In forty years of paediatric practice at Koramangala, Bengaluru, I have seen a great deal change in how we care for sick children. We have better vaccines, better antibiotics, better understanding of complex allergic and respiratory disease. But one treatment has not changed, because it does not need to. Oral Rehydration Solution, ORS, has been the single most effective intervention for childhood diarrhoea and dehydration since it was introduced, and it still is. Every 29 July on World ORS Day, I find myself reflecting not on how far we have come, but on how much preventable suffering still occurs because this simple, proven, inexpensive treatment is either not given correctly, not given at all, or given too late.
What ORS does that nothing else can
Diarrhoea kills children not because of the infection itself but because of what the infection takes away: water, sodium, potassium, and glucose. When a child has loose stools, the intestinal lining is simultaneously losing fluid and losing its ability to absorb plain water efficiently. ORS works because it exploits a different mechanism - the sodium-glucose co-transport system - which remains functional even in an acutely inflamed gut. The right balance of glucose and sodium in ORS solution allows the intestinal cells to actively pull both glucose and sodium across the lining together, and water follows. This is not a supportive treatment while we wait for something better. This is the treatment. No oral medication, no antibiotic, no ayurvedic formulation, and no fruit juice replaces what ORS does at the cellular level in a dehydrated child.
What I still see after four decades in paediatrics
In fifty years of research and advocacy, ORS has saved an estimated 80 million lives globally. And yet, in my clinic at Koramangala in 2026, I still regularly see families who gave their child plain water instead of ORS because they thought it was the same thing. I still see children brought in after three days of diarrhoea with significant dehydration because the family was giving the child nothing by mouth in the mistaken belief that feeding and fluids would worsen the loose stools. I still see ORS prepared incorrectly, with too much water or too little, reducing its effectiveness. I still see antibiotic prescriptions for viral gastroenteritis in children who needed only ORS and zinc. As President of the IAP Infectious Disease Chapter, Karnataka, I was involved in education programmes designed specifically to address these gaps. The knowledge is not absent from the medical community. What is absent is the chain of communication that reliably gets the correct information to the family at home, in the first hour of a child's diarrhoeal illness, before dehydration begins to accumulate.
The role of zinc and why it matters alongside ORS
One thing that has changed in how we manage childhood diarrhoea since my early years in practice is the routine addition of zinc supplementation alongside ORS. The World Health Organization now recommends 20 mg of zinc daily for 10 to 14 days in children with diarrhoea, and for 10 mg in infants under six months. Zinc reduces the duration and severity of the diarrhoeal episode and, importantly, reduces the risk of recurrence in the following two to three months. The mechanism is different from ORS - zinc supports intestinal cell repair, immune function, and gut barrier integrity - but the two work together, and the combination is now considered standard of care. I make a point of explaining this to every family who comes to me with a child with acute gastroenteritis, because zinc is still frequently omitted and the benefit is real and evidence-based.
To every parent in Bengaluru and beyond: if your child develops acute watery diarrhoea, start ORS immediately - do not wait to see whether it gets worse. Prepare the sachet exactly as instructed, which means dissolving one sachet in exactly one litre of clean water and nothing else. Offer small, frequent sips. Continue feeding, including breastfeeding. Add zinc as your doctor advises. And seek medical attention if the child has blood in the stool, appears lethargic or unusually drowsy, is not improving after 24 hours, or shows any signs of significant dehydration such as very dry mouth, no tears when crying, or markedly reduced urine output. ORS is not everything, but it is the most important thing. That has been true for the whole of my career, and I do not expect it to change.
To book a consultation with Dr. Gnanamurthy N at Mother and Child Care Centre, 47, 1st A Main Road, KHB Colony, 7th Block, Koramangala, Bengaluru 560095 (Monday to Saturday, 10:30 AM to 4:30 PM), call +91 63666 69168 / +91 9535315304 / +91 80 25710808.
Written by Dr. Gnanamurthy N, MBBS (Kasturba Medical College, Mangalore, 1984), DCH (KMC, 1987), FIAP (2016), FAAP (Medtrain, 2023), ICPP (Medtrain-Birmingham, 2024), Dr B C Roy Award 2021, Shishu Rathna Award 2024, National Expert Faculty IAP, Former President IAP Bangalore 2011 and IAP Infectious Disease Chapter Karnataka 2014, Paediatrician and Allergy and Asthma Specialist, Mother and Child Care Centre, Koramangala, Bengaluru.
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