• S L Huffman and C Combest.
• Center to Prevent Childhood Malnutrition, Bethesda, MD 20814.
• J Diarrhoeal Dis Res. 1990 Sep 1; 8 (3): 68-81.

AbstractRecent studies have again shown the beneficial effects of breast-feeding in preventing morbidity and mortality from diarrhoea in infants. A case-control study in Brazil has shown that young infants who are not breast-fed have a 25-time greater risk of dying of diarrhoea than those who are exclusively breast-fed. A longitudinal study in the urban slums of Lima, Peru found that exclusively breast-fed infants have a reduced risk of diarrhoeal morbidity when compared with infants receiving only water in addition to breast-milk. Both these studies, along with numerous others in developing countries, point to the need to extend the duration of exclusive breast-feeding to at least 4-6 months. A review of concerned studies throughout the world shows that even in malnourished women, breast-milk output is sufficient to maintain growth of infants up to this age. The addition of early food supplements to infants fed under prevailing environmental conditions in developing countries leads to their increased diarrhoeal attacks and associated reduced food intake. This results in worsened nutritional status of the affected infants. Breast-feeding helps maintain hydration status during diarrhoeal episodes. Studies in Peru, India, and Nigeria have shown that breast-feeding can be continued during diarrhoea when the infants often refuse other foods, specially non-human milk. Thus, breast-feeding is important in providing necessary calories and protein during a time when a loss of appetite for other foods is common. Diarrhoeal disease control programmes need to modify service delivery to ensure that breast-feeding mothers are not separated from their infants while being treated with oral rehydration therapy (ORT) as inpatients or outpatients. Oral rehydration solution (ORS) should be given to infants with cup and spoon rather than bottles, in order not to interfere with suckling. When in a health system bottles are used for treatment, an implicit credibility is given to their role in modern treatment. Programmes also need to include breast-feeding promotion as a part of their activities. This should comprise hospital practices supporting and ensuring breast-feeding immediately after delivery of the infants and subsequently while they are treated in the hospital: immediate breast-feeding after delivery; Mothers and infants rooming together; On demand breast-feeding; No bottle feedings of water or infant formula; No pre-lacteal feeds. In addition, health professionals need to understand the skills for the management of breast-feeding, so that mothers are given appropriate advice on how to breast-feed and counteract breast-feeding problems.

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