American Academy of Pediatrics: No Fruit Juice for Children Under Age 1

Fruit Juice children

In June of 2017, the American Academy of Pediatrics (AAP) issued the first change in their policy on fruit juice for children since 2001. AAP continues to recomended only human milk or formula for babies under 6 months. In the past, fruit juice could be part of the diet after 6 months. The new policy moves the introduction of fruit juice back to one year and recommends limits for fruit juice in older children.

When a product is labeled as fruit juice, according to the US Food and Drug Administration, it must be 100 percent fruit juice or 100 percent reconstituted from juice concentrate. Products that are not 100 percent fruit juice must state the percent of fruit juice and may be labeled as fruit drinks, beverages, or cocktails.

In the past, fruit juice was considered a healthy drink for children. That’s because some fruit juices are good sources of vitamins and minerals. Fruit juice also has no fat or cholesterol. Doctors would recommend fruit juice for children with constipation or for fluid replacement in children with diarrhea.

The new recommendations are more cautious about fruit juice benefits. Children may be getting more than is good for them. Fruit juice is heavily advertised as a healthy drink for children. In fact, children between ages 2 to 18 consume half of their fruit intake through fruit juices or fruit drinks. Children and adolescents are the highest consumers of these drinks.

So Why the Change?

The main reason for the change in children under age one is that fruit juice offers no advantage over whole fruit. Fruit is an important part of a child’s diet, but fruit juice is a high source of sugar without the benefits of the protein and fiber found in whole fruit. Fruit juice may replace healthier whole fruit and that can lead to overweight children. Fruit juice is also bad for children’s teeth.

Details on the New Recommendations

According to the AAP, babies under 6 months get all the nutrients they need from breast milk or formula. Fruit becomes an important nutrient after 6 months, but fruit juice offers no benefit over whole fruit. Here are the high points of the new guidelines:

  • Fruit and vegetables provide important vitamins and minerals for children. A diet high in fruits and vegetables may help protect from heart disease, cancer, and obesity.
  • Parents should know that unpasteurized juice is dangerous. Unpasteurized juice, such as freshly squeezed apple cider, may contain harmful bacteria. Any commercial juice product that is not pasteurized should have a warning on its label. Unpasteurized juice can be very dangerous for children.
  • After 6 months of age, infants can be started on mashed or pureed whole fruit.
  • Toddlers aged 1 to 3 can be started on fruit juice, but juice should be limited to 4 to 6 ounces per day.
  • Sugars in fruit juices can cause cavities when juice comes into contact with teeth over time. Toddlers should not sip fruit juice throughout the day. They should not be given fruit juice in sippy cups or be put to bed with fruit juice in a bottle.
  • Parents should know that too much fruit juice can be a cause of toddler’s diarrhea. Too much fruit juice can cause sugar to get into the colon without being absorbed. The unabsorbed sugar can cause gas, cramps, and diarrhea.
  • Because fruit juice can cause diarrhea, it should not be used to replace fluids in a child who has vomiting or diarrhea. Only an oral electrolyte solution recommended by your child’s doctor should be used for this purpose.

What About Older Children and Teens?

The main problem with fruit juice in older children and teens is that fruit juice can become a source for excess calories, just like soda. Because parents consider fruit juice healthy, they may not recognize the danger. For older children, the danger of diarrhea and cavities continues to be a concern.

A study published in 2017 found that obesity rates for children around the world are now ten times higher than they were 40 years ago. Among developed countries, the United Sates has the highest rate of childhood obesity. With that in mind, here are the recommendations for older children and teens:

  • For children age 4 to 6: no more than 4 to 6 ounces of fruit juice per day
  • For children and teens age 7 to 1: no more than one cup (8 ounces) of fruit juice per day

Finally, don’t forget that limiting fruit juice is not the same as limiting fruit servings. Children definitely need the vitamins, minerals, and fiber from whole fruit. Check out this AAP website for information on how to get enough fruit servings for your child.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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