Shaping the discourse on rehydrating children in heat stress: expositions from India

Heat health responses for young children constitute a unique public health challenge and Oral Rehydration Solution (ORS) have emerged as a key intervention in various advisories and heat action plans HAPs). ORS is an extraordinarily impactful first-line therapeutic intervention in reducing mortality and morbidity on account of dehydration and dyselectrolytemia in children caused by acute diarrheal diseases and is backed by state health and non-health agencies the world over. The reconstitution of ORS into a solution for oral rehydration therapy relies on the packaging instructions and frontline health workers; systematic reviews highlight low levels of knowledge and understanding of these aspects. Most of these HAPs and advisories are conspicuously silent on reconstitution and dosages. We have drawn upon available global literature and Indian evidence to shape this discourse across three strands - policy perspectives, clinical evidence and critiques on inappropriate usage of ORS and mislabeling of rehydration fluids to shape our arguments. It is imperative that only WHO formulated ORS is used for this purpose. Heat Action Plans need to specify age- and weight-specific ORS guidance, in line with the UNICEF advisory. India's linguistic diversity calls for multilingual and pictorial instructions for correct preparation by caregivers, Capacity building of first responders and frontline health workers to correctly administer ORS for children's HRIs is also an urgent imperative.