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OCR for page 29
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
OCR for page 30
· 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
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Representative terms from entire chapter:
acute diarrhea
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