1. Juice in Infancy ( less than 12 months)
1. Fruit juice offers no nutritional benefits for infants younger than 1 year.
2. Fruit juice offers no nutritional benefits over whole fruit for infants and children and has no essential role in healthy, balanced diets of children.
3. One hundred percent fresh or reconstituted fruit juice can be a healthy part of the diet of children older than 1 year when consumed as part of a well-balanced diet. Fruit drinks, however, are not nutritionally equivalent to fruit juice.
4. Juice is not appropriate in the treatment of dehydration or the management of diarrhea.
5. Excessive juice consumption may be associated with malnutrition (over-nutrition and under-nutrition).
6. Excessive juice consumption is associated with diarrhea, flatulence, abdominal distention, and tooth decay.
7. Unpasteurized juice products may contain pathogens that can cause serious illnesses and should be given to children cautiously, if at all.
8. A variety of fruit juices, provided in appropriate amounts for a child’s age, are not likely to cause any significant clinical symptoms.
9. Calcium-fortified juices provide a bio-available source of calcium and often vitamin D but lack other nutrients present in human milk, infant formula, or cow milk.
1. 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.
2. 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.
3. 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.
4. 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.
5. Consumption of unpasteurized juice products should be strongly discouraged in infants, children, and adolescents.
6. Grapefruit juice should be avoided in any child taking medication that is metabolized by CYP3A4 (see list described previously).
7. In the evaluation of children with malnutrition (over-nutrition and under-nutrition), the pediatrician should determine the amount of juice being consumed.
8. In the evaluation of children with chronic diarrhea, excessive flatulence, abdominal pain, and bloating, the pediatrician should determine the amount of juice being consumed.
9. 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.
10. 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.
11. 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.
12. 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).58,59
Melvin B. Heyman, MD, FAAP
Steven A. Abrams, MD, FAAP
Section on Gastroenterology, Hepatology, and Nutrition Executive Committee, 2014–2015