The American Academy of Pediatrics (AA), the nation's largest pediatrician's group, says many small children are drinking too much juice, sometimes displacing milk or baby formula, which are more important to their overall health and development. The association is calling for limits on how much juice kids consume.
Fruit juices contain little if any protein and fat, and they're often shy in vitamins and minerals, with the notable exception of vitamin C. But they are high in carbohydrates, which young stomachs have a hard time digesting, and as result can lead to belly pain, diarrhea, bloating and flatulence, the association says.
The sugar in juice can cause tooth decay, especially in children allowed to sip from a cup, bottle or box for prolonged periods or at bedtime. While some juice producers promote high calcium content for strong bones and teeth, the sugar can undo that advantage, the association says.
And when juice competes with milk or formula for a child's daily calories, it can threaten proper growth and development, the experts say. Moreover, since sugar is high in calories, children who drink excessive amounts of fruit juice may be at increased risk of obesity.
"I think that juice is a healthy beverage, but when consumed in moderation," says Dr. William Cochran, a pediatrician at the Geisinger Clinic in Danville, Pa., and lead author of a policy statement which appears in the May issue of Pediatrics.
"The amount of soda, fruit drinks and juices consumed over last 15 years has increased dramatically, and at the same time there has been a decline in consumption of milk," Cochran writes.
The statement says children under 12 make up 18 percent of the U.S. population, but consume 28 percent of the fruit juice. Although the average infant drinks 2 ounces of juice a day (an appropriate amount), 2 percent drink 16 ounces or more and 1 percent drink at least 21 ounces.
For toddlers, the figures are even higher, with 10 percent of 2- and 3-year-olds and 8 percent of 4- and 5-year-olds consuming 12 ounces a day or more.
These quantities are "very excessive" and may put children on the road to overweight or obesity, Cochran says.
Pediatricians should discuss the importance of moderate intake with parents, who may be seduced by their child's fondness for the heavily marketed drinks, Cochran says.
The academy advises pediatricians to tell parents:
- Not to give fruit juice to infants younger than 6 months.
- Not to give infants juice from bottles or cups that can be used easily through the day.
- Not to feed kids fruit juice at bedtime.
- Children ages 1 to 6 should get only 4 to 6 ounces of juice a day, about the size of a small cup.
- Children ages 7 to 18 should drink between 8 and 12 ounces a day.
The academy also says parents should encourage their children to eat whole fruits, which have the fiber most juices lack.
Parents should stick to all-juice or reconstituted fruit drinks rather than less nutritious juice cocktails. The association also cautions against unpasteurized products which can be contaminated with harmful bacteria such as E. coli and Salmonella.
Jo Ann Hattner, a dietitian specializing in pediatric nutrition in Palo Alto, Calif., says the juice recommendations were sorely needed. "This is not a new concern, and the guidelines are definitely overdue."
Juice makers increasingly promote their products to children, and the advent of boxed juices has made them much more portable by allowing parents to pack them in lunch boxes and backpacks, Hattner says.
Yet many parents don't realize that juice contains as many as 100 or more calories per 8-ounce serving. Infants especially "really can't afford to take those calories in juice" while displacing protein from breast, cow or soy milk, she says.
Geoffrey Raymond, a consultant for Welch Foods, Inc., says grape-product companies agree with the new guidelines. "It's well accepted that kids probably drink too much fruit juice," says Raymond, president of the Mammoth Group in New York City.
"Welch's agrees that shoppers should look at labels, particularly for very young children to make sure that they're getting 100 percent juice."
Terri Haywood, a spokeswoman for Nestlé's beverage division, which makes the popular Juicy Juice line of all-juice drinks, calls the AAP article "very sound."
"We don't recommend juice as a replacement for human milk or formula," says Haywood.
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