Calming Colic

Study finds babies on white grape juice fuss less

MONDAY, May 6, 2002 (HealthDayNews) -- When it comes to your baby's bowels, it seems that not all juices are created equal.

Colicky infants respond better to certain fruit juices, a new study has found. The difference seems to be that some compositions of sugars are more difficult for babies to digest.

At least one nutritionist, however, took issue with the methodology of the study, which used juice provided by Welch Foods, saying it did not conform to recognized pediatric guidelines.

Colic affects roughly 10 percent to 25 percent of babies. The gassy, uncomfortable condition is typically marked by a "rule of threes" -- at least three hours of crying three days a week for three weeks.

While baby books offer suggestions for how to ease the distress of colic, they admit the only cure is growing out of the phase, a blissful transition for parents that usually occurs by the child's third or fourth month.

However, the latest study, which appears this month in the journal Pediatrics, suggests there may be things that make the problem worse.

Fruit juice contains four forms of carbohydrates: sorbitol, fructose, glucose and sucrose. Not only is sorbitol hard for some babies to digest, but juices with a high ratio of fructose to glucose have also been shown to be rough on young gastric systems.

Apple and pear juice, in particular, are both high in sorbitol and have a fructose-glucose imbalance. Earlier research has suggested these drinks may pose problems for some babies.

White grape juice, on the other hand, has no sorbitol and has an even split between fructose and glucose. Also, some evidence shows it goes down smoother in young children.

In the latest study, a team led by Dr. Fima Lifshitz, a pediatrician at Miami Children's Hospital, gave either apple or white grape juice to 30 healthy infants. The children's average age was about 5 months at the start of the study, though the American Academy of Pediatrics doesn't recommend fruit juice for infants under the age of six months. Fourteen of the babies had a history of colic.

Colicky babies who drank apple juice cried and fussed more, expended more energy, slept less, and had more hydrogen in their breath -- a sign of poor carbohydrate absorption -- than colic-free babies who received the beverage.

Apple juice didn't seem to bother the tummies of babies who absorbed sugars normally. However, white grape juice didn't promote gastric trouble, regardless of whether or not a child had colic.

"The composition of the different juices plays a very important role in whether the juice is digested or absorbed or not," says Lifshitz, who has studied the issue for more than a dozen years.

The researchers note the babies who drank white grape juice began doing so several weeks before the study began, whereas many of those who received apple juice got their first taste of it in the experiment. That early introduction might have affected the children's ability to tolerate the juice.

"Obviously, if you've been exposed to a juice, you might develop tolerance" to it, says Lifshitz, who holds academic appointments from the University of Miami and the State University of New York in Brooklyn.

Welch Foods, of Concord, Mass., provided the juice for the study. Lifshitz has been a long-time recipient of grant money from the company, but is not a paid consultant for them, says Geoffrey Raymond of the Mammoth Group, which helps arrange and promote Welch's research. Lifshitz says he has accepted speaking fees from the company on several occasions.

Although Welch Foods makes apple juice, grape products are by far its leading brands, Raymond says. The company markets its white grape juice as a stomach-friendly alternative to other drinks, especially apple juice. "We think it's an important distinction between the two juices," he adds.

Sue Taylor, a nutritionist with the Processed Apples Institute in Atlanta, disputed the results of the latest study.

"I think white grape juice is a perfectly fine product. It's just that apple juice is, too," she says. "To say one is superior over another is not really appropriate."

What's more, Taylor says, the Florida researchers didn't conform to guidelines from the American Academy of Pediatrics in several key respects.

Not only did the children tend to be younger than the age at which the group recommends babies start drinking juice, she says, but they received more juice than the AAP suggests -- 8 ounces versus 4 to 6 ounces daily. They also gave the infants juice in a bottle, though the academy explicitly discourages that practice.

All that's true, Lifshitz says, in the ideal world.

?But a fact of life is that by three to four months of age a lot of babies are already getting juice, and it could potentially be playing a role" in the production of excess gas and colic, he says.

So, while no juice before six months is preferable, parents who insist on feeding their infants juice (and it should always be 100 percent juice) may want to consider white grape over apple or pear, he says. "If you're going to give juice, give the one that is well-digested and absorbed."

Chris Zanobini, executive director of the California Pear Advisory Board, says pear juice, though a bit player in the nation's juice market, shouldn't be overlooked. "It's a substitute" for either apple or grape juice, Zanobini says, that has "a lot of [health] benefits."

Zanobini says the pear industry hasn't funded any studies comparing the digestibility of pear juice with that of other fruit juices.

What To Do

For more on colic and how to soothe a colicky baby, try the American Academy of Family Physicians.

For more on infant nutrition, go to Vanderbilt University.

SOURCES: Fima Lifshitz, M.D., chief, nutrition sciences, Miami Children's Hospital, Miami; Sue Taylor, R.D., director, nutrition communications, Processed Apples Institute, Atlanta; Geoffrey Raymond, Mammoth Group, New York City; Chris Zanobini, executive director, California Pear Advisory Board, Sacramento; May 2002 Pediatrics
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