Mum & Child

Withdrawing some foods when a child has diarrhoea is wrong —Expert

Diarrhoea accounts for one in five deaths amongst children in Nigeria. In-home management of childhood diarrhoea, cultural diversity exists in people’s perceptions of appropriate feeding practices during and after diarrhoeal episodes.

World Health Organisation says that diarrhoea is a health condition in which a child has three or more loose or liquid stools per day, or is described as having more stools than is normal for that person. It is estimated to have killed more children around the World than malaria, Acquired Immunodeficiency Syndrome (AIDS) and tuberculosis combined. Most deaths from diarrhoea are often due to loss of body fluid through dehydration.

In some cultures, especially amongst the Yoruba of Southwestern Nigeria, diarrhoea is believed to be caused by two factors: natural and man-induced. The type of diarrhoea linked with childhood teeth formation is known as ‘Igbe-gbuuru’ and is considered to be natural. In contrast, man-induced diarrhoea is called ‘igbejedi-jedi which is linked with dietary habits, such as the consumption of sugary foods.

While some preventive measures are taken against diarrhoea that is believed to be man-induced, the same is not the case for a case of diarrhoea that is naturally induced. This perception explains the high ill health and deaths due to diarrhoea in children under five.

Now, mothers’ knowledge and perceptions of childhood diarrhoea, as caregivers, often influenced their choice of treatment, and thus related to ill health and deaths that may arise in childhood diarrhoea. In Ibadan North East Local Government Area, for instance, a study found that teething, poor sanitation and consumption of some foods influence people’s perceptions of feeding practices in home management of childhood diarrhoea. The study was in the Nigerian Journal of Sociology and Anthropology.

In addition, mothers’ perceptions of the type of food to be served to children, and the number of feeding times, during and after diarrhoeal episodes varied according to their social status and the food culture of their local environment. Most food substances commonly withdrawn are solid foods such as fruits, meat products, milk products and vegetables.

The study looked at the perception of feeding practices in home management of childhood diarrhoea in the community, including mothers of under-five children, key Informant Interviews with community leaders, herbalists and nurses in public health institutions.

However, Professor Adebola Orimadegun, a consultant paediatrician at the University College Hospital (UCH), Ibadan, said that withdrawing some foods when a child has diarrhoea is wrong.

He stated, “Mothers are expected to focus on replacing the lost fluid. The second thing will be to feed the child as if there is no diarrhoea. If the child is refusing food or he has other accompanying symptoms like fever, they should treat that by lowering the body temperature by either tepid sponging, exposing that child or given paracetamol.”

Professor Orimadegun said salt-sugar solution or fluids from home-prepared meals like rice are home remedies that can be used to replace lost body fluid and as a stop-gap measure at home before the child is taken to the hospital.

“What kills most children during diarrhoea episode is the loss of excess fluid, with the electrolytes that accompany it. That is why every fluid that is lost from the body must be replaced,” he added.

Also, he declared that when the diarrhoea is accompanied by vomiting, the child should be fed more frequently, but little at a time. And if the vomiting is too frequent, the child should be given a liquid diet, maybe watery pap, little at a time.

“At times, it may be advisable to withhold milk. When children who cannot digest milk have too frequent or prolonged diarrhoea, given milk will further worsen it. But it does not mean that it should be stopped totally. But the best is actually to breastfeed. Breast milk has enough water and calories for babies less than six months.”

Professor Orimadegun, however, said that the perception that “my baby has diarrhoea because he is teething”, or developed diarrhoea because he eats a particular type of food cannot be explained scientifically.

“The misconception persists because most cases of diarrhoea coincide with the period of introducing complementary feeding or adult foods. It is at that time that the child also tries to bring out the first set of teeth. The link between all of these is hygiene and sometimes some food intolerance.

“There could be poor hygiene in the process of introducing complementary feed. Breast milk is the purest, so when you introduce water that its quality cannot be guaranteed to a baby whose body immunity cannot cope or for whatever other reasons, they begin to have diarrhoea.”

“So, it is a matter of many events happening at the same time. When a mother says igbeeyin, you cannot say that the mother is wrong because the coincidence is too much to be able to dissociate the two.

“We usually don’t argue with mothers when they say their baby is stooling because he is teething. We will rather say we have heard what they said and begin to find out what other things they are doing that we can correct to make sure it does not reoccur or treat the condition.

“And we tell them what they should do before coming to the hospital, that increases the fluid intake using oral rehydrating fluid, feed the child and if possible breastfeed only and stop all the other extra things that you have introduced. The diarrhoea will stop; most diarrheal cases will stop on their own with time.”

While mothers’ perceptions of feeding practices in home management of childhood diarrhoea were influenced by culture, religion and socio-demographic factors, injurious beliefs need to be dropped towards enhancing the success of the primary health care (PHC) programme.

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