Feeding the gut: The scientific basis for continued enteral nutrition during acute diarrhea

The child with diarrhea should continue to be fed. An evolution in our approach to the nutritional management of children with acute diarrhea has gradually occurred. The American Academy of Pediatrics recently published recommendations for the treatment of children with acute gastroenteritis (Table); these guidelines endorse early feeding of age-appropriate foods, pointing out that this practice does not worsen the diarrhea, may decrease stool output, shorten duration of illness, and improve nutrition. This is a reevaluation of the previous recommendation of gradual reintroduction of milk-based formulas or cow milk beginning with dilute mixtures, indicating that as long as children are monitored for signs of intolerance, a regular age-appropriate diet, including full-strength milk or cow milk formula, can be used safely. Feeding during acute diarrhea should be continued, because a significant amount of nutrient absorption will still occur and thereby allow a better nutritional outcome. These foods should be easily digested and absorbed, be culturally acceptable, cheap, palatable, and lack a deleterious effect on the illness. Breast-feeding should be continued. Children receiving non-human milk should continue with full-strength milk or formula while being observed for signs of lactose malabsorption. If reliable observation is not possible, if the child is malnourished, or if there are signs of severe intolerance, a reduced-lactose or nonlactose formula should be administered. This diet should have an energy density between 0.7 and 1.0 kcal/gm of cooked food. The role of micronutrient supplementation in acute diarrhea is unclear at this time. Diarrheal diseases are a significant cause of pediatric mortality in developing countries, and in industrialized countries, diarrhea is an important cause of office visits to physicians, hospitalizations, and preventable mortality. Therefore there remain significant incentives to optimize the management of diarrhea. It is now clear that depriving the body of nutrition in general and the gut of enteral nutrients in particular entails a variety of adverse consequences. Optimal nutritional therapy, with continued feeding during illness, should be considered a crucial aspect of diarrhea management.