Doctors are would have concerned about an increase in the number of children with gastroenteritis – when stomach infections can cause nausea, vomiting, diarrhea, fever, abdominal pain, headache and muscle pain.
Rotavirus is a common cause of gastroenteritis in children and the rate of rotavirus reported in NSW so far This year is five times what it usually is.
Although there is a lot of gastroenteritis, the good news is that in the vast majority of cases children recover uneventfully.
Yet parents and caregivers receive a lot of conflicting advice about what foods and beverages children should consume during their recovery. Let’s look at the evidence.
Old advice: the BRAT diet
A widely known dietary recommendation when recovering from gastroenteritis is the BRAT diet. That means bananas, rice, applesauce, and toast. These bland foods are supposed to be gentle on the gut, which is important when someone is recovering from gastroenteritis.
Applesauce is a quintessentially American food product and indeed the first mention of this diet was in a American report in 1926 on the treatment of “intestinal intoxication” in children.
The BRAT diet was historically recommended, but has fallen out of favor over the past two decades. There are no clinical trials on the diet itself, but supporting evidence comes from studies which demonstrated how each food in the BRAT diet could aid gastrointestinal recovery.
Bananas and apples are rich in a starch called pectin which can form a gel, which assistance to treat diarrhea. Green banana pulp and flour in particular have proven reduce diarrhea in children. Bananas are also a rich source potassium, which can help replace potassium lost through diarrhea.
Rice-based oral rehydration solutions (a drink made from a mixture of water, rice, glucose, sodium and potassium salts) used to treat gastroenteritis reduces stool volume and duration of diarrhea in patients. A study of Bangladesh on infants with persistent diarrhea found that a rice diet containing green banana or pectin improved stool consistency and reduced stool duration more than a diet of rice alone.
magic apples
It is believed that the use of apples to treat diarrhea to have started in Germany, where a nurse called Sister Frieda Klimsch used the fruit to treat dysentery (a severe form of gastroenteritis) in a hospital.
Another one origin story recounts how a doctor in a German prison camp noticed that prisoners with dysentery who ate apples from a nearby orchard had a shorter, milder illness. The doctor started encouraging them to eat apples to treat diarrhea.
Eating apple peels was observed cause vomiting in infants in the 1930s and so the skin was removed. grated apple was used to treat diarrhea in children around the same time and was helpful in some cases.
Applesauce later became the recommended form of apple for healing gastroenteritis in the United States and is included in the BRAT diet. Interestingly, give diluted apple juice for children slightly dehydrated by gastroenteritis is both safe and effective.
Why Gastro Diet Advice Has Changed
Over the past 20 or so years, most medical professionals have come to the conclusion that the restricted BRAT diet is unhealthy for healing gastroenteritis because it is low in proteins, lipids and energy. All of these nutrients are necessary for healing.
Studies have watch, in general, a normal diet does not aggravate the course of gastroenteritis. It is therefore not necessary to restrict your child’s diet. Fasting while recovering from gastroenteritis is not recommended, but it is important to consider the child and facilitate the reintroduction of foods.
It turns out that fat, lactose and sucrose absorption during diarrhea is limited – so it makes sense to avoiding fatty foods and foods high in simple sugars (including juices and soft drinks) for moderate to severe diarrhoea, as these may make symptoms worse.
Flat soft drinks?
Flat soft drinks such as colas and lemonade deserve a special mention. Some see these drinks as an option to replenish fluids and glucose lost through vomiting and diarrhea. But research has shown that may not be a good idea.
One British study searched the medical literature dating back to the 1950s for evidence supporting the use of soft drinks in gastroenteritis. They found none.
Next, the researchers compared the contents of colas and other sodas with commercially available oral rehydration solutions containing electrolytes and small amounts of sugar. They found that soft drinks not only contained very low amounts of potassium, sodium and other electrolytes, but in some cases up to seven times the glucose recommended by the World Health Organization for rehydration.
Carbonated drinks, still or otherwise, are therefore not considered to provide sufficient fluid or electrolytes and are not recommended.
So what should you eat and drink while recovering from gastroenteritis?
Appropriate foods include fruits, vegetables, lean meats, yogurts, as well as complex carbohydrates like wheat, rice, bread, potatoes, and cereals.
Parents of young children with mild gastroenteritis should keep them hydrated by encouraging fluid intake through water and milk, and discourage fruit juices and carbonated drinks.
For moderate or severe cases, the appropriate liquid for oral rehydration is a commercially available oral rehydration solution (such as Gastrolyte or Hydralyte).
A systematic review and meta-analysis of 174 studies concluded the use of a probiotic (Saccharomyces boulardii) and zinc supplementation can help recover from gastroenteritis by reducing the duration of diarrhea and stool volume.
If symptoms or dehydration are serious, you should take your child to see a GP or go to the nearest hospital emergency department.
