No Fruit Juice for Babies, New Guidelines Say

Fresh fruit is preferable for older children because it provides dietary fiber and less sugar than juice, according to updated policy statement

Fruit juice offers no nutritional benefit to children under age 1 and should not be included in their diet, according to a new policy statement issued by the American Academy of Pediatrics that marks the Academy’s first change in recommendations on fruit juice since 2001.

Over past years, the Academy advised against offering fruit juice to children under the age of 6 months, but has expanded that time frame to include the entire first year of life.
 
The statement, “Fruit Juice in Infants, Children, and Adolescents: Current Recommendations,” to be published in the June issue of Pediatrics (online May 22) accounts for the rising rates of obesity and concerns about dental health based on evidence accumulated over recent years.

“Parents may perceive fruit juice as healthy, but it is not a good substitute for fresh fruit and just packs in more sugar and calories,” said Melvin B. Heyman, MD, FAAP, co-author of the statement. “Small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1.”
 
The new recommendations state that 100-percent fresh or reconstituted fruit juice can be a healthy part of the diet of children older than 1 year when consumed as part of a well-balanced diet. Consumption, however, should be limited depending on a child’s age. 
 
The policy statement recommendations include:

• Intake of juice should be limited to, at most, 4 ounces daily for toddlers age 1-3. For children age 4-6, fruit juice should be restricted to 4 to 6 ounces daily; and for children ages 7-18, juice intake should be limited to 8 ounces or 1 cup of the recommended 2 to 2 ½ cups of fruit servings per day.
• Toddlers should not be given juice from bottles or easily transportable “sippy cups” that allow them to consume juice easily throughout the day. The excessive exposure of the teeth to carbohydrates can lead to tooth decay, as well. Toddlers should not be given juice at bedtime.
• Children should be encouraged to eat whole fruits and be educated about the benefits of the fruit as compared with juice, which lacks dietary fiber and may contribute to excessive weight gain.
• Human milk or infant formula is sufficient for infants, and low-fat/nonfat milk and water are sufficient for older children.
• Consumption of unpasteurized juice products should be strongly discouraged for children of all ages.
• Children who take specific forms of medication should not be given grapefruit juice, which can interfere with the medication’s effectiveness. In addition, fruit juice is not appropriate in the treatment of dehydration or management of diarrhea.

 The Academy supports policies that seek to reduce fruit juice consumption and promote fresh fruit. This support extends to developing policies for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), provided that the policies do not have negative nutritional consequences for children without access to fresh fruit.
 
“We know that excessive fruit juice can lead to excessive weight gain and tooth decay,” co-author Steven A. Abrams, MD, FAAP said. “Pediatricians have a lot of information to share with families on how to provide the proper balance of fresh fruit within their child’s diet.”