Keeping Up-To-Date: Treating Diarrhea

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Keeping Up-to-Date: Treating Diarrhea

Diarrhea is sometimes a problem for breastfed babies, in spite of the anti-infective properties in human milk. A mother whose baby has frequent loose stools (twelve to sixteen per day) that have an offensive odor, will naturally be concerned and may ask her Leader if she should continue nursing. She may have been advised to temporarily wean her baby and give an electrolyte solution instead. Temporary weaning is a difficult experience for both mother and baby and can expose the baby to risk of further infection and nipple confusion. Fortunately the breastfeeding infant with diarrhea will almost always benefit by continuing to breastfeed, because, if necessary, an oral electrolyte solution to prevent dehydration can be given as a supplement to breastfeeding.

Diarrhea is a serious health problem for infants and small children and diarrhea prevention has become a priority for public health agencies and the medical community in developing countries. However, the link between breastfeeding and the prevention of diarrhea is not always well understood. In 1988 and 1989 a medical worker in Pakistan compiled a list of questions most frequently asked by doctors during the Diarrhea Training Unit program and submitted them to Drs. Derrick and E. Patrice Jelliffe at the School of Public Health, University of California, USA. Their answers apply to all babies, and are summarized here:

How can breastfeeding help prevent diarrhea?

Human milk is clean and uncontaminated and requires no feeding utensils which may be a route for bacteria. Human milk contains a wide variety of anti-infective substances to combat intestinal infections. Breastfeeding continues to provide limited protection against infective diarrhea even after the introduction of solid foods.

Do babies need iron rich foods?

No, the young infant is supplied with iron via liver stores acquired as a fetus and from the mother's milk. Iron in human milk has an exceptionally high bio-availability. Supplementary iron is a disadvantage because it alters the accessibility of lactoferrin, an important anti-infective substance in human milk.

Do breastfed babies between four and six months need additional fluids? Water?

No, human milk has a high water content so that breastfeeding is a supply and demand source of food and fluid. This has been confirmed by studies during very hot seasons in Jamaica, India, the Negev, and Pakistan. Urine concentrations of infants remained normal despite extremely high climatic temperatures.

Can breast milk be used for rehydration during diarrhea?

Yes, breastfeeding should be continued during diarrhea. Human milk supplies water, nutrients, and several substances which assist in the absorption of water and nutrients. Human milk contains anti-infective substances to combat the bacteria which is causing the diarrhea. If breastfeeding is discontinued. the mother may believe her milk has become insufficient and introduce formula, thus decreasing her milk supply in a self-fulfilling prophecy and putting the baby at risk.

Do children with diarrhea digest the food they eat?

Foods are digested and absorbed much better during diarrhea than previously believed. The intestines have thousands of villi providing a huge surface area for enzyme contact and absorption. Bland foods like rice, porridge, or pastes are dealt with best. Their starches are hydrolyzed to glucose, which has been recognized to assist in the absorption of water and nutrients.

Should oral rehydration solutions (ORS) be used?

Oral rehydration solutions, either homemade or from packets, do place fluid and electrolytes lost during diarrhea. The ORS packets are best as they also provide potassium and sodium citrate. ORS is not a food and should be used only for a short period of time (preferably no longer than six hours) while breastfeeding is continued. For children older than four to six months of age, the baby should go back to nursing first, then the treatment should be followed by a soft starchy preparation of the local staple (rice, wheat, lentils, etc.), or ripe banana (especially rich in potassium) and yogurt (low in lactose).

References:

Jelliffe, E. P., and D. B. Jelliffe. Queries Concerning Breastfeeding and Diarrhea in Pakistan, Journal of Tropical Pediatrics 1991; 37:205-207.

See also THE BREASTFEEDING ANSWER BOOK, pp. 236-39.

La Leche League International, Inc.

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By Ruth Lufkin

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