Nutrition Interventions for Children with Special Health Care Needs

Chapter 7
Section 2 - Problem-Based Nutrition Interventions
Nutrition Interventions for Diarrhea
Naomi Katsh, MD
Diarrhea is the sudden increase in frequency and looseness of stools. Diarrhea is
sometimes described as the passage of more than three watery stools in 24 hours
or three times the normal number of stools in 24 hours (1,2,3). The best indicator
of the severity of diarrhea is the frequency. If severe or chronic, this condition has a
high potential for morbidity (and mortality, especially in developing countries). It is
estimated that two million deaths occur annually in children under age 5 as a result
of diarrheal diseases (1,4).
The main complication of diarrhea is dehydration from the loss of fluid and
electrolytes with the stools. Nutritional complications may also develop, especially
in chronic situations. Depending on the severity, chronicity, and underlying medical
condition, evaluation and treatment of diarrhea may require input from many
different health professionals including nurses, registered dietitians (RDs), primary
care providers, and gastroenterologists.
Although there is not always a clear distinction, the subject of diarrheal illness can
be approached as either an acute or chronic problem.
Acute Diarrhea
Acute diarrhea refers to a self-limited illness usually of less than 2-3 weeks duration.
Acute diarrhea may lead to electrolyte imbalance and dehydration, which can be
life threatening. Infants and young children with diarrhea are more susceptible to
dehydration than older children and adults because of their smaller intravascular
volume and a lower capacity to concentrate urine (2). Children who have disabilities
that affect oral-motor function are already at risk for dehydration and may be at
even greater risk because of difficulty replacing the fluids lost through diarrhea.
Causes
There are many causes of acute diarrhea. Some common causes include:
• Infection: Diarrhea in children is usually caused by a viral infection of the lining
of the intestine (gastroenteritis) and can be accompanied by vomiting, fever, and
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