Dietary Recommendations After Diarrhea
Resume an age-appropriate regular diet immediately after rehydration is completed, with continued breastfeeding throughout the illness and avoidance of foods high in simple sugars and fats. 1
Immediate Feeding Strategy
Early refeeding (within 12 hours of beginning rehydration) is as safe and effective as delayed feeding and improves nutritional outcomes. 1 The 2017 IDSA guidelines strongly recommend resuming an age-appropriate usual diet during or immediately after the rehydration process is completed. 1
For Infants
- Continue breastfeeding on demand without interruption throughout the entire diarrheal episode, as breast milk reduces stool output compared to oral rehydration solution alone. 1, 2
- Formula-fed infants should resume full-strength lactose-free or lactose-reduced formula immediately after rehydration, not diluted mixtures. 2 While the CDC previously recommended gradual reintroduction with diluted formulas, this recommendation is being reevaluated as prolonged dilution worsens nutritional outcomes. 1
- Lactose-free diets reduce diarrhea duration by approximately 18 hours and reduce treatment failure by half in children under 5 years. 1
For Older Children
Recommended foods include: 1, 2
- Starches: rice, potatoes, noodles, crackers, bananas
- Cereals: unsweetened rice, wheat, and oat cereals
- Other safe foods: soup, yogurt, vegetables, fresh fruits
Rice-based diets are particularly effective, with 81% of children recovering within 7 days in clinical studies. 3 Green banana and pectin have shown therapeutic benefit, with 59% and 55% recovery rates by day 3 compared to 15% in controls. 4
Foods to Strictly Avoid
Foods high in simple sugars worsen diarrhea through osmotic effects and must be avoided: 1, 2
- Soft drinks
- Undiluted apple juice
- Jell-O
- Presweetened cereals
Foods high in fat delay gastric emptying and are poorly tolerated: 1, 2
- Fried foods
- Fatty meats
- High-fat dairy products
Common Pitfalls
The BRAT diet (bananas, rice, applesauce, toast) is reasonable but should not be used exclusively or prolonged, as it results in inadequate energy and protein content in the recovering child's diet. 1 While commonly recommended, supporting data for the BRAT diet are limited. 1
Diluting formula or delaying full-strength feeding worsens nutritional outcomes and prolongs diarrhea. 2 This is a critical error that contradicts older AAP recommendations. 1
Do not diagnose lactose intolerance based solely on stool pH or reducing substances without clinical symptoms. 2 Many infants with lactase deficiency will not have clinical malabsorption. 1
Special Considerations
Instructing patients to refrain from eating solid food for 24 hours does not appear to be useful. 1 Early feeding decreases intestinal permeability, reduces illness duration, and improves nutritional outcomes, particularly important in settings where underlying malnutrition exists. 1
Cereal-milk and cereal-legume diets have been used successfully for dietary management in older children. 1 The absorption of nutrients correlates with nutritional status, with better-nourished children showing superior recovery rates. 3