INTRODUCTION:

In less developed countries where diarrheal disease is highly prevalent and a major cause of death, it recognized that the synergism between diarrhea and malnutrition seriously affects the general health of young children at the same time exerting a lasting effect on growth and development.

Diarrhoea is a condition in which loose or watery stools are passed frequently. Diarrhoea follows irritation or inflammations of the mucous membranes of the bowel by physical, chemical or bacterial agents. When loose motions are accompanied by the passage of blood and mucus, the condition is called dysentery. Infection of the colon by bacteria and amoeba is cause of dysentery

Weanling diarrhoea (Acute Diarrhoea during early childhood):

Diarrhoea occurs frequently in a large majority of weaned infants in the developing countries (the infecting organisms are of non-pathogenic type).

FLUID INTAKE:

Fluid is very important because a child with diarrhoea to become dehydrated. Dehydration is a serious condition in babies and young children.

Fluid loss need to be replaced. Replacing fluids (rehydration) through drinking is essential. Too much water alone, at any age can be harmful because water does not have any sugars or important electrolytes, such as sodium. Specific rehydration solutions include the World Health Organization’s oral rehydration solution.

For most children, drinking more fluids is sufficient, but the most seriously dehydrated children, occasionally it is necessary to give fluid intravenously (by IV). Fluids given by IV are also faster to correct dehydration (www.stlerkes-stl.com/health).

TREATMENT:

· Rest in bed

· Feeding should not be discontinued not more than 6 to 12 hours

· Fluids given by mouth in the form of 1 glass of warm water with 5 gm of sugar and pinch of salt

· Feeding of locally available fruit juices (100 ml) once in 4 hours till the diarrhoea stops.

· Fluids be administered in small amount, repeatedly frequently day and night until the child can take large amounts and food tolerance returns

· After diarrhoea stops the child could be fed on milk and fruit juice and milk pudding till it regains normal health.

ACUTE DIARRHOEA:

The treatment involves the following steps:

· Rest in bed

· Therapy with suitable drugs as prescribed by a physician and

· Correction of water and electrolytes losses

DIET

In severe cases,

· First two days – Give orally the water containing sodium chloride (0.5Percent), Glucose (5%) and orange juice-20%

· 150-200 ml fluid every hour (6 am to 10 pm)

· From third day onwards, 2 hourly feeds (200- 250ml) of the following fluids

· Barley water mixed with equal amounts of skimmed milk or butter milk with added glucose (5%)

· Orange juice with glucose (200 ml) once in four hours

In mild and moderate cases

· When the condition of the patients improves bread, pudding, banana and apple should be introduced along with diluted skimmed milk and fruit juice for a week till the patient will be able to consume a bland diet.

· Avoid condiments and spices

· Avoid food containing roughage (whole grains, millets, legumes, mature vegetables etc.,) as these cause irritation to the mucous membranes of the gastrointestinal tract and diarrhea occur.

Foods to be included and avoided is given in the table-1

TABLE-1 FOODS INCLUDED AND AVOIDED

Foods to be included

Foods to be avoided

Black tea

Lemon –sugar -salt beverage

Tender coconut water

Fruit juices

Barley water

Whey water

Rice Kanji with salt

Banana

Fermented milk

Bland Vegetable soup

Biscuit, Bread, Rusk

Arrow root powder

Sugar syrup

Honey

Milk

Fried foods

High fibre diet

Meat and meat products

Nuts and oil seeds

Whole grains

Spices and condiments

Oral rehydration and prompt feeding remain the cornerstones of therapy for acute diarrhoea. Many studies support the importance of enteral nutrition in recovery from diarrhoea.

Potential advantages of the diet

1. Rice:

Rice is commonly used in the diet of children with diarrhoea due to their low-fiber content, these starches are easily digested. There are some in vitro data to suggest that rice may possess anti-secretary properties. A recent study reported on the efficacy of rice based ORS (Oral Rehydration therapy) compared to gluacre based ORS in a group of (189 Mexican children age three to 24 months with acute diarrhoea, there was a reduced need for intravenous fluids in the rice group an advantages rice based ORS may be lowered osmolarity, which has been associated with less vomiting less stool output and reduced need for unscheduled intravenous infusion compared with standard ORS in children during diarrhoeal episodes.

