What is the recommended diet for patients with gastroenteritis (inflammation of the stomach and intestines) accompanied by vomiting and diarrhea?

Dietary Management for Gastroenteritis with Vomiting and Diarrhea

Resumption of an age-appropriate usual diet is recommended during or immediately after the rehydration process is completed for patients with gastroenteritis accompanied by vomiting and diarrhea. 1

Rehydration First

Before addressing diet, proper rehydration is essential:

• Reduced osmolarity oral rehydration solution (ORS) is the first-line therapy for mild to moderate dehydration 1, 2
• For severe dehydration, intravenous fluids should be administered until pulse, perfusion, and mental status normalize 1
• Once rehydrated, maintenance fluids should continue with ongoing stool losses replaced with ORS until symptoms resolve 1, 2

Dietary Recommendations by Age Group

For Infants

• Human milk feeding should be continued throughout the diarrheal episode 1
• For formula-fed infants, resume full-strength, lactose-free, or lactose-reduced formulas immediately upon rehydration 1
• If lactose-free formulas are unavailable, full-strength lactose-containing formulas can be used under supervision 1
• True lactose intolerance will present with worsening diarrhea upon introduction of lactose-containing formula 1

For Children and Adults

• Resume age-appropriate usual diet as soon as rehydration is complete 1
• Recommended foods include:
  • Starches and cereals 1
  • Yogurt 1
  • Fruits and vegetables (well-cooked or processed to softer textures) 1
  • Rice, potatoes, and other easily digestible carbohydrates 1

Foods to Avoid

• Foods high in simple sugars 1
• High-fat foods 1
• Highly processed foods 1
• Fibrous, raw vegetables and fruits (unless well-processed) 1

Practical Approach to Diet Progression

1. Initial Phase (During Rehydration)

   • Focus on fluid replacement with ORS 1, 2
   • Continue breastfeeding for infants 1

2. Early Feeding Phase (After Initial Rehydration)

   • Begin with small, frequent meals 3
   • Start with bland, easily digestible foods like rice, bananas, toast, and applesauce 1
   • Gradually increase portion sizes as tolerated 1

3. Regular Diet Phase

   • Return to normal diet as quickly as tolerated 1
   • Continue to ensure adequate fluid intake 1

Special Considerations

• For persistent vomiting, administer small volumes frequently (e.g., 5 mL every minute) 1
• Antiemetics like ondansetron may be considered to facilitate oral intake in children >4 years and adults 1, 3, 4
• Probiotics may be offered to reduce symptom severity and duration 1, 2
• Avoid antimotility drugs in children <18 years 1, 2

Common Pitfalls to Avoid

• Fasting or withholding food during diarrheal episodes - this delays recovery and worsens nutritional status 1, 2
• Restricting diet unnecessarily - most patients can tolerate normal foods during or immediately after rehydration 1
• Using sports drinks (like Gatorade) as the primary rehydration solution - these may cause electrolyte imbalances, particularly hypokalemia 5
• Focusing on the "BRAT" diet (bananas, rice, applesauce, toast) exclusively - while these foods are appropriate, they should be part of a broader, nutritionally complete diet 1
• Delaying reintroduction of normal foods - early feeding improves outcomes and shortens illness duration 1