Pediatricians encourage parents to offer water to infants starting at 6 months. But how much do they need? At the 12-month well check, we remind parents to transition to cow’s milk, but what if they prefer a plant-based milk? We urge parents to limit fruit juice and avoid sugary drinks, but are stevia or noncaloric artificially sweetened drinks safe alternatives?
A new consensus statement offers pediatricians more evidence-based guidance to answer questions on what healthy children ages 0-5 years should drink. The statement Healthy Beverage Consumption in Early Childhood: Recommendations from Key National Health and Nutrition Organizations is from Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, and is supported by the AAP, American Heart Association, Academy of Nutrition and Dietetics, and the American Academy of Pediatric Dentistry. It is the first such collaboration of experts from the medical and nutrition organizations on this topic. Chaired by Stephen R. Daniels, M.D., Ph.D., FAAP, the panel did not address breast milk or infant formula.
The statement and an accompanying technical report are available at http://bit.ly/2lzS2lI and http://bit.ly/2lHXUsY.
Recommendations
- Encourage young children to drink primarily water and plain milk. Early childhood offers an opportunity to establish healthy habits and taste preferences. Water is important for hydration, and plain milk offers many key nutrients including calcium, vitamin D, vitamin A, zinc and protein. Fortified soy milk is nutritionally equivalent to cow’s milk and is an acceptable alternative. Water can be introduced as early as 6 months, ideally in an open cup or sippy cup. This helps infants develop cup-drinking skills and familiarity with water. The report includes a table with water and milk intake recommendations.
- Limit 100% juice. Per 2017 AAP recommendations (http://bit.ly/2lx7j6N), parents should avoid giving any juice to children younger than 1 year of age. Children ages 1-3 years should have no more than 4 ounces a day, and children ages 4-5 (technically through age 6 years) should have no more than 4-6 ounces per day. Ideally, children will consume whole fruit rather than fruit juice, but if whole fruits are not available, small amounts of juice can provide some nutritional benefit.
Encourage families to mostly avoid:
- Flavored milks. While previous AAP recommendations for school-age children have allowed for flavored milk as a strategy to help encourage milk intake (http://bit.ly/2lBdo2d), flavored milk is best avoided in children younger than 5 years of age. Young children generally are willing to drink recommended amounts of plain milk if not given an alternative. Avoiding flavored milk helps minimize added sugar intake and prevent establishing a preference for sweet taste.
- Plant milks. Few plant milks (other than fortified soy) are nutritionally equivalent to cow’s milk and are not recommended for exclusive consumption in place of dairy or soy milk, unless medically indicated.
- Toddler milks. Toddler milks or “transitional formulas” are unnecessary for most children and provide no nutritional benefit over a healthy, balanced eating plan.
- Sugar-sweetened beverages.Sugar-sweetened beverages are detrimental to child health. In addition, early exposure to sugary drinks may cause a young child to prefer sweet tastes.
- Beverages with low-calorie sweetener.The health implications of young children consuming artificial sweeteners are not well-understood. Given this uncertainty and that early childhood is a critical developmental period, it is best to err on the side of caution and avoid sweetened drinks, even if they have low or no calories.
- Caffeinated drinks.Caffeine may cause adverse effects in young children, including poor sleep, irritability, nervousness, headaches and difficulty concentrating. There is no established safe level of caffeine for children.
Dr. Muth was one of the AAP representatives on an expert panel that issued the recommendations. She is a member of the AAP Section on Obesity Executive Committee and a lead author of the AAP policy Public Policies to Reduce Sugary Drink Consumption in Children and Adolescents.
