Kids Are Getting Too Much Fruit Juice

From the WebMD Archives

May 7, 2001 -- Fruit juice tastes sweet and kids love to drink it. But for many, it's become too much of a good thing -- leading to some serious health problems. In a revised policy statement, the American Academy of Pediatrics says that parents need to cut back on how much juice their infants, toddlers, young children -- even older children -- are drinking.

"We've seen a dramatic increase in the amount of fruit juice, fruit drinks, and sodas being consumed by children of all ages," says study author William Cochran, MD, associate professor of pediatric gastroenterology and nutrition at the Geisinger Clinic in Danville, Pa. Cochran is a member of the AAP's Committee on Nutrition.

"Juice is a healthy food when taken in appropriate amounts," he tells WebMD. "But juice is basically water and carbohydrates, and too much can cause many health problems." Among them: malnourishment and stunted growth, tooth decay, obesity, and chronic diarrhea.

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The policy statement outlines the difference between fruit juice and juice drinks. To be labeled as a fruit juice, the FDA mandates that a product be 100% fruit juice. In general, juice drinks contain between 10% and 99% juice as well as added sweeteners, flavors, and sometimes fortifiers such as vitamin C or calcium.

The good news about fruit juices: some have high contents of potassium, vitamin A, and vitamin C; some are fortified with vitamin C, which may have beneficial long-term health effects, such as decreasing the risk of cancer and heart disease. Also, when drinks that contain vitamin C are consumed with a meal, they can increase iron absorption by twofold, says Cochran. And juice contains no fat or cholesterol.

The downside: Many fruit juices contain twice the amounts of carbohydrates that human milk and standard infant formulas have, Cochran says. These are in the form of sucrose, fructose, glucose and sorbitol -- all sugars. Unless the pulp is included, it contains no fiber either. Also, fruit juice contains only a small amount of protein and minerals.

And although highly-promoted by manufacturers, calcium-fortified juices have approximately the same calcium content as milk -- but lack other nutrients present in milk and formula, which are important for bone development.

The AAP's recommendations:

  • Juice should not be given to infants under 6 months of age.
  • After 6 months of age, infants should not get juice from bottles or cups that allow them to consume juice easily throughout the day.
  • Infants should not get fruit juice at bedtime.
  • For children aged 1-6, intake of fruit juice should be limited to four to six ounces a day.
  • For children 7-18, juice intake should be between eight and 12 ounces a day.
  • All children should be encouraged to eat whole fruits.

When infants take in large amounts of juice instead of breast milk or formula -- or when toddlers drink juice instead of milk or other foods -- the risk is malnourishment and improper physical development, including short stature, says Cochran.

"There is no nutritional reason to feed juice to infants younger than 6 months," Cochran tells WebMD. In fact, according to the policy statement, "Offering juice before solid foods are introduced into the diet could risk having juice replace breast milk or infant formula in the diet. This can result in reduced intake of protein, fat, vitamins, and minerals such as iron, calcium, and zinc."

Tooth decay in infants and toddlers has been linked with excess juice consumption. "We do not encourage use of 'sippy' cups or putting infants to bed with juices because it promotes tooth decay," he tells WebMD.

Also, infants and young children given too much juice can develop chronic diarrhea, gas, bloating and abdominal pain, says Cochran. "I see many kids with chronic diarrhea, and the reason is they're consuming too much juice," he tells WebMD. "All I do is have them cut back on the juice and the diarrhea goes away. The reason: they're overloading the intestinal track with too much carbohydrate, which ... makes you pass a lot of gas and get diarrhea."

As kids reach adolescence, the potential for obesity escalates as kids ingest too many high-calorie sodas, Cochran says. "A lot of people don't think about all the calories," he tells WebMD. "We also see problems in decreased bone mineralization, because they are not consuming milk." In fact, an estimated 75% of girls are not consuming enough milk, he says.

Along with the AAP recommendations that older children and adolescents drink no more than two 6 ounce servings of fruit juice each day, Cochran says to make sure that kids eat whole fruit -- for the fiber. "Only half the fruit they consume should be in the form of fruit juice," he tells WebMD.

"Excellent paper," says Karen Cullen, DrPH, assistant professor of pediatrics and nutrition for the Children's Nutrition Research Center at Baylor College of Medicine in Houston. "It brings together everything we have been trying to tell people."

"Fruit juice does fit into the diet," Cullen tells WebMD. "It is part of the fruit category on the food pyramid. But we shouldn't be giving juice to children as a pacifier. They should not be sipping it all day. We've forgotten that milk is a healthy beverage, especially with a meal. We've forgotten about water. If kids are thirsty, they should be encouraged to drink water."

Also, because it lacks fiber, fruit juice leads kids to drink more than they should. "It doesn't fill you up like whole fruit does," she says. "You just don't get the cues that you're full, as you do with whole fruit. Therefore, you end up drinking more. You can drink six ounces really fast, and that's about 60 calories a drink - a lot of calories."