Foods and Beverages to Avoid During Diarrhea in Children
Children with diarrhea should avoid foods high in simple sugars (soft drinks, undiluted apple juice, Jell-O, presweetened cereals) and foods high in fat, as these worsen diarrhea through osmotic effects and delayed gastric emptying. 1
Primary Foods and Beverages to Avoid
High Simple Sugar Items
The CDC guidelines explicitly identify specific items that exacerbate diarrhea by creating osmotic gradients that pull water into the intestinal lumen:
- Soft drinks - contain concentrated simple sugars that directly worsen stool output 1
- Undiluted apple juice - high sugar concentration creates excessive osmotic load 1
- Jell-O - pure simple sugar source that increases fluid losses 1
- Presweetened cereals - concentrated sugars worsen diarrhea duration 1
High Fat Foods
Foods high in fat should be avoided because they delay gastric emptying and are poorly tolerated during acute diarrheal illness. 1 The mechanism differs from simple sugars—fats slow gut motility rather than creating osmotic effects, but both worsen clinical outcomes.
The Osmotic Mechanism Explained
Simple sugars create immediate problems when their concentration exceeds the intestinal absorption capacity. 2 When carbohydrate concentration becomes too high, osmolar forces draw water into the gut lumen and directly exacerbate diarrhea. 2 This is dose-dependent—the higher the simple sugar intake, the greater the osmotic load and fluid losses. 2
Complex carbohydrates (starches, cereals) do not create this problem because large polymers are slowly digested by intestinal enzymes before absorption, avoiding excessive osmotic gradients. 2
What Children SHOULD Eat Instead
The CDC recommends continuing a regular diet with specific safe foods:
- Starches: rice, potatoes, noodles, crackers, bananas 1
- Cereals: rice, wheat, and oat cereals (unsweetened) 1
- Other safe foods: soup, yogurt, vegetables, fresh fruits 1
- Breast milk: continue on demand without interruption 1, 3
- Formula: full-strength lactose-free or lactose-reduced formula immediately after rehydration 1, 3
Critical Pitfall: The Lactose Controversy
Despite widespread concern about lactose, most children tolerate continued milk feeding well during diarrhea. 1 The CDC explicitly states that lactase deficiency must be distinguished from true lactose malabsorption—many infants with lactase deficiency will not have clinical malabsorption. 1
Do not diagnose lactose intolerance based solely on stool pH (<6.0) or reducing substances (>0.5%) without clinical symptoms. 1, 3 True lactose intolerance is indicated by severe diarrhea worsening upon introduction of lactose-containing foods, not just laboratory findings. 1
For bottle-fed infants, lactose-free or lactose-reduced formulas can be used if clinical lactose intolerance develops, but routine dilution of milk and routine use of lactose-free formula are unnecessary for most children. 1, 4
Age-Specific Considerations
Infants
- Breastfed: Continue nursing on demand—breast milk actually reduces stool output compared to ORS alone 1, 3
- Formula-fed: Resume full-strength lactose-free or lactose-reduced formula immediately after rehydration 1, 3
Older Children
- Continue regular diet with emphasis on starches, cereals, and age-appropriate foods 1
- Avoid the temptation to restrict diet unnecessarily—adequate caloric intake prevents malnutrition 1
Common Pitfall: The BRAT Diet Trap
The BRAT diet (bananas, rice, applesauce, toast) is reasonable to the extent it includes starches and fruits, but prolonged use results in inadequate energy and protein content in the recovering child's diet. 1 Use it as a starting point, not an extended restriction.
What About Diluted Formulas?
Do not dilute formula or delay full-strength feeding—this worsens nutritional outcomes and prolongs diarrhea. 3 The older AAP recommendation for gradual reintroduction with diluted mixtures is being reevaluated, as evidence shows full-strength lactose-free formula reduces both stool output and diarrhea duration by approximately 50%. 3