls and hatch when water is added. The container needs to be emptied, scrubbed, and dried weekly.

Empty and scrub all water-holding containers around the home every week — flowerpots, buckets, coolers, tyres.
Cover roof tanks and water storage containers tightly at all times.
Use insect-repellent mosquito nets during daytime rest as well as at night — Aedes mosquitoes are most active during daylight hours.
Dress children in long-sleeved tops and long trousers, especially during early morning and late afternoon.
Use DEET-based repellent for children older than two months; concentration should not exceed 30% on children. Do not apply to children's hands, face, or broken skin. Picaridin (20%) is a good alternative offering eight to twelve hours of protection. Do not use oil of lemon eucalyptus products in children under three years.
Confirm the JE vaccine was given at 12 months — families in the Terai and Hill regions should check this before monsoon season.

Pneumonia accounts for 14% of all deaths in children under five globally — 740,180 children in 2019. UNICEF estimates that more than 23,000 children in Nepal could die from pneumonia over a decade on current trends. The rainy season is associated with a measurably higher risk of acute respiratory infection: one study found the monsoon season had a respiratory-infection incidence rate ratio of 2.43 compared with the hot dry summer, with illness during the rainy season linked to more severe cases and longer hospitalisation in children under five. In crowded households with limited ventilation, respiratory viruses circulate more easily.

The most effective protection against the pathogens that cause severe pneumonia — Hib, pneumococcus, measles, pertussis — is immunisation. Nepal introduced PCV10 (pneumococcal vaccine) in 2015 and gives the pentavalent DPT-HepB-Hib vaccine at six, ten, and fourteen weeks. Beyond vaccination, the habits that protect against waterborne illness also protect the lungs: handwashing with soap reduces respiratory infection deaths by about 21%. Exclusive breastfeeding for six months, and reducing indoor smoke from cooking fires, also lower pneumonia risk significantly. Fast breathing is a more reliable early sign of pneumonia than fever alone — a child breathing noticeably faster than usual, even without a high fever, is worth having assessed.

Bacteria multiply faster when it is both warm and humid. Cooked food left at room temperature during the monsoon can become unsafe within two hours. The temperature range of 5°C to 60°C is where bacterial multiplication is fastest — food should be kept hot above 60°C before serving, or refrigerated below 5°C soon after preparation. This applies especially to re-heated rice, dal, and street food during the monsoon. WHO's Five Keys to Safer Food apply year-round, but matter most in the rainy season: keep surfaces and hands clean; separate raw and cooked food; cook thoroughly; keep food at safe temperatures; use safe water and wash raw ingredients. Street food and pre-cooked meals left at ambient temperature carry a higher risk during the monsoon than in cooler, drier months.

Water: boil or treat drinking water consistently; store in a covered, clean container.
Handwashing: soap and water before meals, food preparation, and after the toilet — for adults and children alike.
Mosquito control: empty and scrub all water-holding containers weekly; use nets and repellent for children.
Food: refrigerate cooked food within two hours; reheat thoroughly; wash all produce under clean water.
Vaccinations: confirm rotavirus, typhoid conjugate, JE (at 12 months), and pneumococcal vaccines are current.
ORS and zinc: keep a packet of WHO-formulation ORS sachets at home; if a child develops diarrhoea, start ORS and ask your doctor about zinc supplementation.
Clothing: dress children in full sleeves during peak mosquito hours (morning and late afternoon).

When to check in with your doctor

Most monsoon illnesses are manageable at home with ORS, rest, and careful monitoring. A few patterns are worth a prompt conversation with your health provider. For diarrhoea: a child showing signs of significant fluid loss — sunken eyes, very slow skin-pinch return, inability to drink, unusual sleepiness — should be seen the same day; intravenous fluids may be needed. For dengue: after three to seven days of fever, the temperature may drop below 38°C. This does not mean recovery — it is actually the period when close monitoring matters most. Any new signs during or after the fever coming down (severe abdominal discomfort, persistent vomiting, rapid breathing, unusual tiredness, bleeding from gums or nose, pale or cold skin) are a reason to visit a health facility promptly. For breathing: a child breathing faster than usual — more than 60 breaths per minute under two months, more than 50 between two and twelve months, more than 40 between one and five years — or with visible chest indrawing, should be assessed by a health worker. In general: if a child cannot drink, is vomiting everything, has a convulsion, or is unusually unresponsive, seek care right away. Nepal's Department of Health Services monitors these diseases year-round through the EWARS sentinel surveillance system — your local health post is part of that network.

Key takeaways

Monsoon season brings a predictable rise in diarrhoea, typhoid, dengue, Japanese encephalitis, and respiratory infections in children — understanding why helps families act early.
Handwashing with soap is the single most impactful daily habit: it reduces diarrhoea incidence by 47% and acute respiratory infections in young children by up to 50%.
Aedes mosquitoes breed in tiny amounts of stagnant water around the home — emptying and scrubbing all water-holding containers every week is the most effective dengue prevention step.
If a child develops diarrhoea, start WHO-formulation ORS straight away and ask your doctor about zinc supplementation, typically for a 10–14 day course.
Nepal's national immunisation programme includes vaccines against rotavirus, typhoid, Japanese encephalitis, Hib, pneumococcus, and measles — confirming your child's schedule is current before monsoon is one of the best investments in their health.
A drop in fever after a few days of dengue illness is not a sign of recovery — the days immediately after fever comes down are the period that needs closest attention.

