In 2017 the American Academy of Pediatrics (AAP) came out with a new recommendation that children under age one should not be offered juice as a part of their diet. They also recommend limiting juice to no more than 4 ounces per day in toddlers and young children up to age 6 years and to only 8 ounces per day for age 7 to 18 years. Instead parents should focus more on whole fruit. Previous recommendations from 2001 and 2006 were more liberal and recommended that children under age 6 months should not be offered juice, and recommended limiting intake to 4-6 ounces daily for children ages 1-6 years and 8-12 ounces for children 7 years and older.
As a pediatrician I am happy that these AAP recommendations are taking a harder line on juice consumption in kids. For years in my pediatrics practice I have been telling patients that they should not give their kids juice, and I’m definitely not the only pediatrician who feels that way. But full disclosure, when my kids were much younger I used to buy a bit of juice and I kept it in the house for when they had friends over. Although my kids were not too interested in drinking juice, some of their friends were, and would consume a lot of it when they visited. I finally came to the realization that I was offering pure sugar to kids and that I could hydrate these kids more cheaply and in a healthier way with plain water.
As a pediatrician and founder of the Dr. Yum Project, I have become more keenly focused on how to prevent diet-related illness in children, like obesity and tooth decay, I would take the AAP’s recommendations a step further and recommend that parents do not offer ANY juice at ANY age within their home. It may be fine to let a kid have a juice box at a birthday party, but I tell parents that should consider NOT buying juice or bring it in the home. Here are my reasons why:
- Excess sugar promotes obesity. According to the American Heart Association kids older than age 2 should have no more than 6 teaspoons of “added sugar” a day but note that kids of all ages are consuming many times more than this. Although the sugar in juice is technically naturally occurring, juice is a processed food and there is nothing natural about a toddler drinking the equivalent of 12 apples-worth of sugar in one day. Although the AAP reports no direct correlation between fruit juice and obesity, in my practice I have collected growth curves of overweight children before and after I advise the parents to stop offering juice. These curves show a dramatic normalization of weight once juice is eliminated.
- Bathing the teeth in fruit juice can lead to tooth decay. Kids who are regularly consuming sweet beverages are at more risk of dental cavities. The tooth enamel in kids is relatively soft and prone to further softening when exposed to acid. Fruit juice is highly acidic and can soften enamel quickly, making teeth more at risk for decay. My messaging about no juice and other oral hygiene habits as resulted in startlingly low rates of tooth decay in my practice. Doctor Yum’s “No Cavity Club” is growing strong because parents know juice should be off limits at home.
- Fruit juice starts a pattern of craving sugary drinks. Get kids used to plain water and milk so they don’t look for the next sweet drink like sports drinks or soda. As an alternative in our cooking camps we let kids drink fruit infused water. Kids can slice up the herbs and fruits they love and place them in a pitcher of water to give it some flavor, (without all the sugar).
- Parenting around juice can be challenging: Consider that toddlers are probably some of the most manipulative people the world! Their tactics of auditory assault, public humiliation (think tantrums in the middle of the grocery store), and pure persistence can break even the strongest of parents. If you bring juice into the home, the chances are your toddler will want more than four ounces of it, and in a weak moment you may give in. Why take the chance? Water is free or low cost, and you don’t need to worry about how much of it they drink. Instead of juice, offer whole fruit regularly to get key nutrients and fiber.
Here are recommendations I give my patients’ families when it comes to juice:
- Do not introduce juice to babies or kids of any age within your home. Once they are over a year, an occasional juice offered outside of the home is okay, and should be considered a “treat.”
- Avoid juice to avoid tooth decay. Teach kids to drink lots of water, especially between meals and keep dental work and dentist bills to a minimum. Grazing on drinks other than water (even milk) can predispose kids to tooth decay. For sipping between meals, water is the best choice. Many parents ask about watering down juice but still has sugar and teaches kids to crave sweet beverages.
- In select instances juice can be medicine. For kids with constipation, fruit juice or a fruit puree may be appropriate to help manage constipation naturally. In that instance, treat it like medicine and give a limited amount according to your pediatrician’s recommendations. To help kids learn the distinction between juice for constipation and regular drinks like water, (and avoid any juice meltdowns,) place juice in a different cup and offer it at the same time each day like you would offer a medication.
- Whole fruit is superior to juice. Juicing a fruit can remove key phytonutrients (plant nutrients) including antioxidants that repair cell damage. In addition, so much or our health is controlled by our microbiome, the important world of microbes that resides inside us. When we eat whole, the fiber left behind fuels that microbiome, allowing us to stay healthy. Processed juices do not contain fiber, and therefore do not help sustain our microbiome like whole fruit does.
Pediatricians need to keep educating our patients about juice consumption, especially our higher risk patients. Some of my patients who receive WIC benefits are able to access juice using their benefits, which can be confusing for families. Knowing this, I take the time to educate them on why bringing juice into the home may put their children at risk for obesity and tooth decay and encourage them to teach their kids to drink plain water. As a community we need to look more systematically on how juice is offered at gatherings, schools, daycare camps and other programs and realize that water and whole fruit are better alternatives. Educating those who influence kids about this new recommendation may help us to keep juice consumption to a minimum.