Weighing in on fruit juice: AAP now says no juice before age 1
Steven A.Abrams, M.D., FAAP
One of the most common questions parents ask pediatricians is how much 100% fruit
juice they should give their children. A new AAP policy recommends some children should
be consuming less juice than previously advised.
An AAP policy statement published in 2001 and reaffirmed in 2006 recommended no juice
for children younger than 6 months of age, 4-6 ounces daily for children ages 1-6
years and 8-12 ounces for children 7 and older. Since then, however, considerable
concern has been expressed about increasing obesity rates and risks for dental caries.
Lower daily intakes
The Academy’s new policy Fruit Juice in Infants, Children and Adolescents: Current Recommendations builds on the original but considers the evidence released since then. The new advice
indicates that fruit juice should not be provided to children younger than 1 year
of age unless there is a strong clinical basis for it in the management of constipation.
For older children, maximum daily intakes of 100% juice products should be 4 ounces
for children ages 1-3 years, 4-6 ounces for children ages 4-6 years and 8 ounces for
those 7 and older.
The policy, from the AAP Section on Gastroenterology, Hepatology and Nutrition and
the Committee on Nutrition, is available at https://doi.org/10.1542/peds.2017-0967 and will be published in the June issue of Pediatrics.
Importance of whole fruits, other advice
Further recommendations emphasize the importance of fresh fruit in children’s diets.
Fruit generally contains additional fiber compared to juices. Consistent with recent
AAP recommendations, water and cow’s milk are preferred as primary fluid sources for
children after weaning.
Families of small children with dental caries should have a discussion with their
pediatrician about the child’s fruit juice intake and its possible contribution to
The literature regarding the contribution of 100% juice to obesity development remains
uncertain with recent studies failing to identify a clear connection, especially in
children over age 6. The Academy, therefore, recommends eliminating 100% fruit juice
from the diets of children with excessive weight gain but not necessarily from the
diets of all children.
In addition, the Academy strongly recommends that whole fruit be provided and encouraged
for children participating in the Special Supplemental Nutrition Program for Women,
Infants and Children. The policy also strongly discourages consumption of unpasteurized
These recommendations, taken together, represent a policy goal of decreasing juice
consumption, especially in small children, while ensuring an adequate intake of whole
fruits. It balances the role of a small amount of 100% fruit juice in meeting these
intake goals while limiting the exposure to juice and emphasizing the key roles of
water and milk in a healthy diet. It recognizes that juice may provide some vitamins
— such as vitamin C in orange juice and calcium and vitamin D in some fortified juice
products — but lacks the fiber and protein critical for the growth of children.
The policy clarifies that there is virtually no role for juice during the first year
of life and that expensive juice products designed specifically for infants are not
of value. When juice is served to older toddlers, it is important that it not be sipped
throughout the day or used to calm an upset child. It is not useful for the management
of diarrheal illnesses and may predispose infants or young children to the development
In summary, pediatricians should caution families that there is minimal nutritional
value to fruit juice, and it should be limited to small amounts and generally avoided
Juice should not be introduced to infants before 1 year unless clinically indicated.
Daily intake should be limited to 4 ounces in toddlers ages 1-3 years, 4-6 ounces
for those 4-6 years. For those 7-18 years, limit juice intake to 8 ounces or 1 cup
of the recommended 2-2½ cups of fruit servings/day.
Toddlers should not be given juice from bottles or easily transportable covered cups
that make it easy to consume throughout the day, nor should they be given juice at
Children should be encouraged to eat whole fruits and educated on the benefit of fiber
Families should be educated that human milk and/or infant formula is sufficient to
satisfy fluid requirements for infants, and low-fat/nonfat milk and water are sufficient
for older children.
Consumption of unpasteurized juice products should be strongly discouraged.
Grapefruit juice should be avoided in those taking certain medications (see policy).
When evaluating children with malnutrition — as well as chronic diarrhea, excessive
flatulence, abdominal pain and bloating — pediatricians should determine the amount
of juice being consumed.
In evaluating risk for dental caries, discuss the relationship between fruit juice
and dental decay, and inquire about the amount and means of juice consumption.
Routinely discuss the use of fruit juice vs. fruit drinks, and educate older children
and parents about the differences.
Dr. Abrams is a co-author of the policy statement and incoming chair of theAAP Committee on Nutrition.