When children experience gastrointestinal issues like diarrhea, vomiting, or an upset stomach, parents often seek safe dietary options to ease their symptoms. One traditional approach has been the BRAT diet, which stands for bananas, rice, applesauce, and toast. It’s not a meal with an attitude problem. This bland-food diet is thought to be gentle on the stomach. The BRAT diet was once a staple that most pediatricians recommended for children with an upset stomach. The idea was that it gave the gut a chance to rest and reduced the amount of stool produced. For years, many doctors suggested the BRAT diet for treating diarrhea in children.
However, as our understanding of nutrition evolves, so do the recommendations for managing childhood digestive issues. Experts now say the BRAT diet may not be the best option for children who are ill.
What is the BRAT Diet?
The BRAT diet is composed of low-fiber, easily digestible foods that are low in fat and protein. BRAT is an acronym that stands for bananas, rice, applesauce, and toast. Foods allowed on the BRAT diet include: Bananas, Rice, Applesauce, Toast. What do these foods have in common? They’re all bland and easier to digest during illness. The logic behind the diet is that bland foods will not irritate the stomach and will help reduce the volume of stools.
- Bananas:
- Rice:
- Applesauce: The pectin in applesauce can help firm up stools.
- Toast: Gluten-free bread can substitute regular white bread.
Why the BRAT Diet Fell Out of Favor
Because BRAT diet foods are low in fiber, protein, and fat, the diet lacks enough nutrition to help a child's gastrointestinal tract recover. While the BRAT diet is often well-tolerated during acute bouts of illness, it is nutritionally incomplete. It lacks sufficient protein, fat, and a variety of vitamins and minerals necessary for recovery. The main risk associated with the BRAT diet is its lack of nutrients. Prolonged reliance on this diet can lead to malnutrition, especially in children who are already vulnerable due to illness. It’s important for children to consume a balanced diet that includes a variety of nutrients, which the BRAT diet does not provide. The BRAT diet is restrictive and lacks in nutritional diversity. It’s low in protein, fat, and many essential vitamins and minerals.
Current Recommendations: A Balanced Approach
Pediatric health experts now recommend a different approach. The American Academy of Pediatrics (AAP) started moving away from the BRAT diet in the late 1990s. The AAP affirmed that in 2016. As a result, many health organizations no longer recommend it as a treatment option for diarrhea or other stomach problems. The American Academy of Pediatrics now recommends that kids resume eating a normal, well-balanced diet appropriate for their age within 24 hours of getting sick. That diet should include a mix of fruits, vegetables, meat, yogurt, and complex carbohydrates. Once children are rehydrated and ready to eat, they should resume a normal, balanced diet suitable for their age and development stage. It turns out that most children with diarrhea who get regular food do just fine. The nutritional content of a regular healthy diet is far superior to the BRAT diet.
Read also: Risks Associated with the BRAT Diet
After a stomach illness, reintroduce foods gradually, starting with small, frequent meals. If a particular food does not aggravate symptoms, it can remain part of the child’s diet.
Focus on Hydration
Diarrhea and vomiting can cause dehydration, so make sure your child is getting enough to drink. What you’re eating matters, but hydration should be your first priority. “Diarrhea and vomiting can quickly lead to dehydration, which is the biggest concern for patients experiencing these side effects. As diarrhea can lead to dehydration, it is important that the child drink enough fluids. A child with diarrhea can drink a range of liquids, including water, clear broths, apple juice, or herbal tea.
Give your child fluids for the first 4 to 6 hours. At first, try 1 ounce (2 tablespoons or 30 milliliters [mL]) of fluid every 30 to 60 minutes. You can use:
- An over-the-counter drink, such as Pedialyte or Infalyte -- do not water down these drinks
- Pedialyte frozen fruit pops
- Homemade oral rehydration solution to prevent dehydration: 1 Liter of clean or boiled water, mix in 1/2 teaspoon of salt and 6 teaspoons of sugar and stir until both salt and sugar are completely dissolved.
She recommends hydrating with liquids that contain both sugar and electrolytes, such as diluted juice or sports drinks. “Water alone won’t cut it. If you don’t have access to specialized electrolyte hydration solutions or sports drinks, Siebel suggests making your own. “You can create an oral rehydration solution at home with water, a pinch of salt, and sugar. You can also add a splash of your favorite juice.
If you are nursing, keep breastfeeding your infant. If you are using formula, use it at one half strength for 2 to 3 feedings after the diarrhea starts. Then begin regular formula feedings again.
Read also: Diabetic BRAT Diet Guide
If your child throws up, give only a little bit of fluid at a time. You can start with as little as 1 teaspoon (5 mL) of fluid every 10 to 15 minutes. Be sure to sip fluids and try introducing foods as soon as you can tolerate them.
