Plan B: Treat for Some Dehydration with ORS

In the Clinic: Give recommended amount of ORS over 4-hour period

Determine amount of ORS to give during first 4 hours

• The amount of ORS needed each hour is about 20 ml for each kilogram weight. Multiply the child’s weight in kg by 20 for each hour. Multiply this by four for the total number of ml over the first four hours. One teacup is approximately 200 ml

Show the caregiver how to give ORS solution

• Give frequent small sips from a cup
• If the child vomits, wait 10 minutes. Then continue, but more slowly
• Counsel the mother to continue breastfeeding whenever the child wants
• If the child wants more ORS than shown, give more

After 4 hours

• Reassess the child and classify the child for dehydration
• Select the appropriate plan to continue treatment
• Begin feeding the child in clinic

If caregiver must leave before completing treatment, or the clinic is closing

• Refer if possible. Otherwise:

    - Show her how to prepare ORS solution at home
    - Show her how much ORS to give to finish the 4-hour treatment at home
    - Show her how to prepare SSS for use at home
    - Explain the Four Rules of Home Treatment

1. Give extra fluid

2. Give Zinc 

3. Continue Feeding - Refer to the Counsel the Mother or Caregiver on Infant & Young Child Feeding: 

• Breastfeeding Support
• Expressing Breastmilk & Cupfeeding
• Replacement Feeds
• Correct Volumes and Frequency of Feeds (Breastmilk & Formula)
• Appetite Test
• RUFT (Ready-to-Use Therapeutic Food)
• Feeding Assessment
• Feeding Problems Counselling
• Feeding Recommendations from 6 Months

4. When to Return Birth to 2 months or 2 months to 5 years 

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Integrated Management of Childhood Illness 2022; Child (Age 2 months up to 5 years); Oral Medicines; Plan B: Treat for Some Dehydration with ORS.

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Last checked for updates: June 2023