The B.R.A.T. Diet for Diarrhea in Children

Willow has had diarrhea today and I was talking to my sister and she mentioned the B.R.A.T. diet. What's that? I asked. She told me it's Banana, Rice, Apple(sauce), Toast. She said it's an old fashioned remedy for diarrhea in children.

I was intrigued, so I looked it up. And she was right!! (I guess having 4 children DOES make you smart!! ^_^) She was careful to mention that it was old fashioned and may not be used now a days.

Here's what I found...

According to Carol Rees Parrish, R.D., M.S. (Series Editor for the Nutrition Issues in Practical Gastroenterology) who wrote an article entitled: The BRAT Diet for Acute Diarrhea in Children: Should It Be Used?, Controversy still exists as to what types of foods are best indicated during the acute illness, as well as which foods will provide sufficient calories, easily absorbable nutrients, are palatable and are of low cost. Due to water and electrolyte loss during diarrhea, any dietary plan should always be accompanied by oral rehydration therapy (ORT). ORT effectively treats and prevents dehydration in children and adults with diarrhea.

In the past, the concept of food restriction and bowel rest was based on the acknowledged effects of decreasing stool output. This concept of "gut rest" is now outdated, since randomized clinical trials confirm that refeeding immediately after rehydration is associated with lower stool output, shorter duration of illness, and better nutritional outcomes, compared with more gradual reintroduction of food. Current recommendations on feeding during diarrhea from the America Academy of Pediatrics, the Centers for Disease Control and Prevention, the World Health Organization and other groups include administering an oral diet as soon as the patient has been rehydrated. The BRAT diet is one dietary management tool used by many clinicians and parents around the world during acute diarrhea.

As a side note, I called my pediatrician today since Willow had a slight fever and diarrhea and she suggested feeding her banana's. This is interesting since according to Ms. Parrish, "To date, no clinical trials have been conducted to assess its effectiveness, although some data exist to evaluate the role of bananas and rice in treating diarrhea."

According to About.com: Pediatrics article on the BRAT diet, "Since some of those foods, especially bananas and rice, are 'binders' and are considered to be constipating, they might help diarrhea. But if you wanted to feed them to your child for that reason, you might just add them to his regular diet, instead of just restricting your child to a BRAT diet."

Ms. Parrish, goes on to list potential advantages of the BRAT diet.

Advantages: The role of dietary fiber in diarrhea has been proposed to reduce the duration of liquid stools as well as to reduce the bioavailability of some micronutrients. Banana is rich in amylase-resistant starch, which has been postulated to protect the gastrointestinal mucosa in animals and improve symptoms of non-ulcer dyspepsia and peptic ulcer in humans. Rice is commonly used in the diets of children with diarrhea. There are some in vitro data to suggest that rice may possess anti-secretory properties.

Disadvantages: One concern about the use of a restricted diet is the effect on growth. Baker and Davis described two children who developed acute diarrhea and were treated with bowel rest and clear oral fluids followed by a BRAT diet. Both children subsequently developed severe malnutrition with hypoalbuminemia and edema, which resolved with nutritional support. One three-year-old girl developed kwashiorkor, presenting with an albumin of 1.6 g/dL after two weeks on the BRAT diet. One six-week-old boy developed marasmic kwashiorkor due to both the low protein and energy content of this diet. Although these two case reports represent an extreme outcome, they are reflective of what can happen with prolonged restrictive diets after an episode of infectious diarrhea.

Okay, my first reaction to the disadvantages is this: If your child has diarrhea for two weeks, they should be seeing a doctor and you shouldn't be trying a home remedy, no matter what age they are.

Ms. Parrish summarizes her findings thusly...

The selection of a single type of restrictive diet (e.g., the BRAT diet) during diarrhea can impair nutritional recovery and in fact lead to severe malnutrition. Dietary management during any acute illness should be balanced, providing all of the three major macronutrients, as well as meeting the DRI for micronutrients. Prompt feeding during an acute episode of diarrhea and avoiding unnecessarily restrictive diets is the recommended dietary therapy during acute diarrhea. Nursing should be continued for those infants who are breast-fed and standard full strength formula be given to those formula-fed infants. Age appropriate foods from a variety of sources are recommended to optimize health outcomes. Future studies should evaluate whether certain dietary patterns are associated with more rapid recovery from acute diarrhea, but until these data are available, overly restricted diets should not be recommended.

Now you know!!