Tuesday, May 27, 2014

pediatrician psa: the brat diet

Have you ever heard of the BRAT diet? It's a bland, low-fiber diet intended to be fed to children when they have diarrhea or other GI upset. BRAT stands for Bananas, Rice, Applesauce, and Toast.

Here's the thing, though (which even some doctors aren't aware of): the BRAT diet is no longer recommended. It's not that those foods are bad for kids with gastroenteritis, it's that eating only those foods is an unnecessary limitation on nutrition. In most cases, kids with diarrhea will do just fine eating a regular normal diet as tolerated. Babies should continue their regular breast milk or formula (NOT diluted, which can cause dangerous electrolyte imbalances).

There are a few caveats, though:

- Avoid liquids high in simple sugars (soda, juice, jello, etc) because they tend to make diarrhea worse-- the sugar pulls more water into the intestines.

- Avoid very greasy foods, because they can alter the time it takes for the body to move food through the GI tract.

- Sometimes, kids with GI illnesses can become temporarily "lactose intolerant"-- basically, because their intestines are irritated, they have trouble absorbing lactose. The lactose then stays in the intestines and (just like the simple sugars mentioned above) makes diarrhea worse, and can also make kids gassy and bloated. Most kids with diarrhea do just fine with continued dairy intake, but it's something to talk to your child's doctor about.

If the child doesn't feel like eating much when they're sick, that's okay. The most important thing is that they keep drinking. If the diarrhea is mild, they can generally drink whatever they usually drink and they'll be fine. If the diarrhea is more severe, though, they're losing a lot of electrolytes through their intestines, so it's important to replace those electrolytes to avoid imbalances. The best thing to drink in that case is an oral rehydration solution such as Pedialyte or Enfalyte (or an off-brand version). It's not recommended to mix your own homemade electrolyte solution unless you've been instructed to do so by your child's doctor.

Patients' parents often ask me if it's okay if their child drinks sports drinks like Gatorade or Powerade instead (they do taste better than Pedialyte). Well, that kind of depends. The reason those drinks taste better than Pedialyte is because they're pretty high in sugar, which (as mentioned above) can worsen diarrhea. Also, the electrolytes in Gatorade are designed to replace the ones you lose in sweat, not the ones you lose in diarrhea, so they don't have as much sodium or potassium. But if your child's diarrhea is mild, it's probably okay to drink Gatorade. It's somewhat better than juice or soda.

Electrolyte Composition (based on what I could Google):
Per liter, Pedialyte has:
45mEq sodium, 20mEq potassium, 25gm sugar
Per liter, Gatorade has:
19mEq sodium, 3.25mEq potassium, 58gm sugar
Per liter, apple juice has:
1.3mEq sodium, 27mEq potassium, 100gm sugar

I also get asked about drinking plain water. Again-- if the diarrhea is mild, your child is eating, and they're not especially dehydrated, then water is great. But if the diarrhea is severe or your child is dehydrated, then drinking plain water can lead to dangerous electrolyte imbalances. These cases are when it's most important to drink an oral rehydration solution (and to make an appointment with the doctor!). This is especially true for babies-- if they're refusing formula or breast milk, or if you want to add extra hydration, it's NOT okay to give them plain water. Babies have immature kidneys which aren't as good at balancing the body's electrolytes and water, so babies are especially prone to severe electrolyte imbalances. It IS okay to give babies an oral rehydration solution such as Pedialyte.

For more information, see:
HealthyChildren.org: Diarrhea
KidsHealth.org: Diarrhea

For more detailed, clinician-directed information, see:
The Management of Acute Diarrhea in Children
Practice Parameter: The Management of Acute Gastroenteritis in Young Children

(Legal disclaimer: This information is intended only to provide general information and is not a replacement for medical evaluation, advice, diagnosis, or treatment by your child's doctor. I am a real pediatrician, but I'm not your pediatrician.)

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