Introduction: Among children, diarrhea continues to be a major cause of morbidity & mortality. High prevalence of this is closely linked with poverty and poor personal hygiene. An estimated 60-70% of diarrheal deaths are caused by dehydration. Improved hygienic practices are essential if transmission of routes of water and sanitation related diseases are to be cut. Child to child program based on the principle of children as agents of change is cost effective strategy to spread health messages and hygienic practices. Hypothesis: There is an improvement in knowledge, attitude and practices regarding personal hygiene, environmental hygiene, diarrhea and ORS among school children after health education. Material and methods: Community based interventional study was conducted including all 5th standard students.  Following a pretest three interactive and participatory sessions were conducted. Sessions were focusing on imparting knowledge about personal hygiene, environmental hygiene, diarrhea and ORS and reinforcing correct hygienic practices. Post test was conducted at the end to compare the knowledge and practices for 152 students who participated throughout the program. Data analysis was done by SPSS version 20 & MS Office Excel 2010. Results: There was significant improvement in the knowledge and practices regarding personal and environmental hygiene among school children after intervention. The knowledge regarding use and preparation of ORS improved after intervention. Conclusion: Child to Child program is an effective activity based interactive approach for improvement in the knowledge, attitude and practices regarding personal hygiene, environmental hygiene, diarrhea and ORS.