Fruit juice is considered by many to be a healthy drink for babies. But is it? It can be good or bad for babies depending upon the circumstances. Learn about the benefits and complications associated with giving babies fruit juice.this is for test
- RN, RM, CHN, MHN, IBCLC
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What's in fruit juice
Fruit has a water content of around 90% (variations occur depending on the type of fruit), thus the main component of fruit juice is also water. (Concentrated juice has much of the water extracted during processing.)
Fruit juice is high in simple sugars, such as sucrose, fructose, glucose and sorbitol but deficient in complex carbohydrates. Juice contains only a small amount of protein, no fat or fiber (unless the pulp is included) and only small amounts of minerals and vitamins. Some fruit juices are naturally a good source of vitamin C and others may be fortified with vitamin C or calcium.
Juice drinks, sometimes labeled as 'fruit beverages' or 'fruit cocktails', should not be mistaken for fruit juice. Fruit drinks are not as nutritious as 100% juice. Most fruit drinks contain 10% or less of pure fruit juice and include added sweeteners, artificial flavors and sometimes fortifiers such as vitamin C or calcium. Fruit drinks offer little or no nutritional value to a child's diet.
Grape, orange or other fruit flavored sodas (soft drinks) contain no juice.
Fruit juice or whole fruit
Fruit juice offers no nutritional benefit over whole fruit. Eating whole fruit - mashed or pureed for babies – is a better source of nutrition compared to fruit juice. This is because whole fruit retains the skin and the pulp, both of which are important sources of fiber and other nutrients.
The edible skins of many fruits including apples, pears, plums, prunes, raisins, raspberries, apricots, figs, grapes, blueberries and strawberries include carotenoids and flavonoids. In addition to providing nourishment, these nutrients are antioxidants that protect our health.
A glass of 100% fruit juice contains the juice, and sugar, of several pieces of fruit. Fruit juice can be consumed more rapidly than whole fruit and therefore the risk of over consumption is greater. Drinking too much juice has been linked with many health problems (described below).
The fiber content in whole fruit slows down the digestion and absorption rate of the sugars. The slower absorption rate provides a more gradual rise in blood sugar levels compared to juice from the same fruit.
Unpasteurized juice can contain harmful organisms, such as E-coli, Salmonella and Cryptosporidium. These organisms can cause illnesses that are especially harmful to people with weakened immune systems, such as children, pregnant women or the elderly. Pasteurization kills these organisms that cause spoilage and potential infection.
Problems linked with too much juice
1. Tooth decay
Drinking a lot of juice can damage the enamel of your child's teeth, leading to dental caries (tooth decay). Dental caries have been linked with excessive exposure of the teeth to sugars contained in juice or other sweetened drinks and to a lesser extent milk. Frequent sipping of juice from bottles, feeding cups or boxes of fruit juice during the day or at bedtime promotes the development of dental caries.
2. Excessive gas, bloating and abdominal discomfort
- Babies are prone to stomach aches because they have an immature digestive system. The digestive tracts of young babies (under 6 months) lack sufficient quantities of necessary dietary enzymes to adequately digest the high level of sugars found in juice.
- Even a small amount of fruit juice that contains sugars with a high fructose-to-glucose ratio (such as apple, pear or prune juice) and/or sorbitol (pear or prune juice) can aggravate the intestines and cause restlessness, gas and stomach distress in some babies. (See Carbohydrate Malabsorption for more details.)
- Even as a child's digestive system matures, there remains limits on how much juice an individual can be digest at any one time. A little juice might be tolerated but a lot could potentially cause a stomach ache and/or diarrhea.
- Babies and young children are particularly prone to diarrhea from juice because of their immature digestive systems. When sugar is poorly digested (broken down) it cannot be absorbed into the blood stream, so it will pass into the large bowel. The body gets rid of undigested sugar by flushing it out. Sugar in the large bowel draws in additional fluid and the bacteria naturally present in the bowel ferment the sugar. This results excess gas and watery stools (diarrhea).
- Too much fruit juice (i.e. more