Nutrition Interventions for Children with Special Health Care Needs

Section 2 - Problem-Based Nutrition Interventions
digestive enzymes, and increased permeability of the mucosal barrier. All of these
effects can lead to decreased ability of the gut to absorb nutrients (7,8).
Some children who have chronic illnesses or who are medically fragile may suffer
nutrition deficits from repeated bouts of mild acute diarrhea even when appropriately
managed.
Treatment
Mild acute diarrhea requires no special treatment. Adequate fluid intake should be
a priority, but a strict clear liquid diet is no longer the treatment of choice. Recent
data indicates that feeding with the usual diet is appropriate for most cases of
acute diarrhea (1-3, 5-9). If an infant is breastfed, this should be continued on
demand and other fluids given if needed for supplementation. Breast milk contains
substances which may stimulate and protect the gastrointestinal mucosa (7).
Formula-fed infants also should be continued on their routine formula. Milk and
milk-based formulas have historically been avoided during episodes of diarrhea.
There may be mucosal damage during the illness that creates temporary lactase
deficiency. However, at least 80% of children do not have worsening of diarrhea from
this temporary lactase deficiency and can safely be continued on milkbased formula
or milk (7,8). Change to a lactose-free formula is only recommended if stool output
increases on a milk-based formula (3).
Previous recommendations for treatment of acute diarrhea were for a period of
“bowel rest” with clear liquids only, then gradual re-introduction of first diluted, then
full strength formula or milk along with a very limited diet of solid foods. Diluted
formula is no longer recommended. Current information has demonstrated that early
feeding of a routine diet leads to a better overall outcome. Specific beneficial effects
are decreased duration of illness, improved weight gain, and improved nutritional
state (5,7,8).
There is discussion in the medical literature as to what constitutes the most
appropriate mixed diet for feeding during acute diarrhea. Historically, the BRAT diet
(banana, rice, applesauce and toast/tea) was recommended. This very restricted
diet is high in carbohydrates but very low in calories, fat, fiber, protein, calcium, and
Vitamins A and B12 (8). Current broad guidelines for an appropriate mixed diet are
for food that is palatable, inexpensive, culturally acceptable, and easily digested
(5,7). This may include complex carbohydrates (rice, wheat, potatoes, bread,
cereal), lean meats/poultry, eggs fruits, vegetables, and yogurt (5).
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