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4 SUMMARY Acute diarrhea, besides causing the loss of water and essential electrolytes and leading to dehydration, has adverse effects on nutritional status. Water and electrolytes are replaced with ORT solutions; nutritional consequences require additional intervention. Reduction in food intake, decrease in absorption of nutrients, losses of body stores, and increases in nutrient requirements--all associated with diarrhea--contribute to malnutrition, and in some cases death. On the basis of its review of these nutritional consequences of diarrhea and its assessment of the potential complications of continued feeding during diarrhea, the subcommittee has determined that continued feeding is both safe and beneficial. General recommendations for the nutritional management of diarrhea, discussed in more detail in Chapter 2, are summarized in the following paragraphs. The subcommittee also recognizes that gaps in knowledge still limit understanding of the biologic effects of diarrhea and hinder development of specific protocols for its nutritional management. Research to fill the gaps identified by the subcommittee is outlined in Chapter 3. ~ Children should continue to be fed during acute diarrhea because feeding is physiologically sound and will prevent or minimize the deterioration of nutritional status that normally accompanies such illness. - 29
· A child with acute diarrhea should be fed the most nutrient-dense foods available in the household, i.e., foods with the highest proportion of nutrients and calories relative to bulk. Such foods must be offered frequently (at least once every 3 or 4 hours) and to the extent that the child is willing to eat. · Because cessation of diarrhea is not equivalent to recovery and nutrient deficits persist, feeding extra food (above usual intake) must continue after diarrhea ceases. During recovery, an intake of at least 125% of normal should be attempted with nutrient-dense foods; it should continue at least until the child reaches preillness weight and ideally until the child achieves normal nutritional status, as measured by expected weight for height or weight for length. This might take several weeks or longer, depending on the degree of deficit. · All providers of health care (physicians, nurses, mothers, and others) must be included in educational programs aimed at teaching appropriate dietary management and identifying children who need referral. - 30 -
