What kids drink from day one can have a huge impact on their overall health and development, and leading medical and nutrition organizations have issued new guidance on what, what not and at what age children should sip on various liquids.
Kids should drink breast milk, infant formula, water and milk in early childhood – and limit their fruit juice as much as possible – to best set them up for healthy growth and development, according to the recommendations.
A panel of experts from the Academy of Nutrition and Dietetics, the American Academy of Pediatrics, the American Academy of Pediatric Dentistry and the American Heart Association, under the leadership of nutrition research organization Healthy Eating Research, reviewed existing domestic and international policy statements and evidence-based recommendations to fine-tune guidelines for parents, caregivers and health care providers on what children from birth through age 5 should be provided with drink-wise for a healthy start.
The recommendations, released Wednesday, broke down what children through age five should drink by age:
- 0-6 Months: Breast milk or infant formula.
- 6-12 Months: Breast milk or infant formula; small amounts of plain drinking water introduced once solid foods become part of diet.
- 12-24 Months: Whole milk and plain drinking water.
- 2-5 Years: Skim or low-fat milk and plain drinking water.
"Those recommendations just clarify to parents what are the optimal beverages to provide to their very young children and babies, infants into the toddler ages, the preschool age, which is sometimes a confusing time where children's dietary patterns change quite a bit," says Marie-Pierre St-Onge, professor of nutritional medicine at Columbia University and one of the experts, representing the American Heart Association, from the panel.
Water accounted for 43.7% of total beverage consumption among U.S. youth ages 2 to 19 between 2013 and 2016, according to a 2018 National Health and Nutrition Examination Survey, followed by milk (21.5%), soft drinks (19.9%), 100% juice (7.3%), and other beverages, including coffee, tea sports and energy drinks (7.6%).
Dr. Natalie Muth, a pediatrician in Carlsbad, California, and a spokesperson for AAP who was part of the expert panel, says that what young children drink is as important as what they're eating to set them up for optimal health and for shaping some of their taste preferences later on.
"While there are lots of recommendations available to parents on what children should eat, there's actually not all that many recommendations – and especially not consistent recommendations – on what young children should drink," Muth says. "Combined with a million different types of drinks that now seem to be available to young children, it seemed like it was really time for there to be some type of consensus."
Experts further recommended no more than half a cup – 4 oz. – of 100% fruit juice per day for children between 12 months and 5 years old. They did not recommend juice at all for children under 12 months.
"We really stress that consuming fresh fruits is much, much preferred over consuming fruit juice, but we understand that sometimes parents are in a tight spot and maybe fresh fruit is not available in certain situations," St-Onge says. "In that case, then some small amount of fruit juice may not be a bad thing."
Whether fresh, frozen, canned or dried, "any fruit in any form is better than drinking the juice," Muth says, "But there is allowance for a very small, portion-controlled amount of juice – that seems to be okay."
But some experts disagree with the juice allowance in the recommendations.
"All kids, zero to five, should be drinking milk and water. There is no need for anything else. Have them eat their calories instead of drinking them," Dr. Jamie Jeffrey, a pediatrician in West Virginia and an at-large member of the state's AAP executive committee, says.
The panel did not recommend offering young children any caffeinated beverages, beverages with low-calorie sweeteners, sugar-sweetened beverages, toddler milk or flavored milk – such as strawberry or chocolate milk – at any stage during early childhood as part of a healthy diet. It also did not endorse plant-based milk or non-dairy beverages for "exclusive consumption in place of dairy milk," unless medically advised, because of the lack of key nutrients commonly gathered from consuming dairy milk.
Jamie Bussel, a senior program officer at the Robert Wood Johnson Foundation, which funded the panel in part, says sugary or sweetened beverages are the largest source of added sugar for most kids, contributing to the consumption of excess calories.
"Work to reduce or eliminate (that) consumption is so critical," Bussel says. "We should be continuing to really push on this movement in this country to help kids across the nation grow up at a healthy weight; we can't take our foot off the pedal."
Muth says the recommendations will help parents to "really help set their children off on the right course."
"These recommendations really just help parents to know, at least based on the research we have right now, what are the best drinks for their children – and to feel confident in at least knowing what's best for their kids – and then, hopefully, being able to have support in their communities and their families to be able to offer their children those drinks," Muth says.