Volume 91, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Childhood diarrhea is an important cause of malnutrition, which can be worsened when caretakers limit nutritional support. We queried 390 caregivers and their children in a peri-urban community in Lima, Peru regarding general perceptions of feeding and feeding practices during diarrhea. Overall, 22.1% of caregivers perceived feeding during diarrhea to be harmful. At baseline, 71.9% of caregivers would discontinue normal feeding or give less food. Most would withhold milk, eggs, and meats. Approximately 40% of caregivers would withhold vegetables and fruits. A pilot educational intervention was performed to improve feeding during diarrhea. At follow-up survey 3 months later, none of the caregivers would recommend withholding food. Only 23.2% would recommend discontinuing normal feeding and 1.8% perceived food to be damaging. Misperceptions of the role of feeding during diarrhea pose a significant health risk for children, but a simple educational intervention might have a major impact on these perceptions and practices.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. UNICEF, WHO, The World Bank, UN-DESA Population Division, 2013. Levels and Trends in Child Mortality, Report 2013. Available at: http://www.who.int/maternal_child_adolescent/documents/levels_trends_child_mortality_2013.pdf. Accessed November 2013. [Google Scholar]
  2. UNICEF, INEI, 2011. Estado de la Niñez en el Perú. Available at: http://www.unicef.org/peru/spanish/Estado_Ninez_en_Peru.pdf. Accessed November 2013. [Google Scholar]
  3. INEI, 2013. Encuesta Demográfica y de Salud Familiar 2012. Available at: http://proyectos.inei.gob.pe/web/biblioineipub/bancopub/Est/Lib1075/index.html. Accessed November 2013. [Google Scholar]
  4. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, , 2003. How many child deaths can we prevent this year? Lancet 362: 6571.[Crossref] [Google Scholar]
  5. Bhutta ZA, Das JK, Walker N, Rizvi A, Campbell H, Rudan I, Black RE, , 2013. Interventions to address deaths from childhood pneumonia and diarrhea equitably: what works and at what cost? Lancet 381: 14171429.[Crossref] [Google Scholar]
  6. Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM, , 2002. Effects of stunting, diarrheal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564571.[Crossref] [Google Scholar]
  7. Guerrant RL, Oria RB, Moore SR, Oria MO, Lima AA, , 2008. Malnutrition as an enteric infectious disease with long-term effects on child development. Nutr Rev 66: 487505.[Crossref] [Google Scholar]
  8. Lorntz B, Soares AM, Moore SR, Pinkerton R, Gansneder B, Bovbjerg VE, Guyatt H, Lima AM, Guerrant RL, , 2006. Early childhood diarrhea predicts impaired school performance. Pediatr Infect Dis J 25: 513520.[Crossref] [Google Scholar]
  9. Patrick PD, Oriá RB, Madhavan V, Pinkerton RC, Lorntz B, Lima AA, Guerrant RL, , 2005. Limitations in verbal fluency following heavy burdens of early childhood diarrhea in Brazilian shantytown children. Child Neuropsychol 11: 233244.[Crossref] [Google Scholar]
  10. Richard SA, Black RE, Gilman RH, Guerrant RL, Kang G, Lanata CF, Mølbak K, Rasmussen ZA, Sack RB, Valentiner-Branth P, Checkley W, , 2013. Diarrhea in early childhood: short-term association with weight and long-term association with length. Am J Epidemiol 178: 11291138.[Crossref] [Google Scholar]
  11. Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R, , 2008. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adult. Lancet 371: 411416.[Crossref] [Google Scholar]
  12. Checkley W, Gilman RH, Black RE, Lescano AG, Cabrera L, Taylor DN, Moulton LH, , 2002. Effects of nutritional status on diarrhea in Peruvian children. J Pediatr 140: 210218.[Crossref] [Google Scholar]
