💧 Children's Health

0–5 years

Diarrhoea in Children

Preventing dehydration — the key to managing diarrhoea safely at home.

Diarrhoea is the second leading cause of death in Nigerian children under 5. Most diarrhoea deaths are preventable — they are caused by dehydration, not the infection itself. Oral rehydration salts (ORS) and zinc supplementation are the treatments that save lives, and they can be given at home.

⚠️ Go to Hospital IMMEDIATELY if your child has:

🚨 Child is very sleepy and difficult to wake (severe dehydration)

🚨 Sunken eyes, sunken soft spot (fontanelle), very dry mouth

🚨 No tears when crying, no urine in 8+ hours

🚨 Skin stays pinched up when pulled (loss of skin turgor)

🚨 Blood in stool with fever — possible bacterial dysentery; needs antibiotics

🚨 Diarrhoea in a baby under 2 months old — always needs medical assessment

🚨 Child unable to drink any fluid — vomiting everything

🚨 Severe abdominal pain with diarrhoea

Signs Parents Notice

• Passing 3 or more loose or watery stools in 24 hours

• Abdominal cramps and bloating

• Nausea and vomiting (often accompanies the first 24 hours)

• Mild fever

• Increased thirst

• Reduced urine output — early dehydration

• Irritability — a dehydrated child is fussy and hard to console

• Signs of dehydration: dry mouth, reduced tears, less playful than usual

Home Care — What You Can Do

Start ORS immediately

Oral rehydration salts (ORS) — mix one sachet in 1 litre of clean water. Give sips frequently — 5ml every minute in a young child, more as tolerated. Available in every pharmacy. This single intervention prevents most diarrhoea deaths.

Continue breastfeeding

Do not stop breastfeeding during diarrhoea — breast milk provides fluid, nutrition, and immune protection. Breastfeed more frequently than usual.

Give zinc supplements

10mg per day for infants under 6 months, 20mg per day for children 6 months and above, for 10–14 days. Zinc reduces diarrhoea duration and severity and prevents further episodes.

Continue feeding

Do not starve a child with diarrhoea. Continue age-appropriate foods — rice, banana, boiled potato, mashed yam. "Resting the gut" is not appropriate and worsens nutritional status.

Safe water and hygiene

Use clean water for making ORS and for all drinking. Wash hands with soap after changing nappies and before feeding. This prevents spread to other family members and reinfection.

When to Seek Medical Help

NowAny of the emergency signs above — particularly signs of severe dehydration, blood in stool, or inability to drink.

SoonDiarrhoea lasting more than 3 days in any child, or more than 24 hours in a child under 6 months.

SoonChild is getting worse despite ORS at home, or you cannot keep up with losses.

Common Mistakes to Avoid

🚫 Do not give antibiotics routinely — most childhood diarrhoea is viral and antibiotics will not help
🚫 Do not give anti-diarrhoeal medications (loperamide/Imodium) to children — dangerous and not appropriate
🚫 Do not dilute ORS — use the full sachet in 1 litre as directed
🚫 Do not substitute ORS with sugar water, Coca-Cola, or Lucozade — these worsen diarrhoea
🚫 Do not stop feeding the child — malnutrition worsens diarrhoea and reduces immune response

Tests Your Doctor May Order

Stool Microscopy and Culture

For bloody diarrhoea or diarrhoea not resolving within 5–7 days — identifies bacterial causes (Salmonella, Shigella, E. coli) and parasites (Giardia, Entamoeba).

Full Blood Count

For bacterial dysentery — elevated white cells suggest bacterial infection requiring antibiotic treatment.

Electrolytes

For hospitalised children — to assess severity of dehydration and guide IV fluid replacement.

Malaria RDT

Diarrhoea with fever in a young child should also prompt malaria testing.

How It Is Treated

ORS — The Life-Saving Treatment

WHO/UNICEF ORS is the gold standard. Give 50–100ml per kg over 4 hours for mild-moderate dehydration. For severe dehydration, IV fluid replacement in hospital is needed.

Zinc Supplementation

10–20mg daily for 10–14 days — reduces episode duration by 25% and prevents further episodes in the next 3 months.

Antibiotics — Only When Indicated

Bloody diarrhoea (dysentery): metronidazole (for amoebiasis) or trimethoprim-sulfamethoxazole/ciprofloxacin (for bacterial causes). Not for routine watery diarrhoea.

Rotavirus Vaccination

The rotavirus vaccine (on Nigerian NPI schedule at 6 and 10 weeks) prevents the most severe form of viral gastroenteritis in infants. Vaccination reduces childhood diarrhoea hospitalisations significantly.

Nutrition Rehabilitation

After recovery from acute diarrhoea — increase feeding to restore weight. A "catch-up" feeding period prevents the growth faltering that frequently follows acute illness.

Frequently Asked Questions

What should I mix ORS in?

Clean, safe drinking water — boiled and cooled, or purified. One full sachet in exactly 1 litre. Do not use less water (too concentrated) or more water (too dilute). Do not add sugar or flavouring.

How much ORS should I give?

For mild diarrhoea: after each loose stool, give 50–100ml (10 teaspoons) in children under 2, or 100–200ml in older children. For significant dehydration, give 50–100ml per kg over 4 hours.

Should I give probiotics for diarrhoea?

Some probiotics (particularly Lactobacillus rhamnosus GG and Saccharomyces boulardii) modestly reduce diarrhoea duration. They are safe and may help but are not the primary treatment — ORS and zinc come first.

My child is vomiting everything — how do I give ORS?

Give very small amounts very frequently — a teaspoon every minute (5ml/min). Small amounts given more frequently are retained even when larger amounts are vomited. If the child cannot retain anything for 1 hour, this needs medical assessment.

Why does my child keep getting diarrhoea?

Recurrent diarrhoea in Nigerian children is usually caused by contaminated water, inadequate hand hygiene, or intestinal parasites. Review water sources, hand washing practices, and consider routine deworming (6-monthly from age 1).