Session 3.4 – handout 3 – ORS instruction
Source WASH Cluster HP project Training for Hygiene Promoters module 1
Example Instructions for Management of
Diarrhoea using ORS1
The information below could be adapted for use in a leaflet to support the promotion of
ORS in the management of diarrhoea. Before embarking on this it is vital that you seek
advice from the Ministry of Health and the Health Cluster.
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Diarrhoea usually cures itself in a few days. The real danger is the loss of water from
the child’s body, which can cause dehydration
A child with diarrhoea loses weight and can quickly become malnourished. Food can
help stop the diarrhoea and help the child recover more quickly
A child with diarrhoea should never be given any tablets, antibiotics or other
medicines unless these have been prescribed by a trained health worker
The best treatment for diarrhoea is to drink lots of liquids and oral rehydration salts
(ORS) properly mixed with clean water
Measles frequently causes severe diarrhoea. Immunizing children against measles
prevents this cause of diarrhoea
A special drink for diarrhoea: ORS
What is ORS? ORS (oral rehydration salts) is a special combination of dry salts that,
when properly mixed with safe water, can help re-hydrate the body when a lot of fluid
has been lost due to diarrhoea.
Where can I get ORS? In most countries, ORS packets are available from health
centres, pharmacies, markets and shops.
To make the ORS drink:
1. Wash your hands with soap (or ash) and water before preparing the mixture
2. Put the contents of the ORS packet in a clean container. Add one litre of water and
stir. Too little water could make the diarrhoea worse.
3. Add water only. Do not add ORS to milk, soup, fruit juice or soft drinks. Do not add
sugar.
4. Stir well, and feed it to the child from a clean cup. Do not use a bottle.
5. You can use this mixture for up to 24 hours after you have made it. After this any
unused mixture must be thrown away.
How much ORS drink to give?
 Encourage the child to drink as much as possible.
1
Adapted from The MOST Project (2005) Draft Diarrhoea Treatment Guidelines for Clinic-Based
Healthcare Workers
WASH cholera / AWD EP&R training – session 3.4 – handout 3
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A child under the age of two needs at least a quarter to a half of a large cup of the
ORS drink after each watery stool.
A child aged two or older needs at least a half to a whole large cup of the ORS drink
after each watery stool.
Diarrhoea usually stops in three or four days.
If it does not stop after one week, consult a trained health worker.
Rules for home treatment of diarrhoea
Rule 1: Give the child more fluids than usual
For example:
GIVE
DO NOT GIVE
Breast Milk
Soft drinks
Rice Water
Sweetened tea
Coconut water
Sweetened fruit drinks
ORS
Coffee
Weak tea
Some local medicinal teas or infusions
How much?
Give children under 2-years-old, approximately 50-100ml (¼ large cup) of fluid after
each loose stool. Give older children ½ to 1 large cup. Older children and adults should
drink as much as they want. Even if the child vomits continue to give small sips of ORS.
ORS or recommended home-fluids should be given until the diarrhoea stops. This may
last several days.
Rule 2: Continue to feed the child
For example:
Breast Milk
Local Porridge
Beans
Mixes of cereal, meat and fish
Fresh fruit juices and bananas are helpful because they contain potassium.
Avoid:
 High fibre or bulky foods, such as coarse fruits and vegetables, fruits and vegetable
peels, and whole grain cereals. These are hard to digest.
 Very dilute soups. These are recommended as fluids, but are not sufficient as foods
because they fill up the child without providing sufficient nutrients.
 Foods with a lot of sugar can worsen diarrhoea.
Encourage the child to eat as much as he/she wants. Offer food every 3 to 4 hours (six
times each day) or more often to a young child. Small frequent feedings are best
because they are more easily digested and preferred by the child.
Rule 3: When to return to the clinic
Bring the child to a health worker if the child shows any of the following:
 Passes many stools,
 Is very thirsty,
 Has sunken eyes,
(The above 3 signs suggest the child is dehydrated)
WASH cholera / AWD EP&R training – session 3.4 – handout 3
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Seems not to be getting better after 3 days,
Has a fever,
Does not eat or drink normally.
Home Made Salt Sugar Solution
1. Wash your hands with soap and water before preparing solution.
2. In a clean container mix:
Half a level teaspoon of salt
8 teaspoons sugar
1 litre of clean (boiled) water (or 5 cupfuls – each cup should be 200mls)
3. Stir the salt and the sugar until they are dissolved in the water
4. Give the sick child as much of the solution as it needs, in small amounts
frequently either using a cup or a spoon.
5. Give child alternately other fluids - such as breast milk and juices.
6. Continue to give solids if child is four months or older
7. If the child still needs ORS after 24 hours, make a fresh solution.
8. If child vomits, wait ten minutes and give it ORS again. Usually vomiting will stop.
9. Banana or other non-sweetened mashed fruit can help provide potassium.
10. If diarrhoea increases and /or vomiting persist, take child over to a health clinic.
Home made solution and ORS do not stop the diarrhoea. They prevent the body from
drying up. The diarrhoea will stop by itself.
WASH cholera / AWD EP&R training – session 3.4 – handout 3
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