Diarrhoea in children: rehydration is the treatment

Diarrhoea is one of the most common reasons parents come to a pharmacy, and one of the few where the correct treatment is cheap, simple and widely misunderstood. The illness itself usually passes within a few days without any specific treatment. The danger is dehydration, and preventing that is almost entirely in your hands at home.

Oral rehydration salts: the whole point

Oral rehydration solution is not simply flavoured water. It contains a precise balance of salts and glucose, and the glucose is there because it actively pulls sodium and water across the gut wall even while the gut is inflamed. That mechanism is why it works when plain water does not do nearly as much.

Mix one sachet with exactly the amount of clean water stated on the packet. Not less, not more. Too little water makes the solution too concentrated, which can make dehydration worse rather than better. Use boiled and cooled or treated water, and make a fresh batch every twenty-four hours.

Give it in small, frequent amounts — a few spoonfuls every few minutes works far better than a glassful at once, which often comes straight back up. After every loose stool, offer more. A child who is vomiting as well still needs it; sip by sip, patiently.

Zinc, which is often forgotten

A ten to fourteen day course of zinc alongside rehydration shortens the episode, reduces its severity and makes another episode in the following months less likely. It is recommended by the World Health Organization for childhood diarrhoea and it is inexpensive. It is also, in our experience, the part people have never been told about.

Keep feeding

The old advice to rest the gut by withholding food has been overturned. Continue breastfeeding on demand throughout — breast milk is both food and fluid and is actively protective. For older children, offer ordinary food as soon as they will take it, in small amounts: rice, porridge, bananas, potatoes, well-cooked vegetables.

Avoid very sugary drinks, including fizzy drinks and undiluted fruit juice, because the sugar draws water into the gut and makes the diarrhoea worse. Avoid very fatty foods for a few days. Everything else can return as appetite does.

What not to give

Do not give medicines that stop the gut moving to a young child. They trap the infection inside and can cause serious complications. Do not give antibiotics unless they have been specifically prescribed after an assessment; most childhood diarrhoea is viral and antibiotics make no difference to it.

If somebody offers a traditional remedy you are unsure about, bring it to us and ask before giving it. Some are harmless, a few are not, and with a small dehydrated child the margin for error is narrow.

The signs of dehydration

• Far fewer wet nappies, or no urine for eight hours or more.
• A dry mouth and tongue, and crying without tears.
• Sunken eyes, or a sunken soft spot on a baby's head.
• Unusual sleepiness, floppiness or irritability.
• Skin that stays pinched when you gently lift it.
• Fast breathing or a fast heartbeat.

Any of these means medical help now rather than later. Also seek help for blood in the stool, a high fever alongside the diarrhoea, persistent vomiting that prevents any fluid staying down, severe abdominal pain, or diarrhoea lasting more than a week.

Preventing the next episode

Handwashing with soap after the toilet and before preparing food is the single most effective measure, and it is free. Safe drinking water matters: boil it, or treat it, and store it in a covered container with a tap or a dipper rather than dipping cups in. Keep cooked food covered and reheat it thoroughly.

Rotavirus vaccination substantially reduces severe diarrhoea in infants and is part of the routine childhood schedule. If you are unsure whether your child has had it, check the card rather than assuming.

Signs of dehydration — get help now

• No urine for eight hours, or far fewer wet nappies.
• A dry mouth, and crying without tears.
• Sunken eyes, or a sunken soft spot on a baby's head.
• Unusual sleepiness or floppiness.
• Blood in the stool, or vomiting that keeps everything down.

Questions we are asked about this

Can I just give water or a soft drink instead?

Water alone does not replace the salts being lost, and sugary drinks make diarrhoea worse by drawing water into the gut. Rehydration solution has a specific balance of salt and glucose that actively pulls water across the gut wall, which is why it works when the alternatives do not.

How much should I give?

Small amounts frequently is the key — a few spoonfuls every few minutes rather than a glassful at once, which usually comes straight back. Offer more after every loose stool, and keep going patiently even if the child is vomiting.

Should my child stop eating?

No. Keep breastfeeding throughout, and offer ordinary food as soon as an older child will take it. Resting the gut is outdated advice that slows recovery and leaves a child weaker.

When do antibiotics help?

Rarely. Most childhood diarrhoea is viral and antibiotics do nothing for it. They are used for specific confirmed infections, which is a decision made after assessment rather than at home.

This article is general information from the Dantrio Pharmacy team. It cannot take the place of advice from a pharmacist or doctor who knows your medical history. If you feel seriously unwell, seek medical help straight away.