Oral rehydration at home and in the clinic: plans A and B, continued feeding and warning signs

What it is

Oral rehydration solution (ORS) treats most children with diarrhoea. AIEPI uses three plans. Plan A is for the child without dehydration and is carried out at home with five rules. Plan B corrects some dehydration with ORS given in the clinic over about four hours, with regular reassessment. Plan C, for severe dehydration, is intravenous and belongs to the doctor and the referral hospital. The nurse's work in plans A and B is to prepare the solution correctly, give it in small frequent amounts, keep the child feeding, watch the response and teach the family.

Indications

• Plan A: diarrhoea without dehydration, at home.
• Supervised plan A: no dehydration but persistent vomiting, high-output diarrhoea or refusal of oral fluids; observe in the clinic before sending home.
• Plan B: diarrhoea with some dehydration, in the clinic.
• Prevention of dehydration in any child with diarrhoea who is sent home.
• Volumes by weight, with worked examples, are on the calculation page.

Contraindications and precautions

• Severe dehydration, shock, lethargy or inability to drink: plan C and urgent referral, not oral rehydration alone.
• Another severe classification: refer urgently with the carer giving ORS on the way.
• Severe acute malnutrition: rehydration follows its own protocol; do not apply the standard plan without the doctor.
• Prepare ORS only with safe water and the full sachet in the volume of water stated on the sachet; do not add sugar or salt.
• Avoid sugary soft drinks, sports drinks, packaged juices, coffee and herbal infusions as rehydration fluids.

Equipment

• Low-osmolarity ORS sachets and safe water (boiled and cooled if needed).
• A clean measuring jug or bottle of the volume stated on the sachet.
• Cup and teaspoon; a bib or cloth.
• Scale, intake and output sheet and the AIEPI recording form.
• Two or more sachets to send home, as indicated.

Step by step (and why)

1. Wash your hands and ask the carer to do the same — diarrhoea germs spread by hands.
2. Weigh the child and note the classification — weight sets the plan B volume and is the baseline to judge progress.
3. Dissolve one sachet in the volume of safe water the sachet states and mix well — wrong concentrations can harm the child.
4. Show the carer how to give it by teaspoon every 1–2 minutes, or sips from a cup — small amounts are absorbed even if the child vomits.
5. Keep breastfeeding during rehydration and give more ORS if the child wants it — breast milk continues and thirst guides intake.
6. Record every intake, stool and vomit — the balance shows if losses are being replaced.
7. Reassess hourly and fully at 4 hours, then reclassify — the plan changes with the child's state.
8. When rehydrated, offer food in the clinic to check tolerance — stool output must not rise markedly.
9. Before discharge, teach the plan A rules, check the carer can prepare ORS and give sachets for two days — home care continues the treatment.

Complications

• Persistent vomiting or refusal to drink, so that ORS cannot be given.
• Frequent high-output stools in a child who drinks poorly: this is the child who may need plan C.
• Signs of severe dehydration appearing during plan B (move to plan C, per protocol).
• Return of dehydration at home when the family stops giving fluids or stops feeding.

Next step: when to call for help

• Lethargy, inability to drink or signs of severe dehydration at any time: call the nurse in charge and the doctor at once.
• Still dehydrated at 4 hours, or vomiting that prevents ORS: report for a change of plan.
• At home, return at once if there are many watery stools (more than 10 in 24 hours), repeated vomiting, great thirst, poor eating or drinking, fever, or blood in the stool.
• If the child must leave before rehydration is complete, give sachets, show preparation and agree on how much to give over the next hours, per protocol.

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Elsewhere in DurgiPedia

• Dehydration and fluid overload

Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Cuadro de procedimientos AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia) (Ministerio de Salud y Protección Social de Colombia, 2016); Componente comunitario de la estrategia AIEPI: guía para referentes y coordinadores locales (Ministerio de la Protección Social de Colombia / Organización Panamericana de la Salud, 2010); AIEPI: Guía del facilitador clínico (Ministerio de Salud y Protección Social de Colombia / Organización Panamericana de la Salud, 2012); Diarrhoeal disease (fact sheet) (World Health Organization, 2024).

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