Medical and nutritional organizations weigh in on what children should drink in first five years

By Elizabeth Crawford

- Last updated on GMT

Source: Getty/Yaoinlove
Source: Getty/Yaoinlove

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Children under the age of 5 years should skip flavored-, toddler- and plant-based milks as well as caffeinated beverages, and instead stick to breast milk, infant formula, water and plain milk depending on their age, according to a joint recommendation from leading medical and nutritional organizations.

They also should limit consumption of juice to 100% options and then only if unsweetened fresh, canned or frozen fruit is not an option, according to the first-of-its kind consensus recommendation published Sept. 18.

The guidelines were developed by experts at 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 the Healthy Eating Research organization with funding from the Robert Wood Johnson Foundation.

The organizations crafted the recommendations together to address misunderstandings around existing and divergent guidelines, including suggested consumption amounts or recommended ages for introduction of new beverages that may confuse caregivers, according to the report.

“Whether it is a question about milk, juice, water or other drinks, these new recommendations clear up the confusion and help parents set their kids on the path for healthy growth and development,”​ according to supporting documentation for the report.

In addition, the report explains the recommendations are necessary because “healthy beverage intake is critical in early childhood as beverages can make a significant contribution to dietary intake during this period, and thus may serve as important sources of essential nutrients.”

The reverse is also true, cautions the report, noting that “many beverages also contain added sugar and saturated fats, which can be harmful when consumed in excess”​ and negatively influence children’s long-term taste preferences.

For example, the report notes, “many infants consume milk and 100% juice before their first birthday, which can increase their risk for nutrient deficiencies, such as anemia.”

In addition, it notes, close to half of 2- to 5-year-olds consume a sugar-sweetened beverage daily and the prevalence of sugar sweetened beverage consumption increases throughout childhood.

[Editor’s note: If you are interested in learning more about what children should drink, join us in Chicago in November for FoodNavigator-USA’s Food For Kids Summit​. Get all the details and register here​.]

Dairy milk couched as ‘critical component of a healthy diet’

With this context, two representatives from each of the four national health and nutrition organizations, a chair and a research consultant worked with scientific advisory board of six dietary experts to review roughly 50 documents recommending beverage consumption during early childhood.

Based on these documents, “structured narrative scientific literature reviews for beverages,”​ and multiple meetings over six months, the group determined that children 0-5 years should not consume flavored milks, toddler milks, sugar-sweetened beverages, beverages with low-calorie sweeteners or caffeinated beverages.

They also recommended that unless children had allergies or was raised within a family that abstained from animal products, they should consume milk daily beginning at one year. For the first two years, children should consume 2-3 cups of whole milk daily, 2- to 3-year-olds should consume at least two cups of skim or low-fat milk, and 4- to 5-year-olds should drink at least 2.5 cups per day of skim or low-fat milk.

While the report makes space for children with dairy allergies or in families that avoid animal products to forgo dairy milk, it argues against substituting plant-based or non-dairy beverages for milk, with the exception of fortified soy milk, because many of these alternatives “lack key nutrients found in cows milk”​ and because “our bodies cannot absorb nutrients in these non-dairy milks as well as they can from regular milk.”

The panel further endorses the potentially controversial recommendation by noting that while there has been recent research regarding the role of dairy fat in healthy dietary patters, “in the absence of clear evidence justifying a departure from current recommendations, the panel chose to remain consistent with current guidance recommending whole milk for most​” 1- to 2-year-olds and fat-free or skim for older children.

Fruit favored over fruit juice

The other potentially controversial recommendation is the suggestion that children younger 1 year should not consume 100% juice and that children 1 to 3 years consume no more than 4 ounces daily and children 4 or 5 years old consume no more than 4 to 6 ounces per day.

It also urges that, when possible, children should consume fruit rather than juice so that they consume the fiber that is often stripped out of juice. Furthermore, it suggests that caregivers who opt for 100% dilute it with water at home to make it go further.

The expert panel justifies the potentially controversial recommendation by explaining that dairy is a “critical component of a healthy diet”​ because it is a source of calcium, phosphorous, vitamins A, D and B, protein and zinc.

‘Water is essential for life’

Finally, the report recognizes that “water is essential for life,”​ and as such should be provided to children older than 6 months for supplemental hydration.

Specifically, it recommends, caregivers offer children 6- to 12-months 0.5-1 cup plain, fluoridated drinking water in a cup at meal time, 1-4 cups to children 1 to 3 years old throughout the day and 1.5-5 cups to children 4 to 5 years old.

Children younger than 6 months should only consume breast milk, if possible, the report adds.

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