Nutrition Interventions for Children with Special Health Care Needs

Chapter 7 - Nutrition Interventions for Diarrhea
Assessment Intervention Evaluation/
Outcome
Close, frequent followup
is indicated to see
if appropriate medical
recommendations are being
followed or are effective in
decreasing the amount or
frequency of diarrhea.
Medication may be indicated in some
cases (e.g., pancreatic enzymes in cystic
fibrosis, sulfasalazine or corticosteroids in
inflammatory bowel disease).
Work with primary care provider or medical consultant. Medical
evaluation may include different studies, depending on the clinical
situation, diagnosis (if known), and duration and severity of diarrhea:
• Stool cultures and studies may be done for infectious causes and
fat content
• Blood tests may be done for electrolytes, specific micronutrients:
vitamin E and B12 (if problems with ileal absorption), total protein,
albumin, d-xylose, carotene
• Sweat test
• Gastrointestinal x-rays and/or sigmoidoscopy or colonoscopy and
biopsy
Physical examination to include not only assessment of hydration
status, but also assessment of nutritional status.
Dietary
Dietary triggers of diarrhea
are identified and eliminated
from food pattern.
If food allergy or intolerance is suspected,
try eliminating specific foods that seem to
be related to the diarrhea. Caution must
be taken that an elimination diet is not
so extreme that it leads to inadequate
nutrient intake.
Obtain a diet history and compare with stool history to determine
possible relationships between foods and diarrhea.
Food pattern provides
adequate amounts of
energy, protein, and
vitamins and minerals.
For example, evaluate whether or not onset of diarrhea coincides
with introduction of cow’s milk or cow’s milk protein formula (cow’s
milk protein sensitivity, lactase deficiency); cereals or bread (glutensensitive
enteropathy); foods with table sugar added, (sucrase
deficiency).
Provide instruction about special diets
when indicated (such as lactose-free diet
for lactase deficiency, gluten-free diet for
gluten-sensitive enteropathy, low fructose
for fructose intolerance, etc.) 6-8
90 Nutrition Interventions for Children With Special Health Care Needs
Consider obtaining a 3-7 day food record and a 3-7 day stool record.
Close, frequent follow-up is indicated
to see if appropriate dietary
recommendations are being followed or
are effective in decreasing the amount or
frequency of diarrhea.