Throw out your juice boxes!
That's the basic headline emerging in response to the American Academy of Pediatrics' revised recommendations for fruit juice for kids and adolescents. But such an extreme response is not warranted by the recommendations themselves.
The AAP recommendations aren't new. In the previous version, the AAP recommended against juice for infants under six months old. That recommendation has been raised to one year. The previous recommendations also grouped together all children from ages one to six. Those groups have now been separated into two distinct groupings. The AAP now recommends no more than four ounces for toddlers ages one to three and no more than six ounces a day for kids ages four to six.
Contrary to the way the guidelines have been received, the guidelines don't demonize juice. In some cases, juice is even medically useful. Here's a review of what the AAP's recommendations do and do not tell us about kids' favorite drink.
Not all juices are created equal
The AAP recommendations are careful to distinguish between 100% "fruit juice" and "fruit drinks." The authors conclude that 100% fruit juice can be a part of a healthy diet, but that other drinks masquerading as juice should be avoided.
Even within the category of 100% fruit juices, some juices behave differently than others. The AAP warns against unpasteurized juice for any age group due to the danger of contamination. The AAP warns parents that grapefruit juice can interfere with some medications. It also acknowledges that orange juice has been associated with health benefits for adults and so may also be associated with health benefits for children.
Juice is not associated with significant weight gain in children
One of the main reasons parents avoid giving juice to kids is over concern for weight gain. The AAP recommendations paint a different picture of the relationship between juice intake and weight gain. There is not, as of yet, strong evidence to suggest that fruit juice leads to weight gain. For example, an April 2017 article in Pediatrics found that a daily serving of 100% juice did not significantly impact children's Body Mass Index.
There is, however, some evidence that juice leads to inadequate growth. This can happen in two main ways. First, some fruit juices have been linked with malabsorption, meaning that children who drink a lot of juice may not be getting all of the other nutrients they need. Second, excessive juice intake can lead to bloating and diarrhea, which can lead to a diminished appetite as well as weight loss.
Too much juice may negatively impact eating habits
More juice isn't likely to lead to significant weight gain in children, but it can shape their palette. The USDA's 2015-2020 Dietary Guidelines recommend between 1,000 calories per day for two-year-olds and 1,600 calories per day for eight-year-olds. One six-ounce serving of juice is about 90 calories, which is nine percent of a two-year-old's daily caloric intake and 5.6 percent of an eight-year-old's daily caloric intake.
Because young children are generally better than adults at regulating their food intake they're more likely to stop eating when they're full. That also means children who consume multiple servings of juice have fewer calories to budget toward new tastes and textures. Parents looking to introduce their children to a range of foods may want to limit juice consumption.
Kids ages one to eight are the only age group reaching their suggested daily fruit intake
The AAP's 2017 recommendations draw from nutritional information included in the USDA's 2015-2020 Dietary Guidelines, which recommend approximately one cup of fruit for kids consuming around 1,000 calories per day. The AAP recommendations open with a criticism of how children are getting that fruit: "Unfortunately, data revealed that children two to 18 years of age consume nearly half of their fruit intake as juice."
But further reading of the USDA's 2015-2020 Dietary Guidelines shows that children ages one to eight are the only age group reaching their daily recommended fruit intake. In other words, the juice drinkers among us are getting more fruit servings than anyone else. Although there are good reasons to believe that whole fruit is nutritionally superior to 100% fruit juices, kids actually appear to be doing better than their parents at consuming the right amount of fruit.