  13. Ferdous F, Das SK, Ahmed S, Farzana FD, Latham JR, Chisti MJ, Ud-Din AI, Azmi IJ, Talukder KA, Faruque AS, , 2013. Severity of diarrhea and malnutrition among under five-year-old children in rural Bangladesh. Am J Trop Med Hyg 89: 223228.[Crossref] [Google Scholar]
  14. Brown KH, Gastañaduy AS, Saavedra JM, Lembcke J, Rivas D, Robertson AD, Yolken R, Sack RB, , 1988. Effect of continued oral feeding on clinical and nutritional outcomes of acute diarrhea in children. J Pediatr 112: 191200.[Crossref] [Google Scholar]
  15. Dugdale A, Lovell S, Gibbs V, Ball D, , 1982. Refeeding after acute gastroenteritis: a controlled study. Arch Dis Child 57: 7678. [Google Scholar]
  16. Hjelt K, Paerregaard A, Petersen W, Christiansen L, Krasilnikoff PA, , 1989. Rapid versus gradual refeeding in acute gastroenteritis in childhood: energy intake and weight gain. J Pediatr Gastroenterol Nutr 8: 7580.[Crossref] [Google Scholar]
  17. Sandhu BK, Isolauri E, Walker-Smith JA, Banchini G, Van Caillie-Bertrand M, Dias JA, Guandalini S, Hoekstra JH, Juntunen M, Kolacek S, Marx D, Micetic-Turk D, Razenberg MC, Szajewska H, Taminiau J, Weizman Z, Zanacca C, Zetterström R, , 1997. A multicentre study on behalf of the European Society of Paediatric Gastroenterology and Nutrition Working Group on Acute Diarrhea. Early feeding in childhood gastroenteritis. J Pediatr Gastroenterol Nutr 24: 522527.[Crossref] [Google Scholar]
  18. Isolauri E, Juntunen M, Wiren S, Vuorinen P, Koivula T, , 1989. Intestinal permeability changes in acute gastroenteritis: effects of clinical factors and nutritional management. J Pediatr Gastroenterol Nutr 8: 466473.[Crossref] [Google Scholar]
  19. Levine GM, Deren JJ, Steiger E, Zinno R, , 1974. Role of oral intake in maintenance of gut mass and disaccharide activity. Gastroenterology 67: 975982. [Google Scholar]
  20. WHO, UNICEF, 2008. IMCI Chart Booklet - Standard. Available at: http://www.who.int/maternal_child_adolescent/documents/IMCI_chartbooklet/en/index.html. Accessed November 2013. [Google Scholar]
  21. Brown KH, Peerson JM, Lopez de Romaña G, de Kanashiro HC, Black RE, , 1995. Validity and epidemiology of reported poor appetite among Peruvian infants from a low-income, periurban community. Am J Clin Nutr 61: 2632. [Google Scholar]
  22. Bachrach LR, Gardner JM, , 2002. Caregiver knowledge, attitudes, and practices regarding childhood diarrhea and dehydration in Kingston, Jamaica. Rev Panam Salud Publica 12: 3744.[Crossref] [Google Scholar]
  23. Bani IA, Saeed AA, Othman AA, , 2002. Diarrhea and child feeding practices in Saudi Arabia. Public Health Nutr 5: 727731.[Crossref] [Google Scholar]
  24. Othero DM, Orago AS, Groenewegen T, Kaseje DO, Otengah PA, , 2008. Home management of diarrhea among under fives in a rural community in Kenya: household perceptions and practices. East Afr J Public Health 5: 142146. [Google Scholar]
  25. Jacoby ER, Benavides BM, Bartlett JC, Figueroa D, , 1994. Effectiveness of two methods of advising mothers on infant feeding and dietetic management of diarrhea at an outpatient clinic in Peru. J Diarrhoeal Dis Res 12: 5964. [Google Scholar]
  26. INEI, 2008. Perfil Sociodemográfico de la Provincia de Lima, Perú. Lima, Peru: Instituto Nacional de Estadística e Informática. [Google Scholar]
  27. Riofrío G, , 2003. Understanding Slums: Case Studies for the Global Report 2003, The Case of Lima. Available at: http://www.ucl.ac.uk/dpu-projects/Global_Report/pdfs/Lima.pdf. Accessed November 2013. [Google Scholar]
  28. Pantenburg B, Ochoa TJ, Ecker L, Ruiz J, , 2012. Use of commercially available oral rehydration solutions in Lima, Peru. Am J Trop Med Hyg 86: 922924.[Crossref] [Google Scholar]
  29. Bentley ME, Stallings RY, Fukumoto M, Elder JA, , 1991. Maternal feeding behavior and child acceptance of food during diarrhea, convalescence, and health in the central Sierra of Peru. Am J Public Health 81: 4347.[Crossref] [Google Scholar]