2. Banana:

Bland and easily digested, bananas are a good choice to settle an upset digestive system. The high level of potassium in bananas helps to replace electrolytes that may be lost by severe bouts of diarrhea. Bananas are also rich in pectin, a soluble fiber that helps to absorb liquid in the intestines and thus move stool along smoothly. Bananas also contain a good amount of insulin, another soluble fiber. Insulin is a prebiotic, a substance that promotes the growth of beneficial bacteria (probiotics) in the intestinal system. They are also very easy to digest, giving your body the energy it needs to get well.

Rabbani et al performed of a double blind controlled trail in Bangladesh boys (n=62) age 6-12 month randomly assigned to a diet of rice only or rice mixed with either cooked green banana or with pectin for seven days children receiving pectin or banana containing diet had over all better outcomes than children receiving the rice diet alone (they observed a slight reduction in stool weight by the third days in both groups).

3. Apple:

Like bananas, apples are a good source of pectin. However, the high fiber in raw apples makes them too rough for a dicey intestinal system. Cooking the apples makes them easier on your system to digest, thus allowing you to benefit from the pectin, sugar and other nutrients that lie within.

4. Toast and Crackers:

When your intestines are acting normally, it is important to eat whole-grain products. When you are experiencing acute diarrhea, however, it is better to turn to processed wheat foods. The removal of the outer husk of the grains in these foods results in easier digestion. As an added bonus, the salt (sodium) in crackers will be beneficial in terms of restoring the electrolyte b

5. Yogurt:

It is generally recommended that dairy products be avoided during acute diarrhoea episodes. Yogurt is a major exception to this rule. Look for yogurt that contains live or active cultures, or more specifically Lactobacillus acidophilus and Bifidobacterium bifidum. These active cultures are probiotics and they appear to help to establish a healthier balance of bacteria in the digestive tract.

6. Herbal Tea

There is nothing like sipping a warm cup of tea for a feeling of comfort. Peppermint Tea is especially good for quieting a diarrhoea episode.

Peppermint Tea:

Peppermint has a soothing effect on the gastrointestinal system. It is thought to calm and relax the muscles along the intestinal tract, thus reducing spasms. Peppermint also seems to be effective in reducing intestinal gas.

7. Fibre

The role of dietary fibre in diarrhea has been proposed to reduce the duration of liquid stools. Fibre may improve gastrointestinal mucosa in animals.

REFERENCES:

1. Burden S. Dietary treatment of irritable bowel syndrome: Current evidence and guidelines for future practice. J Hum Nutr Diet. 2001;14:231–241

2. Floch MH. Use of diet and probiotic therapy in the irritable bowel syndrome: analysis of the literature. J Clin Gastroenterol.2005;39:S243–S246

3. Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082–2090

4. Goldstein R, Braverman D, Stankiewicz H. Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints. Isr Med Assoc J. 2000;2:583–587

5. Gregory L. Austin., Christine B. Dalton., Yuming Hu., Carolyn B. Morris., Jane Hankins, Stephan R. Weinland, Eric C. Westman., William S. YancyJr. Douglas A. Drossman. A Very Low-Carbohydrate Diet Improves Symptoms and Quality of Life in Diarrhea-Predominant Irritable Bowel Syndrome. 2009. Clinical Gastroenterology and Hepatology. Volume 7, Issue 6, Pages 706-708. Published Online12 March 2009.

6. Lea R, Whorwell PJ. The role of food intolerance in irritable bowel syndrome. Gastroenterol Clin North Am. 2005;34:247–255

7. Pellett PL. Food energy requirements in humans. Am J Clin Nutr. 1990;51:711–722

8. Shinjini Bhatnagar, Maharaj K. Bhan, Kiran D. Singh, Shailendra K. Saxena, Malini Shariff. Efficacy of Milk-based Diets in Persistent Diarrhea: A Randomized, Controlled Trial. Pediatrics. 1996: 98(6): 1122-1126

9. Simren M, Mansson A, Langkilde AM, et al. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion. 2001;63:108–115

10. Swaminathan, M. Essentials of Food and Nutrition. volume II. The Bangalore printing and publishing Co., Ltd. Bangalore. 1998:171-172.

Received on 25.04.2016 Modified on 10.05.2016

Int. J. Adv. Nur. Management. 2016; 4(3): 396-398.

DOI: 10.5958/2454-2660.2016.00071.5