If your kid has ever had an upset stomach, you’ve probably been told this classic advice from your doctor or a well-meaning relative: follow the BRAT diet. BRAT stands for bananas, rice, applesauce, and toast and this popular diet was recommended by paediatricians for decades because these foods were thought to be easy to digest and helpful for slowing down digestive issues like diarrhea.
But that advice is more than a little outdated. The American Academy of Pediatrics no longer recommends the BRAT diet for diarrhea and other tummy troubles, and lots of experts in health care agree.
“The BRAT diet is a terrible idea,” says Toronto paediatrician Rahul Saxena. “It’s a carb loaded diet and it’s been shown to increase the duration of diarrhea.” That’s because simple carbohydrates can stimulate your body to bring water into the gut and cause loose bowel movements. This is in contrast to the original thinking behind the BRAT diet—that the low-fibre, starchy foods would help bind together loose stool.
And in any case, there’s usually a reason for the diarrhea. “You have to accept the fact that the diarrhea is serving a purpose,” says Saxena. “It’s trying to get rid of the virus so you need to let it run its course.”
Toronto dietitian Ahuva Magder Hershkop similarly doesn’t see the benefit of BRAT diet. “If your child only ate rice for a day because they weren’t feeling well, will it do any harm? Probably not,” she says. But Hershkop’s concern is that this bland diet will likely leave your kid lacking in important nutrients and antioxidants at a time when their body needs it the most.
Focus on hydration
Instead of worrying about what your kid is eating, focus on what they’re drinking, says Saxena. “The thing to remember is that when a kid is sick with gastroenteritis, such as vomiting and diarrhea, the only thing that really matters in the short term is hydration,” he says. Saxena recommends giving fluids, an ounce at a time, every 20 minutes. This way, the lining of the stomach has time to absorb the fluid. For kids under the age of one, continue breastfeeding on demand or, if they are formula-feeding, offer them full-strength formula, recommends the Canadian Paediatric Society (CPS). You can also offer them electrolyte drinks like Pedialyte that are balanced with salt and sugar, and follow the instructions on the bottle for dosage. If your child is older than one year, and aren’t eating at all, try coconut water (an electrolyte drink), non-caffeinated teas, or unsweetened juice to be sure they are getting some sugars and salts. If your kid is eating a bit, beverages with sugar, such as juice, milk, and sports drinks are OK in small amounts, but could also make diarrhea worse, so other options are preferable, says Saxena. Of course, continue to offer your kid water throughout the day.
BRAT diet alternatives
Generally speaking, kids with diarrhea can be offered a variety of foods they normally eat, but Saxena recommends keeping portion sizes small. “Try 25 percent of what they typically eat and see how they do,” he says.
And just because they’re sick, that doesn’t mean they can just eat junk. Anything you consider unhealthy for kids on a regular basis shouldn’t be given to them when they are sick either, says Saxena. “You really want to maximize their nutrition, not give them empty calories,” he says, one of his main concerns with the BRAT diet.
Also: “It’s okay if kids don’t eat sometimes,” says Hershkop. She encourages parents think about when they’ve felt sick and imagine if someone tried to force them to eat. Trust that your kid will eat when they are hungry and feel up to it.
While she doesn’t specifically recommend cutting out any particular foods, Hershkop says spicy dishes, fried food or lots of sugar could potentially aggravate diarrhea. “If they typically eat meals with heavier spice, it’s probably fine. But this isn’t the time to try a new recipe.”
When to worry about diarrhea and vomiting
While typically you just need to let the virus run its course, it’s important to keep an eye out for red flags like blood in the diarrhea, vomiting without diarrhea (as this could signal a bowel obstruction or appendicitis), vomiting that goes from diarrhea back to vomiting (which could indicate it’s something other than a virus) and signs of dehydration, like not peeing regularly (or a lack of wet diapers for babies). If the diarrhea doesn’t seem to be going away or you’re concerned your kid isn’t acting like themselves, it’s a good idea to check in with your doctor. Loose stool that lasts more than five days or vomiting that lasts more than 48 hours warrants a doctor’s visit.
Never give your kid over-the-counter diarrhea medication like Imodium unless you speak to a doctor first. These meds can mask symptoms and potentially prevent the body from getting rid of the infection, says the CPS.