by: Luetwinta Breedlove, BSN, RN
For decades, the BRAT diet has been the "go to" recommendation for children who are experiencing short-term diarrhea, so what has changed and why is this diet no longer recommended?
What is the BRAT diet?
BRAT, which stands for (Bananas, Rice, Applesauce and Toast), are bland foods that are easy to digest and thought to reduce symptoms of diarrhea by slowing down the intestines and decreasing how often you have bowel movements.
What are the concerns about the BRAT diet?
The BRAT diet is unnecessarily restrictive and low in fiber, protein and fat, therefore lacks enough nutrition and has too few calories, which may not help a child's gut fully recover and might prolong the duration of illness for those who solely use this diet.
What are the new recommendations?
While recovering from short-term diarrhea, children need to resume age appropriate foods from a variety of sources that give them the nutrition and calories needed to continue growth to optimize health outcomes, beginning within 24 hours of becoming sick as long as dehydration is not an issue. This diet should include a mix of fruits, vegetables, low fiber starches, meats and complex carbohydrates for example.
Management and treatment
The need to replace fluid losses and to maintain adequate nutrient intake is the most crucial aspect of managing acute diarrhea which can begin at home. It is important that parents/caregivers are instructed properly on signs of dehydration and when a child is not responding to treatment, therefore when necessary, treatment must be followed up with a healthcare provider before the nutritional phase can begin.
When to contact your healthcare provider?
You should contact your healthcare provider:
If you think your child is getting worse.
If your child doesn't get any better in 48 hours
severe stomach pain
bloody diarrhea (more than a streak of blood)
diarrhea that is more frequent/more severe
an increased temperature (100.4° Fahrenheit or 38° Celsius or above for children less than 3 months of age), 102°F (38.9°C) or above for children greater than 3 months of age and when experiencing increased temperatures for more than 48 hours.
reduced urine output
looks very ill, fussy or drowsy
dry mouth
thirst
is light headed, dizzy or weak
Summary
Solely using the BRAT diet is not the best option for children recovering from short-term diarrhea and is no longer recommended by practitioners due to being unnecessarily restrictive. The best diet option for children experiencing short-term diarrhea is a normal, age appropriate, well-balanced diet, which can include, but not limited to bananas, rice, applesauce and toast. Together with oral rehydration and early nutritional support the outlook remains promising to safely and effectively assist children through an episode of diarrhea.
Sources:
Centers for Disease Control and Prevention. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR 2003;52(No. RR-16):[inclusive page numbers].
Assessed and Endorsed by MedReport Medical Review Board