Putting the Squeeze on Juice

Reviewed by Gary D. Vogin, MD on February 15, 2000
From the WebMD Archives

When you hear the phrase "All things in moderation," fruit juice probably doesn't come to mind, but most pediatricians caution parents that allowing kids to drink excessive amounts of juice is a recipe for poor health.

Studies over the past decade have shown a host of potential problems with fruit juice consumption in children, and the American Academy of Pediatrics (AAP) Committee on Nutrition even issued a policy statement in 1991 telling doctors to caution parents about the dangers.

The Dangers of Excess Juice

  • Juices fill kids with empty calories. "Fruit juices can fill kids up so that they're not hungry at the dinner table and are too full to eat more nutritious foods," warns Carlos Lifschitz, MD, an associate professor of pediatrics at the Children's Nutrition Research Center at Baylor College of Medicine in Houston, Texas.
  • Certain juices are associated with tummy troubles. Some fruit juices -- including apple, pear, and prune -- contain sorbitol, a naturally occurring but problematic sugar alcohol. Because sorbitol is not completely absorbed in the small bowel, it makes its way to the large bowel where it ferments and produces gas, says Lifschitz. In addition, many of the juices that contain sorbitol also have an imbalance in the ratio of the sugars fructose and glucose, which may reduce fructose absorption. These factors can lead to cramps, diarrhea, or loss of appetite in a child, says Lifschitz.

    Several studies have reported this malabsorption, or incomplete digestion, including a study published in the October 1999 Archives of Pediatrics and Adolescent Medicine. In the study, researchers gave infants either pear juice, which contains sorbitol and a "bad" fructose to glucose ratio, or white grape juice, which contains no sorbitol and has a "good" fructose to glucose ratio. The infants drank between 90 and 120 milliliters (between .4 and .5 cups). Researchers found signs of malabsorption in five of the seven infants given pear juice, as compared to only two of the seven who drank grape juice. The authors recommended giving children only non-sorbitol juices (for example, grape and citrus).

  • Unpasteurized juices may contain the Salmonella organism. The Food and Drug Administration issued a nationwide alert to consumers in July 1999 warning of a Salmonella muenchen outbreak due to contaminated unpasteurized juice; the juice had labels identifying it as "freshly squeezed" or "fresh." The Salmonella organism can cause serious and even fatal infections in young children. To stay safe, buy pasteurized juice for children.

How Much Is Too Much?

All that said, kids love juice, and a little bit each day is fine. Lifschitz recommends no more than one ounce daily per three pounds of body weight, or about 1.2 cups for the average two year old and 1.8 cups for a five year old.

Juice should never be the main source of liquid for a child (that should be water), nor their main source of nutrition, says Lifschitz. And no child under four months of age should be given anything but mother's milk or formula.

In addition to limiting juice amounts, there are things parents should keep in mind when choosing healthy juices. Melissa Einfrank, RD, a clinical dietician with the University Medical Center in Tucson, Ariz., recommends the following:

  • Look for juices that are fortified with vitamin C, such as apple juice for babies.
  • Calcium-fortified juices are good options, but not as good a source of calcium as milk or other dairy products, which contain vitamin D, aiding the absorption of calcium, according to Einfrank.
  • When possible, offer your children fresh fruit instead of juice, suggests Einfrank. "Fresh fruit contains fiber and nutrients and vitamins that are lost in the juicing process."
  • If you must give your child juice, try diluting it with water. "Kids need fluids, so adding water to juice not only helps decrease the amount of sugar they're drinking but gives them the water their bodies need," she explains.