Giardiasis

Where possible, examine the stools by microscopy.

►If cysts or trophozoites of Giardia lamblia are found, give metronidazole (7.5 mg/kg every 8 h for 7 days). Treat with metronidazole if stool microscopy cannot be undertaken or if there is only clinical suspicion of giardiasis.

Lactose intolerance

Diarrhoea is only rarely due to lactose intolerance. Intolerance should be diagnosed only if copious watery diarrhoea occurs promptly after milk-based feeds are begun and if the diarrhoea clearly improves when milk intake is reduced or stopped. Starter F-75 is a low-lactose feed. In exceptional cases:

► replace milk feeds with yoghurt or a lactose-free infant formula

► reintroduce milk feeds gradually in the rehabilitation phase.

Osmotic diarrhoea

Osmotic diarrhoea may be suspected if the diarrhoea worsens substantially with hyperosmolar F-75 and ceases when the sugar content and osmolarity are reduced. In these cases:

► Usecereal-based starter F-75  or, if necessary, a commercially available isotonic starter F-75.

►Introduce catch-up F-100 or ready-to-use therapeutic food gradually.