Probiotic Drops With ORS and Zinc for Child Diarrhoea

Oral rehydration solution (ORS) and zinc are the two treatments the World Health Organization recommends for every child with acute diarrhoea. Probiotic drops such as Lactobacillus rhamnosus GG can be added on a doctor's advice, but they do not replace either. ORS prevents dehydration, zinc shortens the illness, and continued feeding supports recovery.

Why is ORS the most important treatment?

Diarrhoea becomes dangerous mainly through dehydration, the loss of water and salts faster than a child can replace them. ORS works because glucose and sodium are absorbed together in the small intestine through a transporter protein called SGLT1, and water follows them. This pathway keeps working even when the gut is inflamed.

WHO and UNICEF have recommended low-osmolarity ORS since the early 2000s. Its lower salt and glucose content reduced stool output and vomiting compared with the original formula. Plain water, fruit juice, soft drinks and glucose drinks do not contain the right balance and can worsen diarrhoea.

How should ORS be prepared and given?

Correct preparation matters because a concentrated solution can draw water into the gut and worsen diarrhoea.

Mix exactly. Dissolve one sachet in the volume of clean drinking water printed on the packet, usually one litre. Never add extra powder, sugar or salt.

Use it fresh. Discard any prepared ORS left after 24 hours.

Give small sips. Offer a teaspoon every one to two minutes for infants, or small sips from a cup for older children. Large gulps often trigger vomiting.

Replace ongoing losses. Offer ORS after each loose stool, in addition to normal feeds and fluids.

Pause and resume after vomiting. Wait about ten minutes, then continue more slowly.

What does zinc do and how much is given?

Zinc supplementation shortens episodes of diarrhoea and reduces the chance of another episode in the following months, particularly in children whose diets may be low in zinc. WHO advises giving zinc for 10 to 14 days, even after diarrhoea stops:

• 10 mg daily for infants under six months
• 20 mg daily for children six months and older

Dispersible tablets and syrup forms are available in India. It sometimes causes vomiting if given on an empty stomach, so giving it after a feed often helps. The doctor or pharmacist should confirm the preparation and dose.

Where do probiotic drops fit in?

Probiotic drops are an optional third element. ESPGHAN considers a few strains, including LGG, reasonable to offer alongside rehydration, with a weak recommendation reflecting uncertain benefit. The trial evidence and the reasons for that rating are covered in LGG for acute diarrhoea in children.

If a paediatrician advises probiotic drops during diarrhoea, practical points help:

• give the drops separately from ORS, on a spoon or in a little cool water, so a refused cup of ORS does not also mean a missed probiotic dose
• never mix drops into hot food or drinks
• continue ORS and zinc exactly as advised, regardless of the probiotic

Rhambac® GG Drops from ELMED Life Sciences contain LGG ATCC 53103 at 1 billion CFU per 6 drops. Dose and duration during an illness should come from the prescriber.

What should a child eat during diarrhoea?

Children should keep eating their normal, age-appropriate diet. Breastfed infants should continue breastfeeding, often more frequently. Formula-fed infants should continue their usual formula at normal strength, since diluting it is no longer advised.

Older children can eat familiar foods such as rice, dal, curd, khichdi, bananas and chapati. Very sugary drinks and packaged juices are best avoided because sugar draws water into the gut. Starving a child during diarrhoea slows recovery of the gut lining.

When does a child need a doctor urgently?

Take the child to a doctor promptly if any of these appear:

• fewer wet nappies or no urine for six hours or more
• sunken eyes, dry mouth or no tears when crying
• unusual sleepiness, floppiness or irritability
• repeated vomiting that prevents drinking ORS
• blood in the stool
• high fever, or any fever in an infant under three months
• diarrhoea lasting more than a week

Anti-diarrhoeal medicines such as loperamide should not be given to young children unless a doctor specifically prescribes them. The guide to LGG probiotic drops for infants and children covers broader safety considerations.