PAEDIATRIC GASTROENTEROLOGY: Dietary management of acute diarrhoea in childhood

Abstract

Gastroenteritis in children is usually treated with the graded introduction of milk feeds after rehydration. Although having never been rigorously tested, the practice of gradually increasing milk strength over several days has been considered an appropriate means of warding against lactose intolerance and preventing sensitization to cow's milk antigens. These guidelines were formulated in Europe and North America and invariably lead to a reduction in nutrient intake. Malnourished children in developing countries, however, may experience an average 5-6 episodes of acute diarrhea per year and the nutrient effects are cumulative. A recent study from Latin America explored whether continued feeding is safe for infants under age 6 months and whether malnourished children respond adversely. Infants randomly assigned to receive full strength cow's milk immediately after rehydration did not have more treatment failures, higher stool outputs, or longer lasting diarrhea than those whose feeds were regarded to full strength over 48 hours. It is unclear, however, whether the youngest or more malnourished subjects were overrepresented in the treatment failures. Results also indicate that deciding to change treatment should not be dictated by the presence of reducing substances in the faeces; the majority of infants with reducing substances in their stools did well. This study offers the first scientific support for rapidly reintroducing full-strength milk formula after gastroenteritis is malnourished patients under 6 months of age. The 10% of infants in which dehydration recurs after reintroducing milk feeds are still difficult to manage. In the absence of yogurt or lactose-free formula, a locally-produced modular feed of chicken, starch, and vegetable oil may be suitable.