Why ORS is in the news and what it means for child health in India

With only 60% of children in India receiving correct ORS during diarrhoea, counterfeit products are putting many lives at risk. Now a Hyderabad-based paediatrician is on a mission to change that

For decades, Oral Rehydration Solution (ORS) has been one of the simplest and most effective medical interventions. This humble mix of salts, sugar and water has saved millions of lives worldwide. Used correctly, it can stop dehydration in its tracks, especially in children suffering from diarrhoea or vomiting.

 

Lately, however, this life-saving solution has been making headlines for the wrong reasons. The term ‘ORS’ is being misused by companies selling sugary drinks under the same label, raising serious concerns about consumer safety and public health.

 

What’s the issue?

In recent years, many beverages such as fruit-based drinks, ready-to-drink “hydration” solutions, have been marketed using the term ‘ORS’. These drinks often carry high levels of sugar and do not adhere to the medically recommended formulation of ORS by the World Health Organisation.

 

According to WHO, the standard oral rehydration solution contains 2.6 grams of sodium chloride, 13.5 grams of dextrose anhydrous (sugar), 1.5 grams of potassium chloride and 2.9 grams of trisodium citrate per litre of water. In contrast, these ORS-like sugary drinks can contain 110-120 grams of sugar.

 

Health experts warn that giving children such sugary drinks during diarrhoea or vomiting can worsen dehydration, as the excessive sugar alters the osmotic balance and draws more fluid into the bowel instead of helping absorb it.

 

After nearly eight years of tireless campaigning by Dr Sivaranjani Santosh, the Food Safety and Standards Authority of India (FSSAI) finally acted. In October 2025, the authority issued a directive stating that no food or beverage product may use the term ‘ORS’ (or any variation) unless it meets the required medical-grade formulation.

 

However, the regulatory story took a turn when the Delhi High Court granted interim relief to JNTL Consumer Health (India), a subsidiary of Kenvue, which in turn is owned by Johnson & Johnson. The court directed the FSSAI to review the company’s representation before enforcing the ban, allowing its products to remain on the market in the meantime.  This development has raised concerns about how effectively the regulation will be implemented and whether it can truly safeguard children’s health.

 

Dr Sivaranjani Santosh’s fight

Dr Sivaranjani Santosh is a paediatrician based in Hyderabad who picked up on a troubling pattern – children with diarrhoea were being given ‘ORS’ drinks but were getting sicker instead of better. She found that many marketed ‘ORS’ sachets or drinks had far more sugar than the WHO-recommended formula, and insufficient salts.

 

From 2017 onwards, she began documenting cases, spreading awareness among parents and fellow doctors, writing to regulators, and actively advocating for action against misleading labelling. Over time, several medical colleagues from across India and influencers on social media joined her campaign, helping amplify awareness and educate the public about the dangers of fake ORS products.

 

Why does her fight matter?

Her work matters because the implications are significant:

• Child health risk: When children suffering from diarrhoea are given sugary drinks that masquerade as ORS, dehydration can worsen, leading to serious complications such as seizures, organ failure or worse.
• Public trust: Parents assume that anything labelled ‘ORS’ is medically safe and reliable. If misleading products infiltrate that trust, it undermines confidence in healthcare guidance.
• Regulatory precedent: Dr Santosh’s campaign resulted in the FSSAI directive banning the term ‘ORS’ in mis-labelled food/ drinks, a landmark consumer-protection move.
• Education for caregivers: Her advocacy highlights the importance of caregivers knowing how to correctly use true ORS, not just any hydration product, and understanding the difference.

 

According to NFHS-5 data, only about 60 per cent of children suffering from diarrhoea receive proper ORS treatment. Diarrhoea remains the third leading cause of death among children under five, accounting for roughly 13 per cent of fatalities in this age group.

 

Public health experts warn that the spread of misleadingly branded ‘ORS’ drinks not only delays effective treatment but also undermines decades of public health messaging around Oral Rehydration Therapy, an intervention proven to reduce child mortality by up to 93 per cent. This makes Dr Santosh’s fight all the more critical, as it seeks to protect one of the simplest and most effective life-saving tools in child healthcare.

 

Also read: NHRC seeks report from FSSAI over widespread reuse of cooking oil in India

 

Current status and next steps

While the FSSAI directive is a win, enforcement is key. The interim court stay means some companies may continue to sell products under ‘ORS’ branding until a full hearing, but the production of new variants remains suspended.

Experts urge swift action to remove misleading products from hospitals, pharmacies, schools and stores, and to ensure only WHO-approved ORS sachets are used in medical settings.

 

Takeaways for caregivers

•  Use only WHO-approved ORS sachets from verified medical or pharmacy sources.
• Mix it exactly as instructed - one sachet in one litre of clean, boiled and cooled water.
• Give small sips frequently to prevent dehydration, especially after every loose motion or vomiting episode.
• Store prepared ORS properly and discard any leftover solution after 24 hours.
• Consult a doctor immediately if the child shows signs of severe dehydration such as sunken eyes, lethargy or no urination for several hours.

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