BRAT Diet for Babies with Diarrhea: Does it Work?

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Katie Ferraro (2m 8s):

And I know when your baby starts. Solid foods, it's so easy to blame every bodily change that we see on the food. There's a rash. Must be the strawberries. There's some gas. Let's cool it on the broccoli loose stool. Oh my gosh, have I broken my baby's gut with baby led weaning? But diarrhea is usually not because your baby ate a new food yesterday. And we certainly know that trying to manage it with this really restrictive four food diet is not going to solve the underlying problem of why the child is experiencing diarrhea. Hey there, I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in baby led weaning. Here on the baby led weaning with Katie Ferraro podcast. I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge You need to give your baby a safe start to solid foods using baby led weaning.

Katie Ferraro (3m 4s):

Hello and Welcome back. Today we're talking about the BRAT diet for babies who have diarrhea and Does it Work. If you've never heard about the BRAT diet, I'll tell you what it means. But if you baby's starting solid foods, I know you're paying attention to some of the weird GI stuff that's going on. Maybe your baby's constipated, maybe they're starting to have more diarrhea. So you might be wondering, did food cause this problem A and can I use food to fix it? So today's topic is about the BRAT diet, and that stands for bananas, rice, applesauce and Toast. It's one of those pieces of old school feeding advice that just will not go away. And that's because for decades, parents were told, oh, your baby's got some diarrhea.

Katie Ferraro (3m 45s):

Just do the BRAT diet. But here's the problem. The brat diet is restrictive. It's not nutritionally adequate if you use it for more than a very short period of time, And it doesn't address the most important question, which is why does your baby have diarrhea in the first place? So In this episode, we're gonna look at what the BRAT diet is. It's no longer recommended as the go-to approach, and we're gonna focus instead on when diarrhea in a baby means it's actually time to call your pediatrician. I'm Katie Ferraro, I'm a registered dietician. I am not a pediatrician. And the advice that you learn on the podcast or in any of my content is never intended to replace that of your medical provider. I am a college nutrition professor.

Katie Ferraro (4m 25s):

We spend a lot of time, especially in my nutrition throughout the lifecycle class, teaching about some historical diets, and the brat one always comes up. So I actually really love this topic. It's kind of one of those nerdy nutrition topics that as a dietician, I get a lot of pleasure talking about medical nutrition therapy for diarrhea. So hopefully you will as well. Now, nobody posts the after diaper on Instagram, right? But this is real life. Like when your baby starts solid foods, their poop is going to change. Sometimes it gets thicker, sometimes it gets smellier. Sometimes you do see little pieces of food and you think like, is that the carrot that we ate yesterday? Is this normal? And sometimes your baby will have loose watery stools and you're standing there at the changing table and you're gonna be thinking, is this because of something I fed?

Katie Ferraro (5m 6s):

Is this baby led leaning backfiring on me? Do I need to stop offering real food? Should I do this brat diet, banana rice, applesauce, and toast to make the diarrhea go away? So that's what we're gonna unpack today. And I want to right off the bat reassure you that baby led weaning is generally not going to be the reason your baby has diarrhea. Okay? Diarrhea in babies and young children is most often caused by an illness. Sometimes it can be viral, it can be bacterial, it can be something that happens after antibiotics. Sometimes there are food related issues to explore, especially if it keeps happening. But the fact is that if your baby is self-feeding, soft, safe pieces of real food, that's not gonna be the cause of diarrhea more often than not. So let's take the pressure off of you for a minute.

Katie Ferraro (5m 49s):

You did not break your baby's gut because you gave them some avocado at six months of age. Alright? What is the brat? Diet BRAT stands for bananas, rice, applesauce, toast. Historically, these foods were recommended because they're bland and they're starchy. So the thinking was that they would be easy on the gut and help firm up the stools. And listen, there's nothing wrong with any of those foods individually. Bananas great for fruit for babies. I love it. Rice as a starchy food if you prepare it safely and don't offer it every day. Great applesauce. If we offer from a preloaded spoon, it doesn't have any sugar, fine toast, And I don't love bread for early eaters. There's lots of better whole grain options. But still, like it's not the end of the world for your baby to have toast, the problem's, not the food themselves.

