No, the BRAT Diet Should Not Be Used
A 14-month-old child with mild to moderate dehydration should NOT be placed on a BRAT diet; instead, resume an age-appropriate usual diet immediately during or after rehydration with oral rehydration solution (ORS). 1
The Evidence Against BRAT Diet
The 2017 IDSA guidelines explicitly state that "although the BRAT (bananas, rice, applesauce, and toast) diet and the avoidance of dairy are commonly recommended, supporting data for those interventions are limited." 1 This is a critical point—the BRAT diet persists as a cultural practice without scientific backing.
What Should Be Done Instead
Step 1: Rehydration First
- Use reduced osmolarity ORS as first-line therapy for mild to moderate dehydration (strong recommendation) 1
- For a 14-month-old: Give 50-100 mL/kg over 3-4 hours 1
Step 2: Early Refeeding
- Resume age-appropriate usual diet during or immediately after rehydration is completed (strong recommendation) 1
- This means the child's normal foods—not a restricted diet
- Early feeding (within 12 hours) is as safe and effective as delayed feeding and improves nutritional outcomes 1
Step 3: Continue Breastfeeding
- If breastfed, continue human milk feeding throughout the diarrheal episode without interruption (strong recommendation) 1
Why Early Normal Feeding Matters
The guidelines emphasize that early refeeding:
- Decreases intestinal permeability caused by infections
- Reduces illness duration
- Improves nutritional outcomes 1
Instructing patients to refrain from eating solid food for 24 hours does not appear to be useful 1. The restrictive nature of the BRAT diet may actually delay recovery by limiting nutrient intake when the child needs adequate nutrition most.
Special Consideration: Lactose
While the BRAT diet often includes dairy avoidance, the evidence shows:
- Most children can tolerate their usual lactose-containing formula 1
- A lactose-free diet may reduce diarrhea duration by 18 hours in some cases 1
- However, routine lactose-free feeds are not recommended 2
For a 14-month-old with mild to moderate dehydration, continue the usual diet unless there are specific signs of lactose intolerance.
Common Pitfall to Avoid
The biggest mistake is unnecessarily restricting a child's diet based on outdated practices. The BRAT diet is nutritionally inadequate and lacks the protein, fat, and diverse nutrients needed for recovery. Focus on adequate hydration with ORS and rapid return to normal eating.