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Does Withholding milk feeds reduce the duration of diarrhoea in children with acute gastroenteritis?

Three Part Question

In an [otherwise healthy child presenting with acute diarrhoea] [does withholding milk feeds] [reduce the severity and duration of symptoms?]

Clinical Scenario

An 11 month old presents to the emergency department with diarrhoea. According to mum the child has had these symptoms for 3 days and this was preceded by one day of vomiting. On examinatoin she is mildly degydrated but is tolerating oral fluids well. Mum has been advised by the child's grandmother not to give her usual milk feeds as "it makes the diarrhoea worse". She asks you if this is the right thing to do?

Search Strategy

Ovid 1950-Nov 2008
Limit to Humans and child 0-18 years
{Diarrhea or Diarrhea or Diarrhoea).mp.}AND {oral rehydration or Fluid Therapy}AND { or Milk}

Search Outcome

83 papers found of which 3 reviews articles and 6 RCTs were clinically relevent.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Allen, U D. McLeod, K. Wang, E.E
Feb 1994
Infants 2-12 months of age with diarrhoea of less than one week's duration and mild or moderate dehydration. 39 infants received a soy-based formula and 34 received a cow's milk formula.RCTDuration of diarrhoeaTotal duration of diarrhoea was significantly longer (p=0.03)in those receiving cow's milksmall numbers

March 1988
90 infants with mild dehydration and diarrhea. 53 were included in the early refeeding group and 37 in the late group using either breast or cow's milkRCTevaluation of weight, hydration state, stool frequency and need of hospitalisationNo significant difference between the groups

March 1988
60 children less than 2 years suffering from mild acute gastroenteritis randomly assigned to two different isocaloric feeding regimes.RCTDuration of diarrhoea, weight gainInfants fed milk-free diet showed significantly less energy intake and gained weight less rapidly

Mar-Apr 1986
65 infants hospitalised for acute gastoenteritis. 27 infants had cow's milk and milk products eliminated from their diet. 38 infants received usual milk diet. RCTDuration of diarrheaNo significant difference between groups
Rees L, Brook CG
April 1979
46 children with mild acute gastroenteritis randomly allocated to full-strength milk or clear fluids.RCTLength of hospital stayNo significant difference between the groupssmall numbers


There are a number of RCTS which address the question. All except one found no difference in the duration of diarrhoea in milk fed children. One study found a significantly reduced energy intake and weight gain in children on the milk free diet. The review articles which address the question all found that early re-introduction of a milk diet does not prolong the diarrhoea and is ntritionally beneficial. They all commented that the milk feeds should be in addition to oral rehydration therapy.

Clinical Bottom Line

Withholding milk feeds during an acute diarrhoeal illness in a child with mild dehydration does not shorten the length of the illness. In fact early reintroduction of milk (both breast and bottle) is nutritionally beneficial. This is in agreement with the World Health Organisation recommendations.


  1. Allen, U D. McLeod, K. Wang, E. E Cow's milk versus soy-based formula in mild and moderate diarrhea: a randomised controlled trial
  2. Brown KH, Peerson JM, Fontaine O. Use of nonhuman milks in the dietary management of young children with acute diarrhea: a meta-analysis of clinical trials.
  3. Gazala E. Weitzman S. Weizman Z. Gross J. Bearman JE. Gorodischer R. Early Vs late refeeding in acute infantile diarrhea
  4. Bhan MK. Arora NK. Khoshoo V. Raj P. Bhatnager S. Sazawal S. Sharma K. Comparison of a lactose-free cereal based formula and cow's milk in infants and children with acute gastroenteritis
  5. Isolauri E. Vesikari T. Saha P. Viander M Milk versus no milk in rapid refeeding after acute gastroenteritis
  6. Rees, L. Brook, C.G Gradual reintroductoin of full-strength milk after acute gastroenteritis in children