Dehydration Assessment
Assess each of the 4 WHO clinical signs. Select the option that best matches the child.
kg — for ORS volume calculation
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WHO Plan
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rehydration
ORS (4h)
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mL
WHO Dehydration Classification
| Sign | 0 — No Dehydration | 1 — Some Dehydration | 2 — Severe Dehydration |
|---|---|---|---|
| General appearance | Well, alert | Restless, irritable | Lethargic, unconscious, floppy |
| Eyes | Normal | Sunken | Very sunken and dry |
| Thirst / drinking | Drinks normally, not thirsty | Thirsty, drinks eagerly | Drinks poorly or not able |
| Skin pinch | Returns immediately | Returns slowly (<2s) | Returns very slowly (>2s) |
WHO Rehydration Plans
- Plan A (No/Minimal Dehydration — Score 0–1): Home treatment with ORS. Give 10 mL/kg ORS for each loose stool passed. Continue breastfeeding. Zinc 20 mg OD × 10 days (10 mg if <6 months). Return if worsening
- Plan B (Some Dehydration — Score 2–4): ORS 75 mL/kg over 4 hours in clinic. Reassess every hour. If vomiting: 5–10 mL/kg NG ORS. After rehydration, continue Plan A. Zinc 20 mg OD × 10 days
- Plan C (Severe Dehydration — Score ≥5): IV Ringer's Lactate (preferred) or NS: 100 mL/kg. Children: 30 mL/kg over 30 min, then 70 mL/kg over 2.5 hours. Reassess every 15–30 min. Start ORS as soon as child can drink. Admit to hospital
Zinc Supplementation — Why It Matters
WHO and UNICEF recommend zinc supplementation for all children with diarrhoea: 20 mg/day for children ≥6 months, 10 mg/day for infants <6 months, for 10–14 days. Zinc reduces the duration of diarrhoea by ~25%, reduces stool output, and reduces the risk of subsequent diarrhoeal episodes for up to 3 months. In India and South Asia, zinc supplementation is part of the national diarrhoea management protocol alongside ORS.
Red Flags — When to Refer Urgently
- Severe dehydration (Plan C) — always admit
- Bloody diarrhoea (dysentery) — antibiotic therapy needed
- High fever (>39°C) with diarrhoea in infants <6 months
- Persistent vomiting preventing ORS administration
- Abdominal distension — possible ileus or obstruction
- Worsening dehydration despite Plan B
Related Calculators
⚠ Medical Disclaimer: Clinical dehydration assessment must integrate all 4 WHO signs, vital signs, urine output, and weight loss. This tool is a decision-support guide. Children with severe dehydration, shock, or inability to drink require immediate IV therapy and hospital admission. Always reassess after rehydration.