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A mother with her 11 month old daughter attends the surgery. The child has gastroenteritis and is mildly dehydrated. Mum has been starving the child the past 24 hours as “everything comes back up”. She has read this and also that milk feeds should be avoided, in her health manual at home. Having read a paper once on continuous milk feeding as opposed to gradual regrading of milk, I decide to investigate which approach would be better.
Structured clinical question
In [children with gastroenteritis] is [gradual introduction of feeding better than immediate normal feeding] with regard to [symptom control and time to resolution]?
Search strategy and outcome
Medline 1966–09/01 using the OVID interface.
[exp Gastroenteritis] AND [exp bottle feeding OR exp breast feeding OR exp feeding methods OR “feeding”.mp] LIMIT to human AND (newborn infant OR infant OR preschool child OR child).
A total of 145 papers were found, of which 133 were irrelevant or of insufficient quality. The remaining 12 are shown in table 2.
Nearly all studies showed no significant difference in length of symptoms and hospital stay. Two larger studies showed a significant increase in weight in the initial stages with immediate full strenth feeding. One larger study also showed an increase in severity but not in length of diarrhoea with immedaite feeding. This was associated with faster weight gain. One study showed benefit of lactose free feeds in severe dehydrating gastroenteriris. One smaller study showed more complicated clinical courses with immediate feeding; this was a small study and 20% of the children needed intravenous hydration, possibly related to a more severe illness. In two smaller studies children had solids as well and did not do worse.
CLINICAL BOTTOM LINE
In children with gastroenteritis, gradual reintroduction of feeding is no better than immediate normal feeding with regard to time to resolution and symptom control.
An interactive version of Table 2 is available here, with linked citations
[View Interactive Table]
The linked citations are listed below.
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