Katie Ferraro (6m 31s):

The problem is when we take a baby who's rapidly growing and they're actively developing and they're learning how to eat, and then we restrict them to just four foods 'cause we're trying to fix the diarrhea, okay? That's where the BRAT Diet falls. Short. Major pediatric and public health guidance now emphasizes for diarrhea, not the brat diet, okay? They're recommending hydration, oral rehydration when appropriate and continued feeding instead of prolonged restrictive diets for diarrhea. So the CDCs acute gastroenteritis guidance focuses on oral rehydration therapy, continued feeding and appropriate medical assessment. Okay? The WHO World Health Organization, they track diarrhea care in young children around oral rehydration therapy and continued feeding, and they don't focus on this four food only diet.

Katie Ferraro (7m 16s):

I also do wanna point out that diarrheal disease is one of the primary killers of children under one around the world. So if you live in a part of the world where access to clean water is a concern that oftentimes is the primary underlying cause of diarrhea disease. If you live in a part of the world where you have continual access to clean water, how lucky we are, and your baby is having intermittent, occasional diarrhea, that's a much different situation than the type of diarrhea that, for example, the World Health Organization is tracking, especially in the developing world. So why is the BRAT diet outdated? Okay, it's low in protein, it's low in fat, and it's limited in micronutrients. It doesn't give your baby the variety that they're gonna need during this really important flavor window between six and 12 months of age when they're learning how to eat a variety of foods.

Katie Ferraro (8m 2s):

So again, if your baby has mild diarrhea for a short period of time and they happen to eat some banana or rice as part of the normal diet, that's fine. No one here is demonizing banana. We're not putting toast on the naughty list, but we're just using the brat diet as a whole plan that is outdated. The American Academy of Pediatrics recommends for parents when in their guidance that their children should generally return to a normal age appropriate balanced diet within 24 hours of illness rather than staying on this restrictive brat diet for days. Okay? And that matters because your baby's not a miniature adult on a bland diet. Your baby's in this critical window of learning how to eat real food. So what do we focus on instead? Hydration. Okay, this is the priority with diarrhea is not like, which bland foods can I offer to plug this up?

Katie Ferraro (8m 46s):

The priority is hydration. Remember, babies can become dehydrated much more quickly than older children and adults, especially if the diarrhea is paired with vomiting, fever, or poor intake. So for babies, breast, milk and or formula should continue to be offered on demand. This is not the time to cut back on infant milk, okay? Infant milk is still doing a lot of that nutritional heavy lifting, especially in the first year of life. So if your baby's breastfeeding, keep breastfeeding. If your baby's formula fed, keep offering formula unless your doctor tells you otherwise. So if your baby has moderate diarrhea or you're concerned about dehydration, your pediatrician could recommend an oral rehydration solution. But this is really important. Don't try to make your own electrolyte solutions at home for a baby unless you have very specific medical guidance.

Katie Ferraro (9m 29s):

I mean, we have people making homemade formula on TikTok. So I think making your own electrolytes at home is probably not very far behind. Don't do it. The ratio of the sugar and the salt matters too much or too little can be dangerous. Hey, we're gonna take a quick break, but I'll be right back.

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Katie Ferraro (11m 36s):

So what about juice sports drinks, or natural remedies? Okay, some fluids. Parents will reach for things like juice or sports drinks, sometimes even soda. You hear about sweetened teas, rice water, boiled milk, cultural remedies. And here's the deal. I'm not here to dismiss family traditions or cultural food practices. Food is cultural and many families have home approaches that have been passed down for generations. From a clinical standpoint though, with babies, we need to be really careful. High sugar fluids can actually make the diarrhea worse. And why is that? Because the sugars actually pull more water into the intestines, which can increase stool output. So if your baby already has watery stools, adding a bunch of sugar is not the move. Same thing for sports drinks. Those are formulated for sweaty adults, not children with or infants with diarrhea.

Katie Ferraro (12m 19s):

Okay? So the practical takeaway, stick with the breast milk or the formula and ask your pediatrician if an oral rehydration solution is needed. So can your baby keep eating solid foods? That's the next big question. And in a lot of cases of my diarrhea, babies can continue with an age appropriate diet. Now that doesn't mean mean that you need to offer like a giant plate of 17 different foods, but you also don't need to automatically restrict to four bland foods, okay? We don't wanna force the baby to eat. Baby led weaning is responsive. Feeding your job is to offer your baby, is to decide whether and how much that baby eats, okay? The goal is not to start to panic and offer a restrictive diet because the diaper looked a little wild. What foods might be better tolerated?

Katie Ferraro (12m 59s):

Soft familiar foods, okay? Complex carbohydrates like potato, rice, oats, pasta and toast, prepared safely for your baby's age and stage, fruits and vegetables that your baby's already tried and tolerated. Protein foods, if they're interested, you don't wanna jump to like, oh, my baby must be allergic to this every time there's a loose stool. Okay? When you learn the true signs of allergic food reactions, you'll realize it most often always involves skin and one other sign of allergic reaction. So we don't wanna ignore patterns, I'm saying, but standalone diarrhea on its own is very rarely a sign of true food allergy. Okay? So this is where your clinical team comes in. And then the reason why you always need to remember every baby is different, And it is best to check with your doctor. And I know it sounds weird, but take pictures and take notes what the food that the baby ate or if they were on a medication or if they were sick, and then how often the watery stools were occurring.

Katie Ferraro (13m 49s):

And then take a picture of them too, because that can help the clinician in helping you to find out what the underlying problem is. All right? So foods and drinks to avoid during diarrhea, I would avoid juice, sweetened drinks, sports drinks, any foods with added sugar. And when do we start thinking, gosh, maybe this diarrhea stuff is not just about the food. Okay? When your baby starts solid foods, it's easy to blame every single bodily change on the food rash. Ah, must be the strawberries. Gas. Oh, no more broccoli. Loose stool must be baby led weaning. But diarrhea is usually not because your baby ate a new food yesterday. Again, most diarrhea in children is caused by viral illness according to the apps parent education guidance. And yeah, there are food related reasons a baby might have some ongoing GI symptoms.

Katie Ferraro (14m 32s):

Cow's milk, protein allergy, for example, can cause GI symptoms in some babies. Some babies will have temporary lactose issues after they've had a GI infection. Some babies will have diarrhea after they've been on antibiotics. Some babies in childcare settings are exposed to more viruses and sometimes parasites. So the point is, if the diarrhea is persistent, recurrent, severe, or paired with other symptoms, that's not something we're gonna solve by rotating bananas and toast. That's something we need to evaluate. So when do you call the pediatrician? Okay, I want you to have a low threshold here. If your baby's diarrhea lasts longer than 24 hours, check in with your doctor, especially if the baby is under one year of age. If you wanna seek more urgent care, if you notice signs of dehydration, including no wet diaper for six to eight hours, if your baby has very

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Katie Ferraro (15m 43s):

Dark or pungent smelling urine if there's no tears when crying dry mouth or they're lethargic or unusually sleepy, if they've got that sunken soft spot on their head, high fever, any blood in the stool or repeated vomiting, or if your baby just looks really unwell, right? You know your baby best. And I know sometimes parents worry like, oh, I being dramatic if I call. No, you're not being dramatic. You are being the safety system. Babies can get dehydrated quickly, and dehydration is part of diarrhea that we take seriously. Alright, so here's your clinical takeaway. The brat diet. It's outdated as a go-to treatment for babies with diarrhea, bananas, rice, applesauce, toast. They're not bad foods on their own, but relying on only those foods is restrictive And it won't give your baby the nutrition they need.

Katie Ferraro (16m 29s):

If it's used for any significant period of time for mild diarrhea, most babies can continue breast milk or formula and continue to offer those age appropriate solid foods as tolerated. Steer clear of the high sugar fluids. Don't use sports drinks, soda, juice or homemade electrolyte mixture in place of an oral rehydration solution if that's what your doctor's recommending. And if that diarrhea lasts more than 24 hours, or if your baby is showing those other signs of dehydration, or if you're just worried, call your pediatrician. I'd much rather have you make that call early than spend the day trying to troubleshoot diarrhea with like four bland foods and going down a Google rabbit hole. So I'll put the resources for today's episode, including the references about the Brat Diet on the show notes page for this episode, which you can find@blwpodcast.com/115.

Airwave Media (17m 17s):

A very special thank you to our partners at Airwave Media. If you like podcasts that feature food and science in using your brain, check out some of the podcasts from Airwave Media or online@blwpodcast.com.

Katie Ferraro (17m 28s):

Thanks so much for listening, and I'll see you next time. Bye now.