Once the vomiting and diarrhea settle, many parents wonder what to feed next. Plain rice porridge or broth for several days is a common habit, but the guidance points in a somewhat different direction. This article covers the basic principles for feeding during recovery and the warning signs to watch for.
Why It Happens
Acute gastroenteritis is most often caused by viruses. The lining of the gut is temporarily irritated, so water and nutrients are absorbed less well, causing diarrhea and vomiting. Food moves through quickly, and some children briefly make less of the enzyme that digests lactose. That is why stools can stay loose or frequent for a few days after the child starts to feel better.
Older practice involved fasting or offering only diluted or bland foods. CDC’s 2003 MMWR guidance on managing acute gastroenteritis in children says overly restricted diets should be avoided and that “bowel rest” is not indicated. The 2019 AAFP review notes that guidelines consistently recommend rehydrating a dehydrated child, replacing ongoing fluid losses, continuing breastfeeding throughout rehydration, and starting an age-appropriate diet after initial rehydration. The 2014 ESPGHAN/ESPID guideline likewise advises continuing breastfeeding or returning to the usual diet as soon as possible, and says special formulas are unnecessary for non-hospitalized children unless they were already using one.
How It Differs by Age
For breastfed infants, continuing breastfeeding is the basic advice. For formula-fed infants, the CDC report says diluted formula is not recommended, so the usual strength is kept. Babies on solids, toddlers, and school-age children return to their regular foods once dehydration is corrected. The AAFP review notes that it is not necessary to avoid milk-based products. Infants can become dehydrated quickly, so the younger the child, the more closely wet diapers and feeding amounts are worth tracking.
Care at Home
After vomiting settles, offer oral rehydration solution (ORS) in small amounts often. The CDC report aims to replace the fluid deficit within about 3-4 hours and to give extra ORS to match ongoing losses from diarrhea or vomiting. Once hydration is restored, start regular meals. Small, frequent servings are often easier on the stomach than large meals. Foods the child usually eats, such as rice, banana, potato, lean meat, or yogurt, are fine. Sugary drinks such as juice and soda can make diarrhea worse and are best limited. It can take several days for appetite to fully return, so there is no need to rush.
Common Misunderstandings
First, that only porridge or broth should be given for days. The AAFP material says the BRAT diet (bananas, rice, applesauce, toast) is too restrictive and is not recommended by the American Academy of Pediatrics. Second, that milk must be stopped after a stomach bug; avoiding milk products is not considered necessary. Third, that diarrhea must stop completely before regular food; once dehydration is corrected, eating is encouraged even if loose stools remain. Fourth, that anti-diarrheal medicine should be given first; check with a doctor before giving any medicine to a child.
Signs That Need Emergency Care Right Away
Go to the emergency room right away if your child has a very dry mouth and lips, cries without tears, has not urinated in 8 hours or more, has sunken eyes, or is limp and unresponsive, since these suggest dehydration. Vomiting green bile, blood in the stool, a swollen and very painful belly, or a persistent high fever also needs medical care right away. If it is not an emergency but diarrhea lasts more than 7 days, improves and then worsens, or your child seems to be losing weight, contact your pediatrician. Consider talking with a pediatrician if you are unsure. This information reflects general guidance from the United States and Europe; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.