Early versus Delayed Refeeding for Children with Acute Diarrhoea
Reintroducing a normal diet following acute diarrhoea
Germana V Gregorio*, Leonila F Dans,Maria Asuncion Silvestre
University of the Philippines College of Medicine, Department of Pediatrics, Manila, National Capital Region, Philippines
Early versus Delayed Refeeding for Children with Acute Diarrhoea. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD007296.
To read the full review please follow this link: DOI: 10.1002/14651858.CD007296.pub2.
Many children in developing countries die from acute diarrhoea. Although it is usually caused by infectious viruses or bacteria, the exact organism is rarely known, as it is impractical to test for the organism. Treating the diarrhoea is thus standard therapy, with the recommended policy of using oral rehydration therapy and dietary supplements. Because the gut can be damaged by the infection, many doctors recommend a period of fasting followed by gradual reintroduction of food, although the evidence for when exactly a “normal” diet should be reintroduced is lacking. The authors here looked at children who received ‘early’ refeeding (within 12 hours of the start of rehydration) or ‘late’ refeeding (after 12 hours from the start of rehydration). The authors identified 12 trials that met their inclusion criteria, with a total of 1283 children under 5 years; of these, 1226 were used in the analysis (724 given early refeeding; 502 given late refeeding). There was no significant difference between the two refeeding groups in the number of participants who needed unscheduled intravenous fluids (813 participants, 6 trials), who experienced episodes of vomiting (466 participants, 5 trials), and who developed persistent diarrhoea i.e. greater than 14 days in duration (522 participants, 4 trials). The mean length of hospital stay was also similar (246 participants, 2 trials).There is therefore no evidence to suggest that early refeeding increases the risk of complications after acute diarrhoea such as the need for IV fluids, or increases the risk of developing persistent diarrhoea. Further studies are needed to fully examine other parameters such as duration of diarrhoea, and effect on weight gain.