When is it OK for children to start drinking fruit juice?

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Clinical Inquiries

When is it OK for children to start drinking fruit juice?

J Fam Pract. 2009 September;58(9):500a-500c

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References

1. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States. JAMA. 2006;295:1549-1555.

2. Skinner JD, Ziegler P, Ponza M. Transitions in infants’ and toddlers’ beverage patterns. J Am Diet Assoc. 2004;104(suppl 1):s45-s50.

3. Briefel RR, Reidy K, Karwe V, et al. Feeding infants and toddlers study: improvements needed in meeting infant feeding recommendations. J Am Diet Assoc. 2004;104(suppl 1):s31-s37.

4. Dennison BA, Rockwell HL, Baker SL. Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity [published correction appears in Pediatrics. 1997;100:733]. Pediatrics. 1997;99:15-22.

5. O’Neil CE, Nicklas TA. A review of the relationship between 100% fruit juice consumption and weight in children and adolescents. Am J Lifestyle Med. 2008;2:315-354.

6. Garner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics. 2005;115:496-506.

7. Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding: a systematic review. Adv Exp Med Biol. 2004;554:63-77.

8. Rampersaud GC, Bailey LB, Kauwell GP. National survey beverage consumption data for children and adolescents indicate the need to encourage a shift toward more nutritive beverages. J Am Diet Assoc. 2003;103:97-100.

9. Nielsen SJ, Popkin BM. Changes in beverage intake between 1977 and 2001. Am J Prev Med. 2004;27:205-210.

10. O’Connor TM, Yang SJ, Nicklas TA. Beverage intake among preschool children and its effect on weight status. Pediatrics. 2006;118:e1010-e1018.

11. Dubois L, Farmer A, Girard M, et al. Regular sugar-sweetened beverage consumption between meals increases risk of overweight among preschool-aged children. J Am Diet Assoc. 2007;107:924-934.

12. Johnson L, Mander AP, Jones LR, et al. Is sugar-sweetened beverage consumption associated with increased fatness in children? Nutrition. 2007;23:557-563.

13. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84:274-288.

14. Sohn W, Burt BA, Sowers MR. Carbonated soft drinks and dental caries in the primary dentition. J Dent Res. 2006;85:262-266.

15. Marshall TA, Levy SM, Broffitt B, et al. Dental caries and beverage consumption in young children. Pediatrics. 2003;112:e184-e191.

16. American Academy of Family Physicians. Breastfeeding policy statement. 2007. Available at: http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpolicy.html. Accessed March 25, 2008.

17. Gidding SS, Dennison BA, Birch LL, et al. Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association [published corrections appear in Circulation. 2005;112:2375; Circulation. 2006;113:e857]. Circulation. 2005;112:2061-2075.

18. World Health Organization. The optimal duration of exclusive breastfeeding: results of a WHO systematic review. Indian Pediatr. 2001;38:565-567.

19. US Preventive Services Task Force. Primary care interventions to promote breastfeeding: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149:560-564.

20. American Academy of Pediatrics. The use and misuse of fruit juice in pediatrics. Pediatrics. 2001;107:1210-1213.

Sugar-sweetened drinks: Short on nutrition, long on risk

FAST TRACK

Sugar-sweetened beverages (labeled as fruit drinks) do not replace whole fruits, which contain fiber and nutrients essential to growth.

Sugar-sweetened beverages (labeled as fruit drinks) often replace whole fruits in childhood diets.⁸ As a result, children may fail to meet recommendations for intake of whole fruits and vegetables, which contain fiber and nutrients essential to growth.

Consumption of fruit drinks and other sugar-sweetened beverages by American children has increased 135% since 1977; such drinks account for roughly 9% of daily energy intake.⁹ Data from the Feeding Infants and Toddlers Survey (FITS) indicate that 100% fruit juice and sugar-sweetened beverages are now the second and third leading sources, respectively, of energy (and carbohydrates) for American children between 1 and 2 years of age.³

Data from the National Health and Nutrition Examination Survey (NHANES) suggest that overweight children and adolescents consume more sugar-sweetened beverages than those who are not overweight.¹⁰ Other cohort data show that children who regularly consume sugar-sweetened beverages are twice as likely to be overweight by 5 years of age as children who don’t.¹¹ However, 1 cohort of 521 children followed longitudinally from 5 to 9 years showed no association between sugar-sweetened beverage intake and body fat.¹²

A recent systematic review of 30 studies (15 cross-sectional, 10 prospective cohort, and 5 experimental trials) supports a link between consumption of sugar-sweetened beverages and childhood obesity.¹³

What about tooth decay?

Excess intake of both sugar-sweetened beverages¹⁴ and fruit juice¹⁵ has been associated with increased risk of dental caries. Excess intake is defined as more than 6 oz per day in children 1 to 6 years of age and more than 12 oz per day in children 7 to 18 years. To help reduce the risk for dental caries, children should drink juice from a cup.

Recommendations

FAST TRACK

Remind parents that breastfeeding is the recommended source of infant nutrition for the first 6—preferably 12—months of life.

The American Academy of Family Physicians,¹⁶ American Academy of Pediatrics,⁶ American Heart Association,¹⁷ and World Health Organization¹⁸ all recommend breast milk as the preferred source of infant nutrition for the first 6 (preferably 12) months of life. The US Preventive Services Task Force recently emphasized the need for primary care physicians to further promote breastfeeding efforts.¹⁹

Infants shouldn’t be given fruit juice before 6 months of age.¹⁷ If juice is offered, it should be 100% fruit juice in a cup, not a bottle. Children 1 to 6 years of age should drink no more than 4 to 6 oz of 100% fruit juice per day. Children 7 to 18 years of age should limit intake to 12 oz of 100% fruit juice per day.¹⁷ Infants, children, and adolescents shouldn’t drink unpasteurized juice.²⁰

The American Heart Association recommends that children 1 to 3 years of age consume the equivalent of 1 cup of whole fruit per day. Children from 4 to 13 years should consume 1.5 cups per day.¹⁷

Evidence-based answers from the Family Physicians Inquiries Network