Citation, country Study group Study type (level of evidence) Outcome Key results Study weaknesses
Dugdale et al (1982), Australia 59 inpatients older than 6 months (average 22 months) with acute gastroenteritis were given clear fluids and then allocated either to half strength milk for 24 h and then full strength milk and food or immediate normal milk and food RCT Hospital stay (days) Immediate group 4.7; graduated group 5.4, p>0.5 Small numbers
? length of clear fluids
            Weight During first 24 h of refeeding immediate group lost 0.02 (0.25) kg and the graduated group lost 0.14 (0.21), p> 0.05    
Haque et al (1983), Saudi Arabia 150 inpatients, all stages of dehydration between 1 month and 2 years of age randomised to three different feeding regimens:
(1) clear fluids (6–24h) then gradual 1/4 strength milk reintroduction
(2) clear fluids (6–24h) then full strength milk
(3) continuing full strength milk
RCT Increase in weight at discharge (1) 0.4 (0.1)
(2) 0.8 (0.2)
(3) 1.2 (0.7)
Not stat significant
Large proportion malnourished
      Diarrhoea length (days) (1) 3.0 (1.4)
(2) 3.0 (1.3)
(3) 3.8 (1.2)
Not stat significant
      Vomiting length (days) (1) 1.0 (1.1)
(2) 1.8 ( 1.3)
(3) 1.6 (1.2)
Not stat significant
      Length in hospital (days) (1) 3.1 (1.4)
(2) 3.6 (1.2)
(3) 3.8 (1.2)
Not stat significant
Placzek and Walker-Smith (1984), UK 48 inpatients less than 18 months of age with gastro enteritis, >5% dehydration were after 24 h of GEM allocated to immediately full strength milk or gradual reintroduction RCT Complicated clinical course = recurrence of ether severe vomiting or watery diarrhoea with 2% or more reducing substances 70% (16 ) of full strength group uncomplicated; 96% (24) of gradual group uncomplicated Small numbers
Alternate allocation = randomisation 20% not thriving
Rajah et al (1988), South Africa 72 male black inpatients between 6 weeks and 2 years with prolonged dehydrating gastroenteritis (needing more than 72 h IV fluids) assigned to 4 different feeds; partially modified cows’ milk formula, a lactose free casein containing formula, a lactose free soy protein formula, a lactose free whey- hydrolysate formula RCT Stool weights in 3 days following formula change Significant drop in stool weight
AL110 p<0.01
Alfare p<0.05
Alsoy p<0.05
No change with Lactogen
Only male black children
Bhan et al (1988), India 60 outpatients <5% dehydration between 3 and 24 months were fed either cereal based formula(A) or cows’ milk (B) RCT Duration of diarrhoea post intervention (days) Gr A 11.0 (10.0) > gr B 7.6 (10.8) NS p>0.05 Small numbers
Difficulty comparing two preparations
Selection criteria (close to hospital)
? compliance to treatment at home
Mean weight gain (g/kg/24h) GrA 2.0 (4.2) < grB 5.8(7.8) significant p<0.05
Conway and Ireson (1989), Leeds 200 well hydrated inpatients, formula fed, ages 6 weeks to 12 months, acute gastroenteritis
Gr1: 24h dextrolyte and gradual reintroduction of SMA gold
Gr2: special full strength HN25 untill stools normal, gradual substitution by SMA gold
Gr3: continued full strength SMA gold cap
Gr4: continued formula S
RCT Time to discharge Gr1 6.9 (3.2); Gr2 6.9 (1.9); Gr3 6.9 (2.2); Gr4 7.1 (3.6); NS 117 had ORS before treatment, so is this immediate or delayed full strength feeding
      Duration of diarrhoea (h) Gr1 64 (53.7); Gr2 47 (53.7); Gr3 68 (43.6); Gr4 51 (41.5) NS  
      Severity of diarrhoea Gr2 0.8 (1.7) < Gr3 1.8 (1.5), p=0.05; group1 1.6 (1.7), gr4 1.4 (1.9) intermediate positions  
      Weight gain Day 2 Gr2,3,4 > Gr1 p=0.01; remains significant on day 5 p=0.05  
Ooi et al (1989), Singapore 70 inpatients mild/ moderate dehydration, age 1 week to 50 months, either graduated milk feeds or full strength soy feed CT Duration of hospitalisation (days) Soy 2.8; milk group 2.5, not statistically different Small numbers
?effect on symptoms
?received clear fluids
Armitstead et al (1989), UK 68 children, admitted or gastroenterology casualty, bottle fed, mild acute gastroenteritis dioralyte 24h plus:
(1) gradual milk reintroduction
(2) full strength milk
(3) rapid regrade to whey hydrolysate formula
RCT Hospital stay (days) Gr1 4 (0.2); gr2 3.6 (0.6); gr3 3.5 (0.4) NS ? sufficient number
Bottlefed only (sponsored by Nestlé)
Most mild dehydration
      Reducing substances None in all three groups  
      Weight gain Day 1–4: gr1 -0.35 (0.5); gr2 +0.65 (0.6); gr3 +0.15(0.2)  
      Stool frequency Day 1–4: grp1 4–2.2; grp2 3.7–1.6; grp3 4.3–2.5  
Haffejee (1990), South Africa 309 hospital patients age 3days to 28 months, acute diarrhoea, all stages of dehydration
Formula fed children were randomised to their formula or soy based formula; breast fed children continued this and were divided in breast feeding only and breast feeding plus supplement
RCT Recovery time (hrs) when hydration, weight and nature of stools were normal Formula 70.5 (60.3); breast 60.9 (44.8); breast plus supplement 64.8 (43.3); soya 61.4 (43.5) p>0.05 NS ?blinded
No patient chracteristics (race, % dehydration)
Lifschitz et al (1991), USA 8 children <5 months, mild to moderate dehydration, addition of 13C labelled rice at 6–22h and repeat at 14–17d later. Breath test measurement CT 13C in breath when ill and after recovery Apparent absorption not different, 13 C diarrhoea 86.6%- recovery 94%. NS Small numbers
Boys only
Mild/moderate dehydration only
Hoghton et al (1996), UK 59 outpatient children <3 years old, <7 d gastroenteritis, <5% dehydrated; either immediate modified feeding + ORT (2) or ORT only for 24–48h after which modified food (no milk/wheat) (1) PRCT, single blind Median duration of diarrhoea Grp1 66.5 h; grp2 56h p=0.4 not significant Small numbers
Mild dehydration only
Parents assessed and charted symptoms (bias)
      Median % weight change Grp 1 0.005- grp 2 0.96 p=0.24 NS
      Complication rate Similar, NS
Sandhu et al (1997), Europe 230 weaned European children under the age of 3 admitted to hospital; rehydrated with ORS for 4 hours, then Group A: immediate normal diet, Group B 20h of ORS then normal diet, breast feeding continued throughout RCT Weight gain After rehydration weight gain grA 95g, grB 2g p=0.01; during hospitalisation grA> 200g, grB < 100g p=0.001; weight gain similar by day 5 and 14 No severely dehydrated children
      Complications No significant diffences re complications