  30. Bentley ME, Elder J, Fukumoto M, Stallings RH, Jacoby E, Brown K, , 1995. Acute childhood diarrhea and maternal time allocation in the northern central Sierra of Peru. Health Policy Plan 10: 6070.[Crossref] [Google Scholar]
  31. Huffman SL, Lopez de Romaña G, Madrid S, Brown KH, Bentley M, Black RE, , 1991. Do child feeding practices change due to diarrhea in the Central Peruvian Highlands? J Diarrhoeal Dis Res 9: 295300. [Google Scholar]
  32. Faruque AS, Mahalanabis D, Islam A, Hoque SS, Hasnat A, , 1992. Breast feeding and oral rehydration at home during diarrhea to prevent dehydration. Arch Dis Child 67: 10271029.[Crossref] [Google Scholar]
  33. Khin MU, Nyunt NW, Myo K, Mu MK, Tin U, Thane T, , 1985. Effect on clinical outcome of breast feeding during acute diarrhea. Br Med J (Clin Res Ed) 290: 587589.[Crossref] [Google Scholar]
  34. Brown KH, Peerson JM, Fontaine O, , 1994. Use of nonhuman milks in the dietary management of young children with acute diarrhea: a meta-analysis of clinical trials. Pediatrics 93: 1727. [Google Scholar]
  35. Beattie RM, Vieira MC, Phillips AD, Meadows N, Walker-Smith JA, , 1995. Carbohydrate intolerance after rotavirus gastroenteritis: a rare problem in the 1990s. Arch Dis Child 72: 466.[Crossref] [Google Scholar]
  36. Szajewska H, Kantecki M, Albrecht P, Antoniewicz J, , 1997. Carbohydrate intolerance after acute gastroenteritis–a disappearing problem in Polish children. Acta Paediatr 86: 347350.[Crossref] [Google Scholar]
  37. Trounce JQ, Walker-Smith JA, , 1985. Sugar intolerance complicating acute gastroenteritis. Arch Dis Child 60: 986990.[Crossref] [Google Scholar]
  38. Caulfield LE, Huffman SL, Piwoz EG, , 1999. Interventions to improve intake of complementary foods by infants 6 to 12 months of age in developing countries: impact on growth and on the prevalence of malnutrition and potential contribution to child survival. Food Nutr Bull 20: 183200.[Crossref] [Google Scholar]
  39. Salehi M, Kimiagar SM, Shahbazi M, Mehrabi Y, Kolahi AA, , 2004. Assessing the impact of nutrition education on growth indices of Iranian nomadic children: an application of a modified beliefs, attitudes, subjective-norms and enabling-factors model. Br J Nutr 91: 779787.[Crossref] [Google Scholar]
  40. Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK, , 2003. Effect of community-based promotion of exclusive breastfeeding on diarrheal illness and growth: a cluster randomized controlled trial. Lancet 361: 14181423.[Crossref] [Google Scholar]
  41. Pahwa S, Kumar GT, Toteja GS, , 2010. Performance of a community-based health and nutrition-education intervention in the management of diarrhea in a slum of Delhi, India. J Health Popul Nutr 28: 553559.[Crossref] [Google Scholar]
  42. Lee RG, Garvin T, , 2003. Moving from information transfer to information exchange in health and health care. Soc Sci Med 56: 449464.[Crossref] [Google Scholar]
  43. Mwangome M, Prentice A, Plugge E, Nweneka C, , 2010. Determinants of appropriate child health and nutrition practices among women in rural Gambia. J Health Popul Nutr 28: 167172.[Crossref] [Google Scholar]
  44. Victora CG, Wagstaff A, Schellenberg JA, Gwatkin D, Claeson M, Habicht JP, , 2003. Applying an equity lens to child health and mortality: more of the same is not enough. Lancet 362: 233241.[Crossref] [Google Scholar]
  45. Penny ME, Creed-Kanashiro HM, Robert RC, Narro MR, Caulfield LE, Black RE, , 2005. Effectiveness of an educational intervention delivered through the health services to improve nutrition in young children: a cluster-randomized controlled trial. Lancet 365: 18631872.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 02 May 2013
  • Accepted : 06 Mar 2014
  • Published online : 03 Sep 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error