Diarrhea is an important cause of under nutrition. This is because nutrient requirements are increased during diarrhea, as during other infectious diseases, whereas nutrient intake and absorption are usually decreased. Each episode of diarrhea can cause weight loss and growth faltering.
In children who are undernourished as a result of inadequate feeding, previous diarrhoeal episodes, or both, acute diarrhoeal episodes are more severe, longer lasting, and probably more frequent; persistent diarrhea is also more frequent and dysentery is more severe.
Nutrient intake may decline by 30% or more during the first days of acute diarrhea as a result of:
o anorexia, which may be especially marked in children with dysentery;
o vomiting, which may discourage attempts at feeding;
o withholding of food, which may be based on traditional beliefs about the treatment of diarrhea or on recommendations by health personnel to “rest the bowel”; and
o giving foods with reduced nutrient value, such as gruel or soup that is over-diluted; this may be done with the belief that a diluted food is easier to digest.
To prevent growth faltering, good nutrition must be maintained both during and after an episode of diarrhea. This can be achieved by continuing to give generous amounts of nutritious foods throughout the episode and during convalescence.
In general, the foods that should be given during diarrhea are the same as those the child should receive when he or she is well. This approach is based on evidence that, during diarrhea, the major proportion of most nutrients is digested, absorbed, and used, and that, during convalescence, substantial recovery of lost growth is possible.
The foods recommended for feeding during diarrhea should be continued after diarrhea stops, and extra food should be given, to support “catch up” growth.
A practical approach is to give the child as much as he or she can eat and to provide an extra meal each day for two weeks. If the child is undernourished or is recovering from persistent diarrhea, this should be continued for a longer period, until the under nutrition is corrected.
The child’s usual diet should be reviewed and the mother advised on how she can improve its quality.
Ideally, the child should be seen regularly for follow-up so that his or her weight can be monitored and encouragement and advice on feeding given to the mother.