AAP: No Fruit Juice for Infants

Fruit juice offers no nutritional benefits over whole fruit for infants and children and has no essential role in the healthy, balanced diets of children, said an American Academy of Pediatrics (AAP) policy statement.

While 100% fresh or reconstituted fruit juice can be healthy when consumed as part of a well-balanced diet for children older than 1 year, it offers no nutritional benefit to children under 1 year and should not be included in their diet, reported Melvin B. Heyman, MD, and colleagues from the AAP Committee on Nutrition.

Published in Pediatrics, the statement is the first change in recommendations on fruit juice since 2001.

"Parents may perceive fruit juice as healthy, but it is not a good substitute for fresh fruit and just packs in more sugar and calories. Small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1," stated Heyman.

According to the U.S. Food and Drug Administration, a product must be 100% fruit juice in order to be labeled as fruit juice, and juices that are reconstituted from concentrate must be labeled accordingly. Any beverage that is less than 100% fruit juice must list the percentage of the product that is fruit juice and include a descriptive term, such as "drink," "beverage," or "cocktail," noted the authors.

The AAP policy statement recommended that daily intake of juice should be limited to:

• 4 ounces for toddlers ages 1-3
• 4 to 6 ounces for children ages 4-6
• 8 ounces or 1 cup of the recommended 2 to 2½ cups of fruit servings per day for children ages 7-18

Human milk or a prepared infant formula should be the only nutrients fed to infants until approximately 6 months of age. Offering juice before solid foods are introduced into a child's diet could risk having juice replace human milk or infant formula -- which could result in reduced intakes of protein, fat, vitamins, and minerals such as iron, calcium, and zinc.‍

The AAP statement encouraged pediatricians to become more knowledgeable about fruit juice and fruit drinks in order to better inform parents and patients on the appropriate uses. For example, the committee promoted advocating for a reduction in fruit juice in the diets of young children, as well as a complete elimination in children with abnormal (poor or excessive) weight gain.

Heyman's team also wrote that children should consume more whole fruits than fruit juice, which lacks dietary fiber and may contribute to weight gain. Additionally, excessive juice consumption may be associated with malnutrition (over-nutrition and under-nutrition), as well as diarrhea, flatulence, abdominal distention, and tooth decay.

"Pediatricians have a lot of information to share with families on how to provide the proper balance of fresh fruit within their child's diet," said another co-author, Steven A. Abrams, MD, director of the Pediatric Research Institute at the University of Texas at Austin.

As part of the initiative, the authors suggested that pediatricians support policies that work to reduce the consumption of fruit juice and instead promote whole fruit for toddlers and young children already exposed to juices. The authors specifically mentioned policies for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), provided that they do not have negative nutritional consequences for children without access to fresh fruit.

Other recommendations for monitoring juice consumption among children included:

• Not giving toddlers juice from bottles or easily transportable covered cups that allow them to consume juice easily throughout the day, nor giving juice at bedtime
• Strongly discouraging consumption of unpasteurized juice product in infants, children, and adolescents
• Avoiding grapefruit juice in any child taking medication that is metabolized by CYP3A4, as it has been shown to reduce the activity of intestinal cytochrome P450 3A4

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