If You Remember Nothing Else
- ORS after every loose stool — a quarter to half a cup under 2 years, half to one cup from 2 to 10 years.
- Small sips, often. If your child vomits, wait 10 minutes and start again, slowly.
- Zinc for 10 to 14 days makes diarrhoea shorter and less likely to come back.
- Keep breastfeeding, keep feeding. No need to starve a child with diarrhoea.
- Never give anti-diarrhoea medicines to children, and no antibiotics without a doctor.
- Very sleepy or not able to drink — come in now. No wee for 8 hours — see a doctor today.
How to Give ORS
Oral rehydration salts (ORS) are the single most important treatment for diarrhoea. They are a precise mix of salt and sugar that lets the gut soak up water even while diarrhoea continues. Pharmacies and chemists sell the sachets. Keep a few at home.
- Wash your hands.
- Measure the water exactly. Use the amount written on the sachet, usually 1 litre of clean water — boiled and cooled, or sachet or bottled water. A 75cl bottle is not a litre; measure properly.
- Pour in the whole sachet and stir until it dissolves. Do not add sugar, salt, juice or glucose, and do not make it stronger — too strong can harm a child.
- Give it by cup or spoon, a spoonful every minute or two for a baby, sips from a cup for older children. Feeding bottles are harder to keep clean.
- After each loose stool, give about 50 to 100 ml (a quarter to half a cup) under 2 years; 100 to 200 ml (half to one cup) from 2 to 10 years; as much as they want over 10.
- Cover it and use it within 24 hours. Throw away what is left and make fresh.
No ORS in the House Tonight?
Give breast milk, clean water, rice water, or thin pap or soup while someone gets ORS from a pharmacy. Do not try to make a salt and sugar mixture unless a health worker has shown you exactly how — getting the amounts wrong can make a child worse.
Zinc
Zinc tablets given for 10 to 14 days make an episode of diarrhoea shorter and less severe, and make another episode in the next few months less likely. They dissolve in a little breast milk, ORS or clean water. Ask the pharmacist or health worker for the right tablet and number for your child's age, and finish the course even when the diarrhoea has stopped. Some ORS packs come with zinc included.
Food and Breastfeeding
- Breastfeed more often, not less, and give ORS as well.
- Keep feeding solid food when your child wants it: pap, rice, potatoes, yam, bread, bananas, soups, eggs, fish. Small, frequent meals.
- After the diarrhoea stops, give an extra meal a day for two weeks to help them catch up.
- Formula-fed babies should continue their usual formula at the usual strength — do not dilute it.
When Vomiting Is the Problem
Many tummy bugs start with vomiting for the first day. A child who vomits after big drinks can often keep down small ones.
- Stop for 10 minutes after a vomit to let the stomach settle.
- Start with a teaspoon of ORS every minute or two. For a breastfed baby, short, frequent feeds.
- Increase slowly if it stays down for an hour.
Come In Now
Vomiting and
- green or yellow-green vomit
- blood in the vomit
- severe tummy pain, or a swollen tummy
- very sleepy, or a headache with a stiff neck
- after a head injury
- cannot keep anything down for 4 to 6 hours
See a Doctor Today
Same day
- Vomiting for more than 24 hours
- A baby under 6 months vomiting repeatedly
- A baby 2 to 8 weeks old with forceful vomiting after every feed
- Vomiting with a fever, or with pain passing urine
At Home
Watch and give small sips
- Vomited a few times but keeps small drinks down
- Still weeing and alert
- Diarrhoea has started and the vomiting is easing
What to Avoid
Anti-diarrhoea medicines such as loperamide, or "stoppers" from a chemist.
These are dangerous for children: they can stop the gut working and hide serious illness. Diarrhoea is the body clearing the infection; ORS keeps the child safe while it does.
Antibiotics or metronidazole for every running stomach.
Most childhood diarrhoea is caused by viruses, especially rotavirus, which antibiotics do not touch. Antibiotics are for bloody diarrhoea, suspected cholera, or other infections a doctor has diagnosed.
Soft drinks, glucose drinks or sweet juice "to give energy".
Too much sugar draws water into the gut and can make diarrhoea worse. ORS has exactly the right amount.
Stop breastfeeding or stop food until the diarrhoea stops.
Starving a child makes them weaker and slows recovery. Breast milk and food help the gut heal.
Preventing the Next One
- Rotavirus vaccine at 6, 10 and 14 weeks protects against the most common cause of severe diarrhoea in babies. Check your child's vaccine dates.
- Handwashing with soap after using the toilet, after changing nappies, and before preparing food or feeding a child.
- Safe water: boil drinking water or use a trusted sachet or bottled brand; keep water covered.
- Safe food: eat food while hot; do not keep cooked food more than 2 hours at room temperature in the heat, especially when there is no power for the fridge.
- Exclusive breastfeeding for the first six months protects against diarrhoea.
Questions Parents Ask
Is diarrhoea normal with teething?
No. Teething does not cause diarrhoea. Teething babies put everything in their mouths, which can spread germs. Treat diarrhoea as an illness, with ORS.
My child refuses ORS because of the taste.
Try it chilled, from a spoon or a small cup, or frozen into ice lollies for older children. Do not add sugar or juice. If a child who needs ORS will not drink anything, bring them in to be seen.
How do I know if it is cholera?
Cholera causes sudden, very large amounts of watery stool like rice water, often with vomiting, and can dehydrate a child in hours. During an outbreak, or if you see this, come in straight away and keep giving ORS on the way.
When can my child go back to school or crèche?
48 hours after the last episode of diarrhoea or vomiting, to avoid spreading it to other children.
Could it be worms?
Worms are common and are usually treated through deworming every six months from age one, as national programmes advise. They rarely cause sudden diarrhoea. Bring a child with diarrhoea for more than a week, or with weight loss, to be seen.
Sources
- World Health Organization. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th revision. 2005.
- World Health Organization. Integrated Management of Childhood Illness: chart booklet. 2014.
- WHO and UNICEF. Joint statement: clinical management of acute diarrhoea. 2004.
- National Institute for Health and Care Excellence. Diarrhoea and vomiting caused by gastroenteritis in under 5s (CG84). 2009.
- Nigeria Centre for Disease Control and Prevention. Cholera public health advisories.
Written for parents and carers in NigeriaClinically reviewed by Limi Children’s Hospital cliniciansLast updated September 2026Next review due September 2027