The Kid’s Doctor: Is fruit juice healthy?

I remember when my children were small that it was “routine” to begin offering infants diluted juice around 6 to 9 months of age. Over the years the AAP (American Academy of Pediatrics) continued to advise against offering fruit juice to children under the age of 6 months. Decades later, the AAP has issued new guidelines including the recommendation “not to offer juice to children under the age of 1 year.”

The new recommendations were published in the June issue of Pediatrics, in which they wrote, “While parents may perceive fruit juice as healthy, it is not a good substitute for fresh fruit and just packs in more sugar and calories.” The article continued to state, “Small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1 year.”

I always diluted juice for my children, even when they were older. I added a few cans of water to concentrated juice, and they never even knew it. It just seemed logical to me at the time. But while 100 percent fresh or reconstituted juice may be healthy, it should still be limited depending on a child’s age. The concern over steadily increasing obesity rates as well as dental health and the risk of cavities makes even fresh fruit juice a culprit for added calories and sugar.

The recommendations include: Toddlers should never be given juice from a bottle or in a sippy cup that allows them to consume juice (even diluted) throughout the day. I continue to recommend that the bottle “goes bye-bye” at the 1 year birthday party and a child only drinks from a sippy cup at meals and snacks after that.

The child should also not have a sippy cup to “wag around all day.” Parents often tell me that “their child drinks water all day long” but again that may keep them from eating a healthy meal if they drink throughout the day. You know how many adult diets recommend “drink tons of water all day” so you won’t feel hungry? The same may be said for a toddler who is already a picky eater.

Small children get plenty of fluids at meals and snacks and are not hydrating for athletics like my older patients. There are no recommendations that young children drink a certain amount of water every day, although many parents swear their child needs 16 ounces a day.

In reality children of all ages should be encouraged to eat whole fruits and be educated about the difference between the fruit they choose and juice. With “juicing” being so popular, they need to know that even “green juice” lacks dietary fiber and may contribute to excessive weight gain. I agree that fruit juice is better than no fruit, but for toddlers ages 1-3 years, no more than 4 ounces of juice a day, children age 4 to 6 only 4 to 6 ounces a day and for children 7 to 18 years only 8 ounces (1 cup) of juice. The recommendation is that a child should have 2 to 2.5 cups of whole fruit per day.

I still recommend that my young patients only consume milk (low fat is fine) and water on an everyday basis and add juice later on, when their friends happen to tell them about juice boxes. If you’re going to buy juice at all, I recommend 100 percent fresh fruit juice; and if you can, get juices with added calcium (a little extra never hurts!).

Lastly, juice is not appropriate for rehydration or for the treatment of diarrhea. For those instances it is necessary to use an “oral rehydration solution.”

Dr. Sue Hubbard is an award-winning pediatrician, medical editor and media host.