Oral Rehydration Solution (ORS) for Babies

When your child is suffering from diarrhoea or vomiting, he can lose body fluids quickly and become dehydrated. Small sips of water every few minutes work well, but in case of severe diarrhoea, quite a lot of fluids can be lost in a short time. ORS given at such a time can protect your baby from dehydration and its serious effects.

What is ORS?

ORS stands for Oral Rehydration Solution. It is a solution of oral electrolytes given to children who are experiencing dehydration due to loss of body fluids in conditions such as diarrhoea and vomiting. ORS contains a mix of sodium, potassium, sugar and other important electrolytes needed by the body. When mixed and given in the right quantities, it can quickly replace the lost electrolytes and fluids to rehydrate the body.

When Does Your Baby Need Oral Rehydration Therapy?

Serious cases of dehydration are when ORS is given to infants. Most minor dehydration doesn’t need medical attention and can be treated with breast milk, water, formula and diluted juices. However severe dehydration caused by diseases such as viral gastroenteritis, also called stomach flu, needs ORS for treatment. Also, look for the following symptoms of dehydration in kids:

• Their eyes look sunken, dull or dry
• Their lips appear stretched or chapped
• Dry nappy with little or no urine
• They may be lethargic and fussy
• No tears when they cry
• Cold hands and feet
• Heartbeat is rapid
• Soft spots on their head

Benefits of Oral Rehydration Solution

ORS is a highly effective treatment for diarrhoea in babies. It can treat dehydration caused by loss of fluids that cannot be treated in time by feeding water alone. To understand how fluid absorption in the body works, the concept of osmolarity should be understood. Osmolarity is a measure of the concentration of dissolved salts in a fluid that can apply an osmotic pressure on the fluid. When two solutions of different osmolarity are placed in contact with each other, fluid from the low osmolarity solution flows to the high osmolarity solution. Similar to how raisins soaked in water swell up after a while.

The principle behind ORS therapy is simple: When babies have diarrhoea, fluids move through their intestines too quickly to be absorbed like it does normally. The surface of their intestines is lined with something called ‘sodium-glucose co-transporters’, which is a protein that absorbs salt more effectively in the presence of glucose. What ORS does, therefore, is to give the right mix of glucose, salt and water so the salt and fluid absorption is maximised. Its benefits can be summarised as follows:

• It contains the precise ratio of ingredients, and hence, used instead of sports drinks, paediatric electrolytes and IV hydration
• No need for injections or IV transfer
• It can be self-administered
• ORS gives results within minutes of consumption
• It can be used to proactively avoid dehydration
• Studies have shown that it is safe for all age groups

What Are Oral Rehydration Salts Available as?

They are usually available in the form of oral rehydration powder or pre-mixed bottles available in pharmacies, health centres, markets, and shops. Normally one sachet is to be mixed with 200 ml of water and given to the baby. To maximise the effectiveness of the powder, it needs to be mixed with exactly the right amount of water specified on the sachet. All ORS powder contains a little bit of sugar and there is no need to add anything extra to it. The powders are usually cheaper and have a longer shelf life. Some of the commercial ORS brands include Infalyte, Pedialyte, Resol etc

How to Give ORS to Infants

• Pour the powder into 200 ml of water that is boiled and cooled. Stir well until the powder completely dissolves and the water looks slightly cloudy.
• Give your child the ORS in small and frequents amounts using a spoon, feeder or dropper. Ensure the first doses are small. Small amounts allow the child to better retain the solution without vomiting.
• Gradually give them more until your child has had the full dose that is recommended to them. Allow them to take it at their own pace.
• If the child refuses to drink, use a syringe to squirt the ORS into their mouth.
• In rare cases involving hospitalisation, a child refusing to drink might be fed through a naso-gastric feeding tube.

What Quantity of ORS Your Child Requires

It’s easy to think that our babies need to drink as much as possible to replenish the lost fluids. However, they may be vomiting and unwilling to consume even the recommended amount in one go. This reference is a standard one to follow for oral rehydration salts dosage:

How much fluid to give-

• children under 2 years of age: 50-100 ml (a quarter to half a large cup) of fluid
• children aged 2 up to 10 years: 100-200 ml (a half to one large cup)
• older children and adults- as much fluid as they want.

What to Do if Oral Rehydration Salt is Not Available

If ORS is unavailable at the chemist or you do not have any ingredients at hand, rush your child to the paediatrician or the hospital. Dehydration in infants can be fatal, so act quickly.

How to Prepare ORS Solution at Home

A simple ORS solution can be made at home with the following procedure:

Ingredients:

• Six (6) level teaspoons of sugar
• Half (1/2) level teaspoon of salt
• 1 litre of clean drinking water or boiled and cooled water

How to Make:

Add the sugar and salt to a bowl and pour the water into it. Mix until it has fully dissolved. You can also add a little bit of mashed banana for some extra potassium. It is imperative that you get the proportions right. Adding too much salt or sugar can render it ineffective or worsen diarrhoea.

