|Oral Rehydration Therapy and the Control of Diarrheal Diseases (Peace Corps, 1985, 566 pages)|
|Module Three: Nutrition and diarrhea|
|Session 7 - Nutrition during and after diarrhea|
In communities where malnutrition la common, correct feeding is as important as rehydration for children who have diarrhoea We report on studies from Bangladesh illustrating this point.
A recent careful survey of young children in Bangladesh revealed that, on average, each child suffered 6.8 episodes of diarrhoea per year. Added up, this meant they had diarrhoea for 55 days or 15 per cent of the year(1). Such children will end up severely deprived of nourishment if they are starved all the time they have diarrhoea. Although digestion is less effective during diarrhoea, there is still a significant amount of absorption of nutrients. The Dhaka work has shown that, in children given as much ordinary food as they will take, the amount of protein absorbed is reduced to about 50 per cent, the amount of fats to 60 per cent and the amount of carbohydrate to 80 per cent.(2) This fall in digestive efficiency varies to some extent with the cause and mechanism of the diarrhoea, but the figures show that, in spite of the disease, the children manage to absorb valuable amounts of essential nutrients.
Breastmilk - energy value
Another Bangladesh study compared the normal dietary intake of small children with diarrhoea with that of a group of matched controls. The energy intake of the ill children was reduced by 40 per cent, but among those children who were being breastfed; the energy intake from mother's milk showed very little decrease.(3) This suggests that the loss of appetite is mainly associated with supplementary foods. Breast milk is therefore a particularly valuable nourishment for children with diarrhoea, especially among deprived communities where it may be the main source of high quality protein. Every effort ought to be made to continue breastfeeding during diarrhoea, not least because breastmilk supplies depend on the stimulus of sucking. If breastfeeding is interrupted every time diarrhoea occurs, there will soon be much less of this important food available for the child at the time of greatest need.
Which foods and when?
Despite recent studies, unanswered questions remain about what are the best foods to offer during diarrhoea and when to introduce them. In acute diarrhoea, most foods can be given safely and soon. In chronic diarrhoea, feeding may be more of a problem (ace Diarrhoea Dialogue 10 for Professor G. C. Cook's article on causes and control of chronic diarrhoea). Mother's milk is better tolerated than cow's milk and breastfeeding should continue during diarrhoea. Children with diarrhoea who are being bottlefed need to have the formula diluted with an equal volume of water while the diarrhoea continues.
The important point is to start giving small, frequent feeds of a familiar diet as soon as rehydration is complete, preferably mixed with a little extra vegetable oil to increase the energy content. Vitamin A supplementation is required in areas where xerophthalmia (night blindness) is common.
During convalescence after diarrhoea, children need extra food for 'catch-tip' growth. This can be given as nutritious snacks between meals or as an extra meal every day for several weeks.
Compiled by the Scientific Editors from information provided by A. and A. M. Molla, ICDDR, B, Dhaka, Bangladesh.
(From: Diarrhoea Dialogue: Issue 15, November 1983, p.5)