What to Feed Your Child
When your child is ready for regular foods, try: Bananas, Chicken, Crackers, Pasta, Rice cereal. Beginning to add bland, low-fat foods like bananas, rice, applesauce, crackers, cooked cereals (Farina, Cream of Wheat), toast and jelly, yogurt, cooked carrots, and chicken or turkey. Progress to a “regular” diet if symptoms have improved. Continue to eat small meals every few hours. Stick to a bland, but nutritious diet. Nutrition for nausea, vomiting or diarrhea consists of foods that are bland and gentle on the stomach. The key to following a bland diet is eating bland foods that are gentle on the stomach. Acceptable foods to eat on a bland diet are considered binding foods, meaning they’re low in fiber and may stop diarrhea by firming up your stool. A bland diet is different from the BRAT diet, as it encompasses a greater variety of food and nutrients. This is why a bland diet is now recommended over the BRAT diet.
Other bland foods and liquids to consume on a bland diet include: crackers, cooked cereals, like oatmeal or cream of wheat, herbal or decaffeinated tea, broth, electrolyte drinks, boiled or baked potatoes.
People should avoid foods and drinks that are “non bland” on this diet. They include: Avoid: Apple juice, Dairy products, Fried foods, Full-strength fruit juice. milk and dairy, anything fried, greasy, fatty, or spicy, proteins, such as steak, pork, salmon, and sardines, raw veggies, including salad greens, carrot sticks, broccoli, and cauliflower, acidic fruits, such as berries, grapes, oranges, lemons, and limes, alcohol, coffee, or other drinks containing caffeine. Avoid milk and dairy products for three days.
While the BRAT diet can be helpful for short durations, there are risks associated with following a diet so low in dietary fiber, protein, and fat for an extended period of time. This is why healthcare professionals now recommend a bland diet instead of the BRAT diet.
Read also: BRAT Diet: A Guide
When to Seek Medical Advice
Most cases of diarrhea go away on their own, but you should keep track of a few things when treating diarrhea in children. Our Plano pediatricians want you to feel confident in caring for your child when he or she is sick. Children who have diarrhea may have less energy, dry eyes, or a dry, sticky mouth. They may also not wet their diaper as often as usual.
If you do not get better after 24 hours, make an appointment with your doctor. You should also see a doctor if you’ve been experiencing frequent or severe diarrhea. Your symptoms may be a sign of viral gastroenteritis, or stomach flu, which typically doesn’t require medical treatment. But there are other conditions that cause similar symptoms and do require medical treatment. For example, your symptoms may be caused by: bacteria, a parasite, certain medications, food intolerances, other issues that may need immediate medical attention. Nausea and vomiting may have different causes. Diarrhea may be “acute”, beginning suddenly and resolving over a few days with dietary changes, or of a “chronic” ongoing process.
Even if you think you just have a stomach flu, you’ll want to contact your doctor if you have diarrhea longer than 2 days or if you feel you’re dehydrated.
Call your doctor if you: have a dry mouth, have excessive thirst, stop urinating as frequently, feel tired, or have weakness or dizziness, have dark urine. Dehydration can be life threatening if left untreated.
Also call your doctor if you have: severe abdominal or rectal pain, bloody or black stools, a fever over 102°F (38.8°C), blood or bile in vomit.
With small children and babies, you should call their doctor if vomiting or diarrhea persist for just 1 day.
WHEN TO CONTACT THE PROVIDER Contact your child's provider if your child has any of these symptoms: Blood or mucus in the stool, Dry and sticky mouth, Fever that does not go away, Much less activity than normal (is not sitting up at all or looking around), No tears when crying, No urination for 6 hours, Stomach pain, Vomiting.
Additional Considerations
In the immediate six or so hours after vomiting has stopped, it is best to give your stomach a rest. Following a period of one to two hours, suck on hard candy or popsicles (no chewing). Gradually add clear liquids if the vomiting has ceased. Beginning with a sip or two every ten minutes is a good way to start. Suggestions include water, apple juice, electrolyte beverage, weak tea, Jell-O (in liquid or gelatin form), broth or bouillon (clear base from a non-greasy soup).
If you have nausea or vomiting, it may be hard to hold down food. Some foods may even make your symptoms worse. While the BRAT diet is most often associated with diarrhea, it can also provide relief for nausea and vomiting. If you have nausea, Siebel recommends eating small, frequent meals, even when you don’t feel like it. “It’s important to avoid letting your stomach stay empty for too long, as that can worsen nausea,” she says. Siebel also recommended cold foods, as they’re less likely to trigger nausea due to their lack of strong odors.
If you have food sensitivities, like gluten allergies, you may wonder how the BRAT diet fits into your needs. Siebel notes that there are gluten-free options for the toast and crackers typically used in the BRAT diet. “Gluten-free bread can substitute regular white bread,” she explains.
While the BRAT diet can help you manage GI symptoms, it’s important to remember that it should only be used in the short term, and you should try to mix in other low-fat, low-fiber foods as soon as you feel like you can stomach them. “Ultimately, we want cancer patients to get back to a more balanced, nutrient-rich diet as soon as possible,” Siebel says. That’s an important reminder if you don’t love the idea of eating such a starchy diet. “It can be really frustrating,” Siebel says. The bottom line: stay hydrated, take small bites and always communicate with your care team when you’re dealing with GI problems.