Fruit juice in infants, children, and adolescents: current recommendations

Historically, fruit juice was recommended by pediatricians as a source of vitamin C and as an extra source of water for healthy infants and young children as their diets expanded to include solid foods with higher renal solute load. It was also sometimes recommended for children with constipation. Fruit juice is marketed as a healthy, natural source of vitamins and, in some instances, calcium. Because juice tastes good, children readily accept it. Although juice consumption has some benefits, it also has potential detrimental effects. High sugar content in juice contributes to increased calorie consumption and the risk of dental caries. In addition, the lack of protein and fiber in juice can predispose to inappropriate weight gain (too much or too little). Pediatricians need to be knowledgeable about juice to inform parents and patients on its appropriate uses.

So the recommendations were

Juice should not be introduced into the diet of infants before 12 months of age unless clinically indicated. The intake of juice should be limited to, at most, 4 ounces/day in toddlers 1 through 3 years of age, and 4 to 6 ounces/day for children 4 through 6 years of age. For children 7 to 18 years of age, juice intake should be limited to 8 ounces or 1 cup of the recommended 2 to 2.5 cups of fruit servings per day.

Toddlers should not be given juice from bottles or easily transportable covered cups that allow them to consume juice easily throughout the day. Toddlers should not be given juice at bedtime.

Children should be encouraged to eat whole fruit to meet their recommended daily fruit intake and should be educated regarding the benefit of fiber intake and the longer time to consume the same kilocalories when consuming whole fruit compared with fruit juice.

Families should be educated that, to satisfy fluid requirements, human milk and/or infant formula is sufficient for infants and low-fat/nonfat milk and water are sufficient for older children.

Consumption of unpasteurized juice products should be strongly discouraged in infants, children, and adolescents.

Grapefruit juice should be avoided in any child taking medication that is metabolized by CYP3A4 (see list described previously).

In the evaluation of children with malnutrition (overnutrition and undernutrition), the pediatrician should determine the amount of juice being consumed.

In the evaluation of children with chronic diarrhea, excessive flatulence, abdominal pain, and bloating, the pediatrician should determine the amount of juice being consumed.

In the evaluation of the risk of dental caries, pediatricians should routinely discuss the relationship between fruit juice and dental decay and determine the amount and means of juice consumption.

Pediatricians should routinely discuss the use of fruit juice and fruit drinks and should educate older children, adolescents, and their parents about differences between the two.

Pediatricians should advocate 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.

Pediatricians should support policies that seek to reduce the consumption of fruit juice and promote the consumption of whole fruit by toddlers and young children (eg, child care/preschools) already exposed to juices, including through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)