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Am Fam Physician. 1999;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.

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

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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