Questions parents ask

How do I know if my child's diarrhoea needs hospital care or can be managed at home?: For most cases, starting ORS at home and monitoring closely is appropriate. The signs that suggest your child should be seen promptly include sunken eyes, a skin pinch that returns to normal very slowly, inability to drink or keep fluids down, and unusual sleepiness or difficulty waking. If you notice any of these, visit a health facility the same day — intravenous fluids may be needed. For milder diarrhoea without these signs, ORS with careful fluid-intake monitoring, plus zinc supplementation as advised by your doctor, is the WHO-recommended approach.
My child had dengue fever and the fever has just broken — is the worst over?: Not necessarily. The days immediately after the fever drops (typically three to seven days after onset) are when close monitoring is most important. Some children develop more serious complications during this window, even though they seem better. Continue watching for severe abdominal discomfort, persistent vomiting, rapid or difficult breathing, unusual tiredness, bleeding from the gums or nose, or pale and cold skin. If any of these appear, visit a health facility promptly.
Are there mosquito repellents that are safe for my young child?: Yes. DEET-based repellents are considered safe for children older than two months; the concentration should not exceed 30% on children. Do not apply to their hands, face, or broken skin, and wash it off with soap and water when they come indoors. Picaridin (20%) is a well-studied alternative offering eight to twelve hours of protection. Products containing oil of lemon eucalyptus should not be used in children under three years. For infants under two months, physical barriers — nets, full-coverage clothing, and removing standing water — are the recommended approach.
My child's vaccinations are up to date for the standard schedule. Is there anything extra to check before monsoon?: The main vaccines to confirm for monsoon season are: rotavirus (in Nepal's national programme), typhoid conjugate vaccine (TCV, from six months), Japanese encephalitis (given at 12 months — especially important for families in the Terai and Hill regions), and pneumococcal (PCV10, given at six weeks, ten weeks, and nine months). If you are unsure whether any of these were given, your local health post can check the immunisation record and catch up any missed doses.
How quickly can food become unsafe during the monsoon?: In hot, humid conditions, cooked food left at room temperature can reach unsafe bacterial levels within two hours. This applies to re-heated rice, dal, curries, and especially street food. The safest approach is to refrigerate leftovers soon after cooking, reheat thoroughly before serving, and avoid food that has been sitting at ambient temperature for more than two hours. Washing all raw fruits and vegetables under clean water is also more important during the monsoon than in drier months.

Sources

WHO — Diarrhoeal disease fact sheet (2023)
WHO — Water, sanitation and hygiene interventions and the prevention of diarrhoea (2023)
WHO — Household water treatment and safe storage (2023)
WHO — Zinc supplementation in the management of diarrhoea (2023)
WHO — Typhoid fact sheet (2023)
WHO — Hepatitis A fact sheet (2024)
WHO — Dengue and severe dengue fact sheet (2024)
WHO — Dengue – Nepal, Disease Outbreak News (2022)
WHO Nepal — Responding to dengue outbreak in Nepal (2022)
WHO SEARO — Dengue and severe dengue – South-East Asia Region (2023)
WHO — Pneumonia in children fact sheet (2022)
WHO — Five Keys to Safer Food (2022)
WHO — Public health advice on food safety during summer (2023)
WHO Nepal — Nepal introduces Rota virus vaccine against diarrhoea in children (2020)
UNICEF Nepal — More than 23,000 children in Nepal could die in a decade unless world acts on pneumonia (2020)
UNICEF — UNICEF WASH Response Nepal – COVID-19 Lessons Learned (2021)
Department of Health Services (DoHS), Government of Nepal — Surveillance of Communicable Disease Program (EWARS) (2023)
AAP / HealthyChildren.org — How to Choose an Insect Repellent for Your Child (2023)
International Journal of Environmental Research and Public Health (PubMed-indexed) — Effects of Climatic Factors on Diarrheal Diseases among Children below 5 Years of Age at National and Subnational Levels in Nepal: An Ecological Study (2022)
PubMed-indexed peer-reviewed journal — Prevalence, clinical outcomes and rainfall association of acute respiratory infection by human metapneumovirus in children (2019)
International Journal of Surgery (PubMed-indexed) — Japanese encephalitis prevalence and outbreaks in Nepal and mitigation strategies (2024)
Vaccine (PubMed-indexed) — Updated estimation of the impact of a Japanese encephalitis immunization program with live, attenuated SA 14-14-2 vaccine in Nepal (2017)
WHO — Integrated Management of Childhood Illness (IMCI) — Assess and Classify the Sick Child (2014)

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