When sugar poses as medicine: Doctors warn against 'ORS' drinks for children

Physicians across India are urging caregivers to be wary of packaged, sweetened drinks promoted as ORS (Oral Rehydration Solution). Though packaged in bright bottles and pitched as quick hydration, many of these products contain excessive sugar that can aggravate rather than relieve dehydration in children.

The alert follows action by India’s regulator, the Food Safety and Standards Authority of India (FSSAI), which told manufacturers to stop using the term “ORS” in product names or advertising unless their formulations matched World Health Organization (WHO) criteria. The Delhi High Court has temporarily stayed that directive after a manufacturer contested the order.

Doctors say this mix-up threatens children's safety

Sugary drinks sold as ‘ORS’ are unsafe, say experts

Pediatrician Dr Sivaranjani Santosh of Hyderabad, who has campaigned against counterfeit ORS products for years, warns these beverages can be dangerously sweet. She notes many commercial bottles contain sugar levels far above what children should ingest.

The WHO recommends an ORS concentration of about 13.5 grams of sugar per litre. By contrast, some ready-to-drink products marketed as ORS have reported sugar contents exceeding 110 grams per litre — a concentration that can impede fluid absorption and worsen dehydration.

Dr Santosh said, "FSSAI’s effort was a step toward protecting kids. These sugary preparations are not therapeutic ORS — they behave like high-sugar fluids that may do more harm than good."

Consequences of using the wrong solution

Clinicians warn that administering inappropriate rehydration fluids carries real risks. Dr Dhanasekar Kesavelu from Apollo Hospitals reports seeing children with abnormally low sodium and elevated blood sugar after consuming such drinks.

He added, "There have been instances where infants developed severe complications — including seizures and intracranial bleeding — linked to improper hydration fluids."

Dr Srinivas Midivelly of Yashoda Hospital says admissions for dehydration related to these misleading products have risen in recent years. "A correctly prepared WHO-approved ORS can be lifesaving. But sugary beverages masquerading as medical solutions can worsen a child’s condition," he noted.

What genuine ORS looks like

Authentic Oral Rehydration Solution balances sugar with essential salts — sodium, potassium and chloride — so the gut can absorb fluid and electrolytes lost during diarrhoea or vomiting. Precise mixing with clean water, as directed on the packet, is crucial.

Experts caution that sports and energy drinks are not substitutes: they often contain high sugar and inadequate electrolytes, which can be counterproductive.

Dr Kesavelu recommends, "Purchase WHO-approved ORS sachets from reputable pharmacies and dissolve them exactly as instructed. Do not estimate or dilute them by guesswork."

Why fake ORS harms children

Dr Santosh recalls children whose conditions worsened after caregivers gave them these sweetened 'ORS' bottles. "Although fatalities were not reported in those cases, many youngsters became sicker. These products prioritise marketing over safety," she said.

Clinicians also note that cheerful packaging and images of healthy kids can mislead parents into thinking the drinks are medically appropriate.

Guidance for parents

Doctors offered practical steps for families to protect children from dehydration and avoid harmful products:

Use only real ORS: Buy WHO-approved ORS sachets at trusted pharmacies and mix exactly as instructed.

Avoid sugary drinks: Refrain from buying beverages labelled as "energy," "electrolyte," or "ORS" unless a physician confirms their suitability.

Watch ingredients: Read labels closely; very high sugar content is a red flag.

Keep children hydrated naturally: Offer water, coconut water, or a carefully prepared home solution of lemon, salt and a small amount of sugar instead of packaged alternatives.

Feed hydrating foods: Offer water-rich fruits and vegetables such as cucumber, watermelon and oranges to help maintain fluids.

Consult a doctor: Seek medical attention promptly if a child has diarrhoea, vomiting or signs of dehydration such as dry mouth, sunken eyes, lethargy or reduced urine output.

The wider concern

Beyond individual cases, clinicians say the episode highlights problems with misleading marketing and lax labelling. They call for clearer rules to prevent medical terms like "ORS" from being used to sell ordinary sugary drinks.

Parents are encouraged to stay informed and cautious when choosing rehydration options. As Dr Santosh put it, "A legitimate ORS can save lives; a counterfeit one can make a child much worse."

Summary:
Medical professionals in India warn that many sweetened drinks advertised as "ORS" contain dangerously high sugar, which can deepen dehydration in children. Parents should use WHO-approved ORS sachets, check labels carefully and seek medical advice for dehydration.