Letters to the Editor

Management of Gastroenteritis in Breast-Fed Children



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Am Fam Physician. 1999 Apr 1;59(7):1754-1756.

to the editor: I would like to commend Drs. Eliason and Lewan for their excellent review of the diagnosis and treatment of gastroenteritis in children.1 The authors point out that oral rehydration solutions are useful in treating children with mild dehydration. The solutions allow a rapid return to full formula feedings and the ability to continue the use of milk containing lactose. However, the treatment of gastroenteritis and mild dehydration in children who are breast feeding is not addressed in this article.

Many cases of both viral and bacterial infectious diarrhea might be prevented2 or their courses considerably lessened by breast feeding.3 If criteria for the use of oral rehydration1 are met in a child who is breast feeding, continued breast feeding is the preferred method for oral rehydration. Not only does breast milk provide the proper concentrations of electrolytes, but it also provides nutrition in the form of easily digestible proteins and fats.4

Since many breast-fed children refuse all oral intake except breast feeding while they are ill, increasing the frequency of feedings increases the mother's milk supply to meet the child's increased needs. Of course, the child's hydration status should be closely monitored. Even if intravenous hydration becomes necessary, breast feeding can and should continue,5 for all of the above reasons. If the mother is unable to stay in the hospital with the child around the clock, expressed breast milk may be used for oral feedings. In addition to the risks to the child, abrupt weaning would place the mother at risk for engorgement, obstructed lactiferous ducts and mastitis.

REFERENCES

1. Eliason BC, Lewan RB. Gastroenteritis in children: principles of diagnosis and treatment. Am Fam Physician. 1998;58:1769–76.

2. Riordan J, Auerbach KG. Breastfeeding and human lactation. Boston: Jones and Bartlett, 1998:142–3.

3. Duffy LC, Byers TE, Riepenhoff-Talty M, La Scolea LJ, Zielezny M, Ogra PL. The effects of infant feeding on rotavirus-induced gastroenteritis: a prospective study. Am J Public Health. 1986;76:259–63.

4. Lawrence RA. Breastfeeding: a guide for the medical profession. 4th ed. St. Louis: Mosby, 1994:91–148.

5. Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States. Pediatrics. 1997;99:E5.

in reply: We certainly agree with Dr. Saenz that breast feeding is important as a means of both preventing problems with diarrhea in young children and providing nutrition to children who have gastroenteritis. Perhaps we did not sufficiently emphasize breast feeding for gastroenteritis in children,1 but the importance of continued oral nutrition was emphasized. The final paragraph contained the following statement:

“Children with severe diarrhea need adequate nutrition in order to restore their digestive abilities, to recover from their illness and to prevent development of so-called ‘starvation diarrhea.’2 Unless children have severe vomiting, they should not be deprived of nutrition for longer than one to two days. Breast feeding should continue. Special elemental formulas may be needed at times to provide nutrition until clinical recovery is adequate.”1

REFERENCES

1. Eliason BC, Lewan RB. Gastroenteritis in children: principles of diagnosis and treatment. Am Fam Physician. 1998;58:1769–76.

2. DeWitt TG. Acute diarrhea in children. Pediatr Rev. 1989;11:6–13 [Published erratum appears in Pediatr Rev. 1989;11:124]

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.



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