Refeeding after acute gastroenteritis.

definition of some external characteristics used in the assessment of gestational age in the newborn infant. Sir, Dugdale et al.1 compared the results obtained in two groups of infants suffering from acute diarrhoea who were submitted to either a rapid or a graduated refeeding regimen, and concluded that weight loss during the first 24 hours of refeeding was less and the length of hospital stay after milk introduction was shorter in the first group. However, the P values of the differences (O 1> P> 0. 05) are widely considered to be either not significant or on the threshold of significance. The data concerning the number of days in hospital after refeeding are confusing as 7 (25%) of 28 infants in the first group and 3 (9%) of 32 in the second group had to go back to clear fluids because of recurrent vomiting or diarrhoea, which means that in an appreciable number of infants (17%) milk introduction was tried more than once. Dugdale et al. gave no indication of the nutritional status of their patients; however in view of the fact that the mean age was about 22 months in both groups, and that 61% of the infants had mild or non-evident signs of dehydration (weight loss <5%), we can infer that diarrhoea was generally not severe. They stated that in developing countries children with acute diarrhoea are left on milk, particularly if breast fed; this is so because the biological and nutritional properties of human breast milk make it uniquely suitable both in health and disease (except in the case of some inborn metabolic diseases). Its high lactose content, which might have been an inconvenience during acute diarrhoea or soon after it, is not harmful in practice. The same is true for infants with cows' milk protein-sensitive enteropathy for whom breast milk is usually the best feeding alternative despite the frequent coexistence of lactose intolerance.2 However, in the non-breast fed infant with acute gastroenteritis and malnutrition it is thought best to interrupt, or decrease, the use of a lactose formula.3 Severe diarrhoea and delayed recovery are more likely to occur in the first months of life particularly in mal-nourished infants.4 The problem is not when and how to refeed an older and well nourished child or infant with mild gastroenteritis, but how to treat the young or malnourished infant who has severe diarrhoea. In this case there are no …