Contemporary issues in the dietary management of children with acute diarrhea include the optimal timing of introduction of foods during illness, the appropriate use of milk-containing treatment regimens and mixed diets containing common staple foods, and the proper use of specific micronutrient supplements. Results of recent clinical trials indicate that children should be fed continuously during illness with their usual diets. Most young children fed exclusively with non-human milks can continue to consume these products. However, the subgroup of patients with more severe diarrhea and dehydration may have a slightly increased rate of complications and would, therefore, benefit from close supervision or a modification of their diet. Breastfed infants should continue to nurse at the breast during diarrhea. Treatment of anorexia consists of correction of the underlying metabolic derangements and antimicrobial therapy when indicated. Despite the previous focus of dietary management during diarrhea, attention to convalescent feeding is also necessary to assure complete nutritional recovery following illness.
PIP: This paper was presented as a part of a symposium given at the 1993 Experimental Biology Meeting, co-sponsored by the American Institute of Nutrition and the American Society for Clinical Nutrition. In addressing acute diarrheal disease in children younger than 5 years of age, this paper focused primarily on the dietary management aspects in that group. Most previous efforts concerning acute diarrhea have focused on rehydration of the patients with solutions containing glucose, carbohydrates, and key electrolytes. Nutritional aspects have only recently been recognized to be of significant importance in the treatment of acute diarrheal children. Diarrhea prevalence has a direct impact in children's growth. By using improved approaches in treating acute diarrhea, and thereby reducing the negative impact of nutritional complications, including nutritional loss, growth can be maintained even during times of illness. In this study, a regime of continuous feeding therapy immediately following rehydration therapy resulted in no loss in a child's growth rate, while delaying food therapy was associated with weight loss. It was also concluded that lactose-containing milk diets may be used, especially in cases of mild diarrhea. However, cases of severe lactose intolerance were found to contribute to further physiological complications and delayed health recovery. Breast-fed infants, it was concluded, could continue to breast feed, as they showed little intolerance problems. Improving and stressing continuous and proper nutrition during illness-free periods is very important for normal growth, improving resistance to disease agents, and in reducing the future negative impact of acute diarrheal episodes.