Continued normal feeding and clear fluids only followed by gradual milk strength reintroduction or immediate full strength produced no significant differences in outcome and symptoms

Is it necessary to regraduate milk after acute gastroenetritis in children?
Haque KN et al
Tropical and Geographical Medicine 1983; 35:369-73

Three-part Clinical Question
In children with gstro-enteritis is gradual introduction of feeding better than immediate normal feeding with regards to symptom control and time to resolution?

Search Terms
Medline 1966- 09/01 using OVID interface( exp Gastro-enteritis) AND ( exp bottle feeding OR exp breast feeding methods OR "feeding".mp) LIMIT to human AND ( newborn infant OR infant OR preschool child OR child ).

The Study
Non-blinded randomised controlled trial with intention-to-treat.

The Study Patients
150 inpatients (76 males, 74 females), acute gastro-entritis at all stages of dehydration between 1 month and 2 years of age, 14.6% breast fed, 25.3% bottle-fed, 59.3% mixed

Control group
(N = 52; 52 analysed): clear fluids (6 to 24 hrs) then gradual 1/4 strength milk reintroduction

Experimental group
(N = 46/52; 46/52 analysed): one group clear fluids (6-24 hrs) then full strength milk, the other group continuing full strength milk

The Evidence

Non-Event Outcomes	Regraded group	Clear-Full group	Full Group	P-value
Increase in weight at discharge(kg)	0.4(0.1)	0.8(0.2)	1.2(0.7)	NS
Diarrhoea length (days)	3.0(1.4)	3.0(1.3)	3.8(1.2)	NS
Vomiting Length (days)	1.0(1.1)	1.8(1.3)	1.6(1.2)	NS
Length in hospital (days)	3.1(1.4)	3.6(1.2)	3.8(1.2)	NS

Comments
Large proportion of patients malnourished

Appraised by
Nico Grunenberg, Ravenswood Surgery, New Road, Forfar, DD8 2AE; 28 November 2002
Email: peni.grunenberg@virgin.net