These days run through my city, and imagine that several cities in Spain, a virus that is causing stomach flu in large numbers of adults and children, leaving them out of orbit for a few days.
Many mothers take their children to the doctor because they have had diarrhea for two days and most pediatricians and doctors are surprised because gastroenteritis is the typical disease that everyone has ever suffered and whose treatment we all know: fasting and astringent diet (or soft diet), that is to say, "I don't know what they are coming for ... to do the diet and that's it ... heals himself".
The truth is that the treatment is not even that, because several scientific studies conclude, regarding the treatment of gastroenteritis, that there is no reason to change the type of diet. In other words: in case of diarrhea, forget the soft diet of a lifetime, because you do not need to go hungry or eat differently.
What is gastroenteritis?
Before we talk about diet, it can be interesting to know what is really a gastroenteritis. The ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology, and Nutrition) together with the ESPID (European Society for Paediatric Infectious Diseases), define the GEA as a reduction in the consistency of evacuations (liquid or semi-liquid) and / or an increase in their frequency (usually 3 or more than 3 in 24 hours), which may be accompanied by fever or vomiting. The duration is usually less than 7 days and never more than 14 days.
In Babies and more How to act in acute diarrheaThis definition would not work in the case of nursing babies, since all, or most, poop several times a day (more than 3, no doubt) and the consistency is practically liquid, obviously being normal.
Initial treatment
As stated in a fantastic (and extensive) guide for professionals, dedicated to knowing what is the best way to address acute gastroenteritis (GEA), the ideal treatment is start giving oral rehydration serum as soon as diarrhea appears, and before 6 hours return to the usual food. Apparently, this reduces associated complications and the number of visits to the doctor and to the emergency department.
For this, the child is given 60 to 120 ml of oral serum, little by little, with a glass or a spoon. The bottle is discouraged because it can stimulate nausea and present a greater number of vomiting.
And the astringent diet for diarrhea?
As we have said, it is common for the doctor, before a diarrhea, to tell us that we have to do an astringent diet for our son: boiled rice, cooked apple, sweet ham, toast and there are even those who say that fasting is phenomenal.
The reality, according to scientific studies, is that A gastroenteritis should not be considered a contraindication to continue with the same diet as always. Let's say that at the time the child has been given oral serum and when he wants to eat something, we should give him regular food (this recommendation has a level of scientific evidence I, A, which is the highest, the most reliable).
Children with GEA can lose between 100 and 200 grams for each day they spend with the virus. The reason is threefold: fluids are lost, the intestine stops absorbing nutrients properly and appetite is reduced. The commented studies come to conclude that early feeding helps reduce the duration of diarrhea and also shows an improvement in weight gain, without producing a greater amount of bowel movements.
In Babies and more The formula with probiotics causes fewer episodes of diarrhea than normalThe American Academy of Pediatrics (AAP) and ESPGHAN recommend, therefore, in children with GEA not dehydrated, continue with the usual diet. If a child is dehydrated, hydrate with oral serum and, when the hydration is over, restart the feeding as soon as possible.
But I have a baby fed only with breastfeeding
On more than one occasion I have heard breastfeeding mothers returning from the emergency department with treatments for diarrhea (usually oral serum) and with recommendations to stop breastfeeding and even with an indication to give bottles of lactose-free milk.
In the same way that it is not necessary to change the feeding to a child who eats, it is not necessary to change it to a child who drinks breast milk. The studies carried out in this regard (you can see them all in the guide on the management of GEA that I have mentioned before) show a significant reduction in the prevalence of diarrhea when breastfeeding is exclusive until 6 months of age. In addition there is a reduction in volume, number of bowel movements and duration of diarrhea when children are breastfed.
But I have a baby fed only with formula milk
When treating babies fed only with formula milk, it is usually customary to recommend that parents stay the same, but dilute the powder a little more, that is, by adding a little more water per cup of milk. In the studies carried out in this regard, a therapeutic failure (the treatment is not valid) of 16% is shown for children who received undiluted milk compared to 12% of children who received diluted milk. This means that it is recommended to dilute the milk, because as a treatment it works better.
However, when the data were analyzed with children without severe dehydration (those who have just started having diarrhea or those who have been a few days but are accepting food well and are not dehydrating), no significant differences were observed between the use of milk diluted and undiluted milk. They also analyzed the weight gain with both types of food and saw that those who drank undiluted milk, logically, recovered the weight better.
After all these data the recommendation is that if a child is not dehydrated or if the dehydration is mild, diluted artificial milk should not be recommended.
And soy milk and lactose-free milk?
The use of lactose-free milks has also been studied, which are being used a lot lately, and it has been observed that the rate of therapeutic failure in the group of children who drink lactose-free milk is 12%, while the failure in children fed with formulas with lactose is 22%. This difference is greater if only children with severe diarrhea are studied, as the therapeutic failure is 38% for lactose formulas and 16% for those who drink lactose-free milk. But nevertheless, when only children without dehydration are analyzed or in cases with non-severe diarrhea the differences are not significant.
With regard to the duration of diarrhea, the administration of formulas with lactose seems to be associated with a longer duration of the disease, with differences of up to one more day suffering from diarrhea.
With regard to the formulas derived from soybeans, there are not enough studies to support their use routinely in children with GEA. The only studies that exist to date do not show differences in the duration of diarrhea, duration of hospitalization or therapeutic failures.
In Babies and more Symptoms of gastroenteritis in children Returning to the topic of diet for children
We have already commented that before a GEA there is no reason to perform an astringent diet or soft diet. Given this, many parents will wonder what diet to do then. Well, the diet will simply depend on the child's food preferences, on their dietary patterns and, above all, on their desire to eat. It is likely that the child rejects some foods that he usually consumes and asks, instead, for some that simply fancy him at that time. You are also likely to eat significantly less than you usually eat when you are healthy. Everything is normal because the diarrhea diet is what a child does: eat little and selected. As your body accepts more food, it will ask for more food.
Concluding
If it's a baby who drinks breast milk, everything should stay the same. If it is a baby who drinks artificial milk, it can remain the same or it can be temporarily replaced by a formula without lactose (if my children took LA I would do it). If it is a child who already eats all the recommendation is to stay the same, offering the same food, maybe more cooked or crushed, to digest it better, and offering oral rehydration serum.
Probiotics can also be given, as some have proven effective in reducing the days of diarrheal episodes. The astringent diet is not recommended, unless the child likes it, because it can cause him to eat less than necessary and lose more weight than expected. In other words: No need, you better eat what you want.
Photos | OakleyOriginals, Various brennemans, pfly on Flickr In Babies and more | How to act in acute diarrhea, Diarrhea: the danger of dehydration, The best diet if there is gastroenteritis
