This post is also available in: Svenska

Oral rehydration solution (ORS) is indispensable when children are sick, especially if they have gastroenteritis. It prevents dehydration and fluid deficiency in children. You can make your own ORS according to the children’s emergency room’s prescription, or buy one at a local pharmacy. Check the age limits of commercial products.

When does your child have dehydration?

At the very least, your child can be on and off during the day. If their fever is low and they are alert, happy and want to play, then they’re OK. If they sleep more than usual then that is quite OK, but they should be able to wake up sometimes by themselves.
Check their urine. It can be difficult to judge diapers especially when they have a lot of diarrhea. But you have to try your best.
If they’re skin is warm, dry and of their normal color, then they are OK. A little paler is perhaps fine. But gray-green pale and sticky? That’s not OK!
Look for saliva in their mouth. And if they cry, check that they have tears.

Do not wait until your child has become dehydrated before you start giving ORS. Signs of dehydration include, becoming dull, not urinating, becoming cold with sticky skin and no saliva in the mouth. ORS should be given from the very first vomiting or diarrhea episode!

It can be purchased in powder form at the pharmacy. It is really important to mix in the exact amount of water stated on the packet to ensure that you’ve made the right strength (measure it!).

Recipe for your own Oral Rehydration Solution (ORS)

1 liter (33.8oz) of clean water (tap water in Sweden is sufficient)
0,5 tsp salt (sodium chloride or plain cooking salt. Do not use mineral salt, other salt variants, or flake salt as it will be the wrong amount.)
2 tablespoons granulated sugar

Stir the salt and sugar until dissolved. Taste! It should taste a little salty but slightly more sweet. Importantly, it should be fully drinkable for your child. You can mix in a little juice concentrate (2 teaspoons in the whole liter) to improve the taste, but I can’t guarantee it’ll get any better. Taste it and determine what you think will be least difficult to get into your child.

Again, it is REALLY IMPORTANT to measure and follow this recipe exactly, so the right concentration of sugar and salt are in the solution. No cheating! A solution with too much sugar or salt can worsen the situation rather than help it.

A correctly mixed ORS is a life-saving and amazing medication!

ORS from the pharmacy is well balanced and works well. It is just as important to mix it with the right amount of water as it is to mix the homemade liquid substitute correctly.

Some ORS (e.g. Resorb in Sweden) are not recommended for children, especially children under three years of age. It contains more sugar and less salt per liter than the recommended solutions which can interfere with the salt balance of the body.

How much ORS do children need to prevent dehydration?

A sick child being fed liquid via a spoon by their mother — Feed your child ORS, little by little

If they vomit, begin giving the ORS via a syringe (without a tip). 5mL every five minutes. After half an hour without vomiting, you can give 10mL every ten minutes. After an hour without vomiting, you can give your child ORS in a baby bottle in small sips. If they vomit again, go back to 5mL every five minutes.
If your child only has diarrhea, you can give the ORS more frequently as soon as symptoms appear.

Give 50mL of ORS for every diarrhea your child experiences.

If your child’s only form of liquid is ORS, you’ll need to compensate for their daily fluid intake (e.g. all the fluid the child usually consumes in food and drink) plus the fluid losses (e.g. diarrhea and vomiting).
So there’s a lot of fluid you have to give! But if you can follow through with this and your child is alert, pees and has warm skin, you can pat yourself on the back. What a fantastically talented, wise and life-saving parent, you are!

When will the child receive anything other than ORS?

When your child does not vomit and does not have very intense diarrhea (i.e. has less than 8 episodes/day), you can give them liquid other than ORS. Mix a bit of sugar in it. It’ll give them some energy. Frozen liquid or ice cream is also fine. Fruit puree or porridge usually also works well.
Food can wait until the baby wants it. Liquid, however, can’t wait. It’s crucial.

What to do if the child doesn’t want to drink ORS?

Force the baby. You’ve read this correctly. Force the baby. We are not used to forcing our children to do things in Sweden today, and that is good. But when it comes to fluid, especially during gastroenteritis, we must! Sit your child on your lap, hold their flailing arms and insert the syringe (without tip), deep into the mouth (or outside the teeth) and inject the liquid towards the inside of the cheek as far back as you can get it. A little bit may have been spat out, but most of it goes in. If you feel like the worst parent in the world forcing your child, I just want to say, from a pediatrician, YOU ARE NOT. In fact, quite the opposite. You’re giving the child what they need even if the child doesn’t understand it.

Read this if you’re not coping with your children (you’re not alone)

When do I need to take my child to the hospital?

If a child under the age of two has very frequent diarrhea (10-15/day or more) for a few days, you should visit the hospital. Even if you manage to give enough ORS to your child, it’s important to check that the salt balance in the blood is OK. Often, you can go home and continue with ORS.
If they vomit so much that it is impossible to take in ORS.
For infants under three months of age with copious vomiting and diarrhea, we would like to assess them in the children’s emergency room.
Children who have a huge stomach ache, even if it’s only short bursts.
Children showing signs of dehydration (refer to above) that do not get better after a few hours of ORS.
Is the child exhausted? Difficult to wake up? Has cold, pale and sticky skin? Or just hangs like a rag doll?
The child has copious diarrhea with blood. If the child has a few diarrhea episodes per day, with little blood, you can go to the medical center the next day.
When you can’t take it any more and don’t have anyone to help at home, then tell someone at the hospital, “I’m alone and can’t take it any more, I have to sleep!”. Otherwise, it may be difficult for the pediatrician to understand why it is not possible to be at home when the child is not dehydrated.

Refer to point #8 above. Child-rearing is a full-time job and more so when you’re dealing with a child with gastroenteritis. Make sure you share the load, whenever possible. A sick parent can’t take care of a sick child. If that’s the case, the other parent must stay at home. If you are a single parent, you will need the help of another adult.

Feeling like a bad mother? – When you can’t cope with your kids

Gastroenteritis or winter vomiting in children – infection and incubation period

Baby poo – what is normal? Green poop or slimy – what does that mean?

Fever in babies and children – what to do and when is the fever too high?

Gastroenteritis and breastfeeding