Bangkok Post

Paediatric­ians say no fruit juice in child’s first year

Parents believe drinks are a substitute for solids, but are way of the mark


Top paediatric­ians in America are advising parents to stop giving fruit juice to children in the first year of life, saying the drink is not as healthful as many parents think.

In the past, the American Academy of Pediatrics (AAP) had advised parents to avoid 100% fruit juice for babies younger than six months. Late last month, the group toughened its stance against juice, recommendi­ng that the drink be banned entirely from a baby’s diet during the first year.

The concern is that juice offers no nutritiona­l benefits early in life, and can take the place of what babies really need: breast milk or formula and their protein, fat, and minerals like calcium, the group said.

This is the first time the paediatric­ians’ group has updated its guidelines on fruit juice since 2001.

“I think this is a fantastic recommenda­tion for infants, and it’s long overdue,” said Dr Elsie Taveras, chief of the division of general paediatric­s at Mass General Hospital for Children in Boston, who was not involved in the new report.

“Parents feel their infants need fruit juices, but that’s a misconcept­ion.”

The new recommenda­tions may surprise parents who thought 100% fruit juice was healthy for babies, or nutritiona­lly equivalent to fruit itself.

But whole fruit typically has more fibre than fruit juice and is less likely to cause dental decay, said Dr Steven Abrams, a lead author of the new AAP report and chairman of paediatric­s at the Dell Medical School at the University of Texas at Austin.

Whole fruit is “less of a pure sugar intake”, Abrams said. “We want kids to learn how to eat fresh foods. If you assume fruit juice is equal to fruit, then you’re not getting that message.”

Dr Man Wai Ng, the dentist in chief at Boston Children’s Hospital, applauded the ban on juice for infants and took a hard-line stance for preschoole­rs and older children. “One hundred percent fruit juice should be offered only on special occasions, especially for kids who are at high-risk for tooth decay,” she said.

Four ounces of apple juice has no fibre, 60 calories and 13g of sugar. By comparison, a half cup of apple slices has 1.5g of fibre, 30 calories and 5.5g of sugar. The fibre in a piece of fruit also increases fullness.

In terms of sugar and calories, storebough­t juice is similar to soda. For instance, 4 ounces of lemon-lime soda has 12.6g of sugar and 46 calories, both slightly less than apple juice.

The new report, published online in the journal Pediatrics, also advised restrictin­g fruit juice to 120ml daily for one- to threeyear-olds, and 180ml a day for four- to sixyear-olds. The 2001 guidelines gave parents more wiggle room to decide if 120ml or 180ml daily was appropriat­e for preschoole­rs. By contrast, the advice for four- to six-year-olds stayed the same.

The latest report curbed the maximum daily intake for older children, ages six-18. It used to be 360ml; now only 240ml are advised.

There is not a convincing link between obesity and children drinking modest amounts of fruit juice. Still, the report said, juice “has no essential role in healthy, balanced diets of children”.

In a statement, Cathy Dunn, a spokeswoma­n for Gerber, said the company is supportive of the AAP’s new advice for infants, and plans to update its website to reposition “all Gerber juices for the toddler milestone, which is 12 months or older”.

Stephanie Meyering, a spokeswoma­n for the Juice Products Associatio­n, a trade group, said that while “juice is not necessary for children under age one”, real fruit juice “is a nutritious complement to whole fruit in a balanced diet” for toddlers and older children.

Some manufactur­ers, like Gerber, make juice for infants, marketing it as a way to add vitamin C and flavour variety to a baby’s diet.

But Abrams said: “You want to be careful about saying ‘drink juice for vitamins’ because they can be added to anything.”

Another concern is that juice can be a gateway drink of sorts, Taveras said, adding: “We have studies that show infants who drink more juice in that early life period are more likely to go on to drink soda and sugar-containing beverages.” Currently, the US federal government’s advice on healthful eating, called the Dietary Guidelines for Americans, does not weigh in on juice for very young children. The guidelines, which are compiled by the Agricultur­e and Health and Human Services department­s, make recommenda­tions only for ages two and older. The guidelines count a cup of 100% fruit juice the same as a serving of fruit, but urge that at least half the recommende­d amount should come from actual fruit.

It is unclear if the next US Department of Agricultur­e guidance will forbid juice for infants.

But the very young will be included for the first time in the 2020 guidelines, according to Brooke Hardison, a USDA spokeswoma­n.

Some federal assistance programs have restricted juice for very young children. Since 2009, the Special Supplement­al Nutrition Program for Women, Infants and Children, known as WIC, has stopped listing juice as an acceptable purchase on the checks given to new mothers and babies in their first year. A WIC check, voucher, or electronic benefit transfer (EBT) card specifies which foods in

Infants who drink more juice are more likely to go on to drink sugary beverages

what quantities can be bought at stores, so once a baby becomes a toddler, 100% fruit juice can be purchased.

In 2010, the Institute of Medicine of the US National Academies — a private non-profit — called for the “omission of fruit juice of any type before the age of one year” in federally supported day care centres.

More than 4.2 million children, including those in Head Start, take part in the Child and Adult Care Food Program.

By October, child care centres and daycare homes will be prohibited from providing fruit juice to infants as part of a reimbursab­le meal through that programme.

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