Guidelines for offering juice to babies

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.”
• According to the Australian Government’s National Health and Medical Research Council, “Fruit juice is not necessary or recommended for infants under 12 months of age.”

For babies over six months

• Some authorities do not recommend  juice at all for babies under 12 months old.
• 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.
• Offer the juice from a cup rather than a bottle. Offering it only with meals will help to reduce the risk of tooth decay.
• Dilute the juice (the UK’s NHS recommends one part juice to 10 parts water), or try using juice just to flavor water.
• If you do offer juice, limit baby’s intake to no more than 3-4 ounces total per day so that baby is not filling up on it to the extent that he has no appetite for other foods.

In their Infant Feeding Guidelines, The Australian Government’s National Health and Medical Research Council says that “Fruit juice is not necessary or recommended for infants under 12 months of age. Sweetened drinks are associated with dental caries. Tea, herbal teas and other drinks are of no known benefit to an infant and could possibly be harmful.”

Health Canada also does not recommend juice in the first year.  After 12 months, they advise to “Limit fruit juice and do not offer sweetened beverages. If your child seems thirsty, offer water.”

In the UK, the NHS advises, “Babies under six months old shouldn’t be given fruit juices. Diluted fruit juice (one part juice to 10 parts water) can be given to children with their meals after six months.”

The American Academy of Pediatrics’ policy statement recommends that babies younger than 12 months should not be given any juice, and children aged 12 months to 3 years should get no more than 4 ounces per day.

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.

References

Infant Feeding Guidelines from the Australian Government’s National Health and Medical Research Council.

Infant Nutrition from the Government of Canada.

Drinks and Cups for Children from the National Health Service Website (UK).

American Academy of Pediatrics, Committee on Nutrition. Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Pediatrics 2017 June Vol 139 Issue 6.

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. (Reaffirmed in 2007 & 2013.)

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.