Nutritional management of acute diarrhea

Despite recommendations from several bodies such as the World Health Organization and others that feeding should be continued during diarrhea, the practice of withholding food during the early stages of diarrhea is still widespread. This contributes to a deterioration in patients' nutritional state. The principal controversy in the nutritional therapy of acute gastroenteritis centers on the relative risks of cows'-milk feeds. The two things that need to be considered in determining the optimum approach to feeding the child with acute diarrhea are the optimum timing for feeding children in relation to the onset of and recovery from symptoms and, secondly, the effects of specific food ingredients in the diet. Recent studies have demonstrated that the vast majority of young children with acute diarrhea can be successfully managed with continued feeding of undiluted non-human milk. Routine dilution of milk and routine use of lactose-free formula are not necessary, especially when oral rehydration therapy and early feeding (in addition to milk) form the basic approach to the clinical management of diarrhea in children. Confounding factors are the severity of the diarrhea, coexistent malnutrition, and young age (< 1 y); such infants are much more likely to have complications from early feeding with undiluted milk and some would advocate use of specifically designed lactose-free formula in such children. Children who are fed exclusively with human milk and those who receive solid foods with or without human milk may safely continue to receive their usual diets during diarrhea. Those who are fed exclusively with non-human milk--especially when very young and with severe diarrhea or malnutrition--should be closely observed if they continue to consume milk or they should receive a special formulation (e.g., a cereal-milk mixture or fermented milk product). The use of nutrient-dense mixtures of common foods may be advisable to promote compensatory growth in those who lose weight during illness or because of anorexia or malabsorption.