What you need to know about food and hydration when your child is throwing up and/or has diarrhea from a stomach bug
We’ve ALLLL been there. The dreaded stomach bug. Tis’ the season! When your child gets sick with a stomach bug, life gets derailed. All of a sudden, schedules get rearranged, work gets missed, laundry piles up, survival mode kicks in, and all of your focus is directed to comforting and taking care of your little one (and making sure that siblings and YOU don’t get sick too).
It’s inevitable– no matter how much we focus on hand washing, immune-boosting foods, and getting enough rest, sickness is going to happen when you have kids. And more than likely–if you have multiple kids–it will make it’s way through your household. I hear you–it sucks! But when a stomach bug hits, it’s important to know how to care for your child so that they can recover as fast as possible.
So, here’s what you need to know about nutrition and hydration when your child has a stomach bug and is throwing up or has diarrhea:
Forget the “BRAT” Diet
This one of those long-standing nutrition myths that just won’t die. Although there’s no clinical evidence to prove its efficacy, the BRAT diet remains one of the top recommendations by pediatricians and doctors (not to mention your mom, mother-in-law, aunt, friends etc.) for children who are vomiting and/or have diarrhea . The BRAT (banana, rice, applesauce, toast) diet can be found in medical books from as far back as the 1920’s and has since been recommended for treating diarrhea. And I can see how it makes sense to so many parents — BRAT foods are easily tolerated, kids generally accept and like them, and it’s easy (and easy is really tempting when you’re dealing with a sick kid!).
But in reality, your little one needs more than four foods (and the limited nutrition they provide) in order to heal. The BRAT diet is simply too restrictive. Sick kids need a variety of nutrients, including protein, in order to recover. And it’s for this reason, that The American Academy of Pediatrics no longer recommends the BRAT diet, and why other healthcare experts agree (including me!). In fact, one could argue that the BRAT diet is so heavy in simple carbohydrates, that it could actually PERPETUATE diarrhea. See, simple carbohydrates draw water into the gut, which can cause loose bowel movements. Eek! This is the opposite of its intended purpose.
Now, following the BRAT diet for a day or two won’t do any harm. And if those foods are the ones that your child is craving, go for it. But the point is, it’s not necessary (or recommended) to limit your child to only BRAT diet foods. It’s better to let your child eat whatever nutritious foods they want to or will eat. They’re craving a bagel with peanut butter and jam? Great! They feel like soup or spaghetti–let them have it!
The truth is, children can eat a variety of foods that they would normally eat when they’re sick. Try offering smaller amounts (so that they don’t get overwhelmed and turned off), and focus on maximizing nutrition when they DO have an appetite. Go easy on foods such as high-sugar treats and sweets, spicy dishes, or fried food as they could could potentially exacerbate diarrhea.
Focus on hydration
Instead of focusing on exactly what your child eats when they’re sick, worry more about keeping them hydrated. When a child is sick with gastroenteritis (stomach flu or bug), and is vomiting and/or has diarrhea, the only thing that really matters in the short term is hydration. What I recommend is giving small amounts of fluid every 15-20 minutes or so, which gives the lining of the gut time to absorb it (and doesn’t over-fill your child’s queezy stomach).
For babies under the age of one who are breastfeeding, continue to feed on demand, and for formula-fed babies, continue to feed formula (and prepare as per usual–not diluted). For breastfed babies over the age of one, you can also feed on demand during sickness.
For children over the age of one, water is always number one, but you can also offer hydrating drinks such as commercial, regulated electrolyte drinks like Pedialyte, small amounts of diluted unsweetened fruit juice or gingerale, soup, smoothies, and real-fruit popsicles. If your child is feeling well enough to eat, you can also offer small amounts of milk if they are craving it.
Set aside the Division of Responsibility in Feeding for now:
I have many posts focusing on teaching parents about Ellyn Satter’s Division of Responsibility in Feeding. It’s the cornerstone of my feeding philosophy and extremely important when teaching your kids how to love food, self-regulate their intake, and have a healthy relationship with food long term. In a nutshell, it means that parents are responsible for what, when and where food is served, and kids are in charge of if and how much food is served. But, when your child is sick–because nutrition and hydration are so paramount–the Division of Responsibility can take a back seat until they’re well. This means, if they would prefer a peanut butter sandwich to the casserole that was served for dinner, let them have the sandwich. If they would like to eat their crackers and cheese snuggled up with you on the couch while you watch cartoons, let it happen. If your child asks for a popsicle out of the blue–let them have it.
The bottom line is to make sure that your kids stay hydrated and nourished with a variety of foods that they want to eat, don’t rely on the BRAT diet, and make sure that you’re keeping up with hand-washing (to prevent the spread of illness!). If you’re concerned that your child’s illness is prolonged, or they are showing any signs of a more serious health problem (dehydration, blood in their stool, etc.) contact their health care provider right away for further guidance.