When Oral Rehydration Salts Start Working

The oral rehydration salts will show their effect immediately and dehydration normally gets better in three to four hours.

What if Your Child Vomits (Sick)

When your baby has a stomach bug, vomiting, and diarrhoea often come together. When they are losing fluids through loose stools and vomiting, prepare a good amount of ORS solution. Give it to them in small quantities often, such as 10 to 20 ml every 5 to 10 minutes. A large portion of drinks can cause them to feel sick and throw up again. It is important to give them the full amount over longer time. Also, keep in mind:

• If the child gets sick and throws up within 30 minutes of consuming ORS, give it to them again.
• If the child throws up after 30 minutes of consuming ORS, they don’t need any more until you notice that they have runny stools.

What if You Forget to Give This Medicine to Your Infant?

If you forget to give them their dose, give another one as soon as you remember.

What if You Give Too Much of ORS to Your Baby?

Extra doses of oral rehydration solution can cause hypernatremia, the baby may show signs of fluid retention, altered sensorium. In that case please consult your Paediatrician.

Are There Any Side Effects of ORS Solution?

Oral rehydration salts have no side effects if given in the recommended dosage. If anything worries you, call your doctor immediately. Also, remember if you’ve mixed ORS in water, but not used it for over an hour, you need to discard it. It can, however, be stored in a refrigerator for up to 24 hours.

Can You Give Other Medicines Along With This Medicine?

Yes, other medicines can be given along with oral rehydration salts as long as they conform to these points:

• Unless your doctor has specified not to, you can give your children medications that have ibuprofen or paracetamol.
• You must inform your doctor about any allergic reactions your child might have had to any medicines that were given to them before. If you forgot to tell the doctor, check with them or with the pharmacist before giving your child ORS.
• If you’re considering switching medicines or going for complementary or herbal medicines, discuss this with a doctor or pharmacist first.

More About ORS

• If the child is unable to retain any fluids given to him and is showing signs of dehydration, contact the doctor straight away.

• If the child is not willing to take the oral rehydration solution, then try giving him water or a diluted juice. Water should be boiled and cooled for younger babies less than a year old. Inform your doctor if they are refusing fluids completely.

• During the first 24 hours of having diarrhoea, it’s recommended that babies not have any food other than breastmilk. If the child is older, avoid giving him solid foods and milk in the first 24 hours, as they may irritate the stomach and worsen diarrhoea. If you see signs of improvement in your child, continue giving him water or diluted juice along with oral rehydration salts, each time you notice runny poop.

• As diarrhoea gets better, you can start normal feeding after 24 hours. A tummy bug can cause kids to have mild diarrhoea that’s recurring for up to a month.

• If you notice that your child’s diarrhoea is severe and not improving for over 48 hours, along with other signs of deterioration of his health, rush him to the hospital. Heavy loss of fluid and serious dehydration can be fatal.

• Oral rehydration solution should not be used as a treatment for diarrhoea for longer than two or three days, unless your doctor has advised you so.

• Never use milk or juice to mix with oral rehydration salts instead of water or add extra salt or sugar to the solution. It is designed to offer the body the right balance of water and electrolytes to help in fluid absorption by the tissues and recover from diarrhoea.

• You must ensure that you use the exact amount of recommended water to prepare ORS out of the salts. Too much or too little water can change the electrolyte balance and will not work effectively.

• Avoid ORS if your child has a kidney or liver condition unless your doctor advises you to use it.

Things to Consider

• Wash your hands with soap or use a sanitise to clean hands before making the solution.
• Contact your doctor if you’re doubtful that the medicine is working. In the meantime, continue giving the medicine as usual.
• Medicines prescribed for your child are for your child only. Do not give recommend it to others. If their condition remains the same, they need to consult the doctor.
• If you see that someone may have accidentally taken your medicine, contact your doctor.
• Do not use medicines that have expired or have come close to their ‘best before’ date on the pack. Such medicines should be returned to the pharmacist to be disposed of properly.

From Where Can You Buy ORS?

Oral rehydration salts are available in all pharmacies in the form of packets that are inexpensive.

Where Should You Store Oral Rehydration Solution?

• Store the medicines in their original containers.
• Keep them somewhere safe in a cupboard out of direct sunlight, heat or high humidity.
• Ensure to keep it out of the reach of children.

What are the Alternative Home Remedies for Dehydration?

There are some alternatives to ORS that have been used as home remedies by some mothers over the years. The following remedies are similar to ORS and are effective as infant rehydration solution:

• Breast milk
• Gruel; a diluted mixture of cereals and water
• Rice water or Congee
• Carrot soup
• Coconut water

Remember that ORS is only meant to prevent dehydration caused by diarrhoea and vomiting. It cannot be used to treat the underlying cause. Therefore, always use it under the supervision of a doctor.