Diet Guidelines Change for Kids Who Have Diarrhea

For as long as anybody can remember, doctors and nurses have suggested the BRAT diet for children suffering from diarrhea.

But the diet--like the children its name connotes--should be given a time-out.

The diet’s name stands for the first initials of its ingredients--bananas, rice, applesauce or apple juice and toast. Doctors once thought those foods would allow the digestive tract to rest while the viral infection that commonly causes diarrhea ran its course.

But restricting a child’s diet to that menu of foods is now believed to do more harm than good.

Nonetheless, said Claire Dalidowitz, team leader of clinical nutrition at the Connecticut Children’s Medical Center, health-care providers continue to prescribe the BRAT diet.

The American Academy of Pediatrics no longer recommends the diet because it does not provide adequate nutrition and can actually worsen diarrhea.

Instead, the pediatrics group recommends reintroduction of the child’s regular diet within 24 hours of the first episode of diarrhea, although parents should avoid including spicy and fried foods until the child has recovered.

The diet can become dangerous if a child is kept on it for too long. Two months ago, doctors at the Connecticut children’s hospital treated a girl who came in with a bright red rash on her cheeks, buttocks and genital area, Dalidowitz said.

The rash was a classic symptom of a zinc deficiency. Zinc is an important nutritional mineral found in meat, fish, poultry and dairy products--all taboo items on the BRAT diet. It turned out that the girl had been on the diet for several weeks after a bout with diarrhea, Dalidowitz said.

A gastrointestinal specialist at the hospital prescribed a zinc supplement, and the rash disappeared within a day, Dalidowitz said.

Zinc is an often overlooked mineral that is an important factor in growth, skin development, immune function and in helping the body express genetic information.

Although zinc is probably not an issue over a short duration of the diet, good nutrition is important for children with diarrhea. During bouts of diarrhea, the lining of the intestine breaks down, and nutrients in healthful foods are important for recovery, Dalidowitz said.