Choosy mothers choose . . . fruit!

Since the American Academy of Pediatrics (AAP) published its first recommendations regarding fruit juice 16 years ago, pediatricians have been waving off parents from serving young children apple and other fruit juices in bottles and sippy cups, encouraging water be given instead, because of both caloric and dental caries concerns. Now the AAP has issued a new policy statement that goes further than ever on what constitutes optimal quantities of fruit juice product consumption for children of all ages.¹

The AAP’s new policy, “Fruit juice in infants, children, and adolescents: current recommendations,” states flatly that “Fruit juice offers no nutritional benefits for infants younger than 1 year” and recommends that no fruit juice products be given to children aged younger than 1 year unless “there is a strong clinical basis for use in the management of constipation.”

Calories, carbs, and caries

In the context of today’s concerns about growing obesity rates, fruit juices’ vitamin C benefits are seen as less beneficial than in prior years. Moreover, the lack of fiber and protein and high sugar content make juices a less ideal nutritional choice than whole fruits themselves.

Therefore, the new AAP statement recommends a maximum daily intake of 4 ounces of 100% fruit juice products for children aged 1 to 3 years. For children aged 4 to 6 years, the AAP suggests that juices be limited to 4 to 6 ounces per day. Juice intake should now be limited to 8 ounces-down from the previously recommended 12 ounces-for children aged between 7 and 18 years, or 1 cup of the recommended 2 to 2.5 cups of fruit servings per day.

Juice is not fruit

In interviews, the authors state that the underlying goal of the new policy is to clarify the difference in nutritional value between juice and fruit. Because juice is viewed as nutritious, the AAP states, limits on consumption are not usually set by parents.

While emphasizing the importance of fresh fruit over juice in children’s diets, the statement authors from the AAP’s Section on Gastroenterology, Hepatology, and Nutrition Executive Committee stopped short of directly associating 100% fruit juice consumption with the development of obesity, stating that recent studies in the literature have yet to clearly establish that link. However, the policy expressed concern about excessive fruit juice consumption’s association with tooth decay, as well as gut woes from diarrhea to flatulence and abdominal distention. The report also dispelled the notion that diluting juice with water mitigates its impact on children’s teeth, stating that common parental practice “does not necessarily decrease the dental health risks.”

Parents are also cautioned against using fruit juice to treat dehydration or to manage diarrhea, reiterating the AAP practice parameter that only oral electrolyte solutions be used to rehydrate infants and young children and that a normal diet be continued throughout an episode of gastroenteritis.

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In addition, the statement warns against serving unpasteurized juice products to children citing the potential presence of pathogens that can cause serious illness.

Decreased juice consumption as a policy goal

The policy statement outlines 12 recommendations for pediatricians, encouraging them to “become advocates for a reduction in fruit juice in the diets of young children and the elimination of fruit juice in children with abnormal (poor or excessive) weight gain.” It further recommends that pediatricians “support policies that seek to reduce the consumption of fruit juice and promote the consumption of whole fruit by toddlers and young children (eg, childcare/preschools) already exposed to juices, including through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), provided that those policies do not have negative nutritional consequences (ie, inadequate total calories, absence of any fruit in the diet) for children without access to fresh fruit.”

Snap out of it!

Bottom line, juice should not be edging out what babies really need nutritionally in the first year of life: breast milk or formula, and protein, fat, and minerals such as calcium. Families can best be served by ongoing education in the pediatrician’s office about changing what are often generations-old juice habits and reaching instead for better nutritional bargains as part of a balanced diet.

As Steven A. Abrams, MD, policy statement coauthor and chairman of the Department of Pediatrics at the Dell Medical School, University of Texas at Austin, concludes: “We primarily are supporting that kids learn how to eat fruit rather than fruit juice. I think that comes across more strongly than it has before.”

REFERENCE

1. Heyman MB, Abrams SA; Section on Gastroenterology, Hepatology, and Nutrition; Committee on Nutrition. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017;139(6):e20170967.