AAP Guideline: No Fruit Juice for Infants

Pam Harrison

May 23, 2017

The American Academy of Pediatrics (AAP) has issued new recommendations on the appropriate consumption of fruit juice for infants, toddlers, and adolescents, starting with an admonition to completely avoid fruit juice in the first year of life.

"Pediatricians play a central role in children's health and nutrition by providing guidance to pediatric patients and their parents," Melvin Heyman, MD, from the University of California in San Francisco, and colleagues write. "Open assessment and recommendations for appropriate dietary habits, including consuming whole fruit rather than fruit juice, can help encourage parental support of healthy rates of weight gain." they add.

The policy statement was published online May 22 in Pediatrics.

Dr Heyman and colleagues emphasize that infants should be fed only human milk, or infant formula when breast-feeding is not possible, until they are approximately 6 months of age. "There is no nutritional indication to give fruit juice to infants younger than 6 months," they write. For infants older than 6 months, parents should be counseled to give the infant juice in a cup, not in a bottle, if fruit juice is needed for medical reasons.

"Infants can be encouraged to consume whole fruit that is mashed or pureed," the authors continue. "After 1 year of age, fruit juice may be used as part of a meal or snack." When used as part of a healthy diet for children over the age of 1 year, parents should buy only 100% fresh or reconstituted fruit juice. They note that fruit drinks are not nutritionally equivalent to fruit juice.

The quantity of juice consumed should not exceed 4 ounces per day for toddlers between the ages of 1 to 3 years and 4 to 6 ounces per day for children between 4 and 6 years. For older children and adolescents, 8 ounces of juice a day is more than adequate.

Moreover, giving toddlers juice at bedtime should be avoided, the authors emphasize, and toddlers should not be allowed to consume juice all day long out of a covered cup or a bottle.

Toddlers and young children should also be encouraged to eat whole fruit, and pediatricians in turn should do their part to support policies that reduce fruit juice consumption in toddlers and young children.

"[H]igh intakes of juice can contribute to diarrhea, overnutrition or undernutrition, and the development of dental caries," the authors write. "The dilution of juice with water does not necessarily decrease the dental health risks."

When evaluating children with clinical signs of malnutrition, the authors remind pediatricians that they should ask parents how much fruit juice their child is consuming, as it can be a source of either undernutrition or overnutrition in children. The same should be done for children with complaints of chronic diarrhea, excessive flatulence, or abdominal pain or bloating, and physicians need to make sure parents understand how harmful fruit juices can be to dental health.

Parents also need to be cautioned against using fruit juice to treat diarrhea or dehydration. "Consumption of unpasteurized juice products should be strongly discouraged in infants, children, and adolescents," Dr Heyman and colleagues write. "Grapefruit juice should be avoided in any child taking medication that is metabolized by CYP3A4," they caution.

Older children and adolescents should similarly be encouraged to consume whole fruit instead of fruit juice so as to increase fiber intake. Parents also need to realize that water and low or nonfat milk are more than adequate to meet fluid requirements in older children.

"Pediatricians can also advocate for changes in public policy, especially in schools, where improved fruit and vegetable intake has been associated with policies promoting healthier dietary choices," the authors observe.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online May 22, 2017. Full text

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