Guidelines for offering juice to babies

August 2, 2011. Posted in: Solid Foods

Juice is in the same category as solid foods. Babies need nothing other than breastmilk for the first six months (except in rare cases).  

For babies under six months

  • Babies under six months should not be given juice. According to the American Academy of Pediatrics Committee on Nutrition, “There is no nutritional indication to feed juice to infants younger than 6 months. Offering juice before solid foods are introduced into the diet could risk having juice replace breast milk or infant formula in the diet.” The American Academy of Pediatrics Section on Breastfeeding notes: “During the first 6 months of age, even in hot climates, water and juice are unnecessary for breastfed infants and may introduce contaminants or allergens.” 

For babies over six months

  • Juice intake, like water intake, can interfere with breastfeeding because it fills baby up so that he nurses less.
  • Juice should be introduced just like any other new food. For example, applesauce and apple juice should be introduced separately.
  • Limit juice intake to no more than 3-4 ounces per day so that baby is not filling up on it to the extent that he has no appetite for other foods.
  • Offer the juice from a cup rather than a bottle.
  • Dilute the juice with equal amounts of water, or try using juice just to flavor water.

The American Academy of Pediatrics has recently released a policy statement recommending that babies younger than 6 months should not be given any juice, children aged 6 months to 6 years should get no more than 4-6 ounces per day, and children older than 7 should have no more than 8-12 ounces of juice daily.  

The potential hazards of too much juice

  • Drinking too much juice can lead to malnutrition or anemia, as a child is missing out on other necessary nutrients, including proteins and complex carbohydrates.
  • Drinking a lot of juice can damage the enamel of the teeth, leading to tooth decay. This is particularly a problem when the juice is offered in a bottle, rather than a cup.
  • Drinking a lot of juice, especially apple juice, may cause loose bowel movements and constant diarrhea.
  • Consumption of greater than 12 fl oz/day of fruit juice by young children has been associated with short stature and obesity (see studies by Dennison et al); other studies did not observe this association (see studies by Skinner et al). Consumption of more than 12 fl oz/day of fruit juice has also been associated with nonorganic failure to thrive (Smith et al, 1994).
  • Fruit juices that contain sorbitol or high levels of fructose as sweeteners may cause restlessness, gas and stomach distress in infants (Cole et al, 1999). The sweeteners may cause problems in babies because young children often have difficulty breaking down carbohydrates, including these sugars.
  • Unpasteurized juice may contain harmful bacteria, such as E-coli and Salmonella.  

Additional information

Beginner Juice by Dr. William Sears

References

American Academy of Pediatrics, Committee on Nutrition. Policy Statement: The Use and Misuse of Fruit Juice in Pediatrics. Pediatrics 2001 May; 107(5):1210-1213.

American Academy of Pediatrics, Section on Breastfeeding. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics. 2005 Feb;115(2):496-506.

Cole CR, Rising R, Lifshitz F. Consequences of incomplete carbohydrate absorption from fruit juice consumption in infants. Arch Pediatr Adolesc Med 1999 Oct;153(10):1098-102.

Dennison BA, Rockwell HL, Nichols MJ, Jenkins P. Children’s growth parameters vary by type of fruit juice consumed. J Am Coll Nutr 1999 Aug;18(4):346-52.

Dennison BA, Rockwell HL, Baker SL. Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity. Pediatrics 1997 Jan;99(1):15-22.

Dennison BA. Fruit juice consumption by infants and children: a review. J Am Coll Nutr 1996 Oct;15(5 Suppl):4S-11S.

Skinner JD, Carruth BR. A longitudinal study of children’s juice intake and growth: the juice controversy revisited. J Am Diet Assoc 2001 Apr;101(4):432-7.

Skinner JD, Carruth BR, Moran J 3rd, Houck K, Coletta F. Fruit juice intake is not related to children’s growth. Pediatrics 1999 Jan;103(1):58-64.

Smith MM, Davis M, Chasalow FI, Lifshitz F. Carbohydrate absorption from fruit juice in young children. Pediatrics 1995 Mar;95(3):340-4.

Smith MM, Lifshitz F. Excess fruit juice consumption as a contributing factor in nonorganic failure to thrive. Pediatrics 1994 Mar;93(3):438-43.

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