Feeding Children with Diarrhea

Use these illustrations when helping educate Central American communities. You can download and print full-size versions by clicking on the thumbnail-size versions below.

Illustration: Woman and baby on changing table Illustration: Illustration: Exposure to diarrhea

Illustration depicting how to care for infants and young children with diarrhea

Illustration of mom washing hands after changing child's diaper

Childhood diarrheal diseases cause 1 out of 9 childhood deaths worldwide. Approximately 88% of diarrhea cases are due to unsafe drinking water, poor sanitation and insufficient hygiene. Diarrhea is defined as experiencing more than three liquid stools a day.

Germs causing diarrhea originate from stool and usually spread to contaminate water, food or other objects, ultimately causing diarrhea. Reasons for the spread of germs that cause diarrhea include:

  • People or animals defecating near drinking water
  • Farmers using contaminated water to irrigate crops
  • People failing to practice proper hygiene once hands become contaminated
  • Food preparers failing to practice sanitary practices while cooking

A Problem in Central America

Diarrhea is a pertinent public health problem in Central America. For instance, in 2013 in Guatemala, diarrhea caused 18% of all deaths of children under five. Although there is no shortage of water in Central America, some countries and communities do not allocate appropriate resources to provide clean water for all residents. This contributes to the 2.1 million urban and 13.2 million rural individuals who lack access to safe drinking water.

The use of pit latrines for toilets and open defecation are common practices in Central America, both of which can lead to the spread of germs that cause diarrheal diseases. In some Central American countries, the resources the government expends to control and treat diarrhea may be up to four times the amount it would cost to improve water sanitation systems.

Acute and Chronic Diarrhea

Poor nutrient absorption in the gastrointestinal tract and dehydration are of major concern with acute diarrhea, which is defined as diarrhea lasting less than 14 days. When diarrhea exceeds 14 days, it is considered chronic diarrhea, and nutrient malabsorption can become severe. Diarrhea can also lead to death by depleting hydration and disrupting electrolyte status. Recurring diarrheal illness can lead to malnutrition which renders a child’s immune system incapable of coping with illnesses such as respiratory infections and measles, resulting in increased morbidity and mortality.

Childhood Diarrhea and Malnutrition

Childhood diarrhea plays a significant role in malnutrition. Infections within the intestine can lead to loss of key nutrients, damage to the gut mucosa and impaired nutrient absorption, which could then induce more severe malnutrition.

Proper nutrition is imperative to breaking the vicious cycle of malnutrition and diarrhea. Well-nourished children are more resilient during a diarrheal illness. Continual feedings during diarrheal episodes and increased breastfeeding is crucial for better clinical outcomes.

Because caregivers may not understand the importance of continual feedings during diarrhea, nutrition education for parents and caregivers is essential for the health of the child. Whereas it may be beneficial to avoid raw fruits, milk and greasy foods, it's important to continue offering a balanced diet. For children under six months, increasing breastfeeding during illness is highly encouraged as it provides ample nutrition and acts as an oral rehydration solution. Inquiries should be made within communities to understand the common feeding and breastfeeding practices for children with diarrhea.

Preventing Diarrhea

Primary prevention of diarrhea is to control fecal-oral transmission of pathogens through water sanitation and hygiene. Effective interventions include rotavirus vaccinations, breastfeeding and oral rehydration therapy as well as community education on safe water, sanitation and hygiene practices.

The World Health Organization and The United Nations Children Emergency Fund recommend including household water treatment methods, proper disposal of feces and promotion of hand-washing with soap and water to prevent diarrhea.

With safe drinking water, adequate sanitation, improved hygiene and routine vaccines, diarrhea is a preventable disease.

Current WHO and UNICEF guidelines for managing diarrheal diseases in children include evaluating hydration status, fluid replacement, continued feeding, increased breastfeeding, zinc supplementation and sometimes antibiotics for 10 to 14 days.

Low osmolarity, glucose-based oral rehydration solutions are recommended to prevent or treat diarrhea. Low osmolarity solutions reduce the need for intravenous fluids and decrease stool output in children when compared to a standard formula.

Oral rehydration salts are commonly available over the counter in local pharmacies and general goods stores in many Central American communities. These need to be added to water that is potable, either bottled or from a source treated by chlorine, ultraviolet light, boiling or micro-filtering.

A Recipe for Rehydration

Where over the counter oral rehydration salts are not available, a simple mixture of 1 liter clean water, ½ teaspoon salt and 8 teaspoons sugar can be used. Alternatively, 8 heaping teaspoons of powdered rice or other grains can be used instead of sugar. This version needs to be boiled for 5 to 6 minutes to create a very thin gruel and then has to be cooled. One-half cup mashed bananas, coconut water or fruit juice can be added to either drink to provide potassium. Children should be fed rehydrating drinks every few minutes, even if vomiting, until they are able to urinate and appear well hydrated.

Additional Diarrhea Education Resources

Straightforward education on water safety and sanitation and proper hand-washing is a key part of diarrhea prevention and management education. The Global Water, Sanitation, & Hygiene section of the Centers for Disease Control and Prevention website contains health promotion materials including how to make oral rehydration solution. The Centre for Affordable Water and Sanitation Technology websites provide free, downloadable materials on the topics of sanitation, hygiene and health, including the concept of microbes and how to prevent them for spreading.

Additional Resources

  • Arvelo W, Degollado J, Reyes L, Alvarez A. Perceptions regarding oral rehydration solutions for the management of diarrhea in guatemalan children: Implications for diarrheal management in the americas. Rev Panam Salud Publica. 2013;34(2):121-126.
  • Halder GE, Bearman G, Sanogo K, Stevens MP. Water sanitation, access, use and self-reported diarrheal disease in rural honduras. Rural Remote Health. 2013;13(2):2413.
  • Pantenburg B, Ochoa TJ, Ecker L, Ruiz J. Feeding of young children during diarrhea: Caregivers' intended practices and perceptions. Am J Trop Med Hyg. 2014;91(3):555-562.
  • Ramirez-Sanchez IM, Doll S, Bandala E. Drinking Water and Sanitation in Central America: Challenges, Perspectives, and Alternative Water Treatment. United States of America. American Chemical Society: December 3, 2015.
  • Who Technical Staff. Water, Sanitation and Hygiene Interventions and the Prevention of Diarrhoea. World Health Organization. 2011. Accessed February 5, 2016.
  • World Health Organization. WHO recommendation on the management of diarrhoea and pneumonia in HIV-infected infants and children. Published 2010: 1-52. Accessed February 5, 2016.
  • World Health Organization/United Nations Children's Fund. Clinical Management of Acute Diarrhoea. 2004: 1-8. Accessed February 5, 2016.