Nutrition Interventions for Children with Special Health Care Needs

Chapter 7 - Nutrition Interventions for Diarrhea
Medications are generally not prescribed or recommended for infants or children
with acute diarrhea. Viruses are the predominant cause of acute diarrhea, especially
in developed countries; therefore antibiotics are not indicated when treating acute
diarrhea illnesses. Very few studies regarding medications have been done with
children to demonstrate safety or efficacy. The potential risks of medications,
including antispasmodics and anti-motility agents are felt to greatly outweigh any
potential benefits (1,2,5,7).
Mild (3-5%) to moderate (6-9%) dehydration resulting from acute diarrhea can
be treated with oral rehydration. There are commercially available preparations
(e.g., Pedialyte ® , Rehydralyte ® ) for oral rehydration. In developing countries
childhood deaths from diarrheal illness, while still unacceptably high, has decreased
dramatically due to oral rehydration solution (ORS) programs for treatment and
prevention of dehydration.
Since 1975, The World Health Organization (WHO) and the United Nations Children’s
Fund (UNICEF) have recommended the formulation of ORS used in developing
countries. Since 2002 there has been a new recommendation for a lower osmolarity
ORS. This new preparation has been found to be more effective for acute, noncholera
diarrhea in children and causes fewer cases of hypernatremia (high sodium). Adult
cholera patients may still need higher sodium preparations in some instances (4).
Osmolality is a major factor in determining the efficacy of Oral Rehydration Solutions.
In general, juice, broth, carbonated beverages, and sports drinks should not be used
for oral rehydration because their high osmolalities may induce osmotic diarrhea and
the electrolyte content is not appropriate (1-3,5,7,8). Diluted juice, broth, and sports
drinks can be used for some children if other, more appropriate rehydration fluids
are not available. Cereal-based oral rehydration therapy has also been proposed
as a method of rehydration which also provides some nutrients (4,7). There are no
commercially available cereal-based products at of the time of this writing.
Here is a recipe for cereal-based orT (oral reHydraTion THerapy) soluTion
½ - 1 cup dry infant rice cereal
2 cups (16 oz) water
¼ teaspoon table salt
Measure salt and dissolve in water. Gradually add cereal to the water until the
mixture is as thick as is drinkable. Mix well. Discard after 6 to 8 hours or if it
becomes too thick to drink (4).
Intravenous rehydration (in an outpatient or inpatient setting) may be required when
oral rehydration attempts have failed or when dehydration is greater than 10% and/
84 Nutrition Interventions for Children With Special Health Care Needs