Feeding of Children with Protracted Diarrhea in Developing Countries

Acute infectious diarrhea with dehydration is among the two main causes of infantile morbidity and mortality in less developed countries. The complex etiology of childhood diarrhea and its close relationship with environmental conditions and nutritional status must be stressed in designing and evaluating possible treatments. In the present chapter, we attempt to express some of our thoughts and reports of our work on patients with diarrhea, the product of many years of work in Argentina and in other Latin American countries. After 2 years of systematic use of the WHO-UNICEF oral rehydrating solution (ORS), we feel that it has been a true breakthrough in the management of acute infectious diarrhea. The effectiveness of the method clearly dispelled our initial skepticism. A controlled study done by our group showed the ORS to be effective in 92% of the cases (102 patients) irrespective of age, nutritional status, or severity of diarrhea. It was even given to patients with severe dehydration, and only two children showed plasma sodium slightly above the normal level. The average sodium intake for the whole group was 9 mg/kg per day, which is similar to or less than what is used in i.v. rehydration regimens. An evaluation of the i.v. rehydration of diarrheic patients was performed in the same hospital in 1978. Patients in this study are comparable in age, nutritional status, and severity of diarrhea to the ones rehydrated with ORS. Table 1 shows the obvious advantages of the latter method. Currently, oral rehydration is used routinely in this hospital with excellent results. We consider it safe, inexpensive, and effective, and it allows the mother or caretaker to participate in the treatment of the child. We have always been concerned with the question of how and with what a diarrheic patient should be refed, since the outcome of the diarrhea is so closely linked to the improvement of nutrition and vice versa. The very rapid clinical recovery (sense of well-being and appetite) of the child rehydrated with the WHO-UNICEF ORS is conducive to an earlier introduction of food, raising some questions as to the advisability of this modality. The classical studies of Chung et al. (1) demonstrated that feedings could increase fecal losses but simultaneously promote absorption of nutrients to an extent that could be helpful in preserving the nutritional condition of the child.