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Three Part Question

In [pediatric patients with gastroenteritis] does [the BRAT diet] [decrease the length and severity of the disease course]?

Clinical Scenario

A 6 year-old boy presents to the emergency department with vomiting and diarrhea for 4 days. He is able to hold down liquids but appears dehydrated. After adequate fluid administration orally, the patient appears well enough to be discharged home. Is the BRAT (bananas, rice, applesauce, and toast) diet going to improve the patients overall outcome?

Search Strategy

Medline via OVID interface
(Pediatrics OR children) AND (gastroenteritis OR vomiting OR diarrhea) AND (diet OR BRAT diet)

Search Outcome

No relevant papers identified.

Comment(s)

Gastroenteritis is a common illness seen in the pediatric population, and it accounts for a large portion of emergency room visits each year. Patients are assessed for their hydration status, and oral fluids are the preferred method of rehydration. If a child is unable to tolerate liquids by mouth due to emesis, anti-emetics can be administered to assist. Dehydration and inability to take oral fluids can lead to a need for intravenous fluid administration with a possibility of admission based on the severity of dehydration. Once a child is able to be discharged home the question of what diet should be started to improve clinical course and outcome arises. Traditionally, the BRAT (bananas, rice, applesauce, and toast)diet has been recommended by physicians for patients with gastroenteritis. The belief is that it improves the child's intake and provides some form of nutrition as it is mild in nature and easily tolerated. Despite this, there have been no studies on whether this intervention has improved the outcome of the disease course. The diet does however have advantages and disadvantages. The bananas and rice portions are higher in fiber leading to more solid stools and a decrease in the frequency of diarrhea. Another advantage is that it is reassuring for parents that they are administering some form of treatment for the child out of the hospital. One of the major disadvantages is that it does not supply a source of protein needed for the body during an acute illness. A child would be better starting a general diet providing adequate nutrition. Overall, the BRAT diet does not have any significant data supporting or condemning its use. Randomized trials comparing it to a general diet are needed evaluating its effect on clinical outcome.

Clinical Bottom Line

When encountering a child with gastroenteritis the BRAT diet can still be considered but used with caution. The parent needs to be educated that it does not have adequate nutrition to support the child's acute illness but does provide some sort of oral intake. The child should be advanced to a general diet as soon as possible. Oral fluids with appropriate electrolyte composition is still the mainstay of treatment and should be encouraged.