It is amazing to me that beliefs (not facts) about diarrhea continue to
persist in the advice given to parents from pediatric office nurses.  I
think some of this bad advice stems from the fact that there is high
turnover and low pay in many offices, some of the nurses are two-year rather
than BS nurses, and many are prob. temps who don't really get good
orientation in the protocols of the practice.  I feel certain most of the
DOCS know that ritual starvation during diarrhea is bad for babies, and that
neither human milk OR formula feed need to be discontinued during episodes.

"After vomiting has ceased there is little evidence that withholding food
from a child with diarrhea is medically helpful."  DeWitte,T:  Acute
Diarrhea in Children, Peds in Review, 1989, 11(1):6-13.

"Recovery [from acute diarrhea] may be hastened by continuing to breastfeed
and offer normal diet, ...weight loss is minimized."  Candy,C:  Recent
advances in the care of children with acute diarrhoea, J Adv Nurs, 1987,
12(1):95-9.

"Dietary restriction in cases of mild infantile diarrhea is often advocated
but has not been shown to be effective....An unrestricted diet does not
appear to affect the course or symptoms of mild diarrhea."  Margolis,M et
al:  Effects of Unrestricted Diet on Mild Infantile Diarrhea, AJDC, 1990,
114:162-64.

These are not new refs, as you can see.  Again, it is important for LCs to
learn how to search the lit. for supporting documentation.  All the info on
diarrhea in breastfeeding is in the standard bfg texts, and is footnoted in
them (which would have been a way other than a medline type search to locate
primary refs). It's been my exper. that citing the med. refs is better than
quoting the secondary sources.  Some health profs are suspicious of
breastfeeding texts.  Also, I would use tact in communicating the info.  You
might copy a few salient refs, and attach to a brief note to the doc whose
practice it was and say something like:

"Your patient, Mrs. Smith, contacted me for an opinion about cont. to nurse
during her child's recent episode of diarrhea.  I shared with Mrs. S. that I
had not seen anything in the literature to suggest that cont. to nurse was a
problem.  Since this information was different than what she heard from the
nurse, and since there may be more going on than I am privvy to,  I wanted
to let you know about the conversation and to attach the following refs that
I based my advice on. "

If the nurse has given the patient bad info, this allows the doc (not you)
to correct and re-educate her.  You also give everybody a little wiggle
room.  Don't expect people to thank you when you prove you know more than
they do.  It's never gonna happen.  Just try to find a kind way to be a
useful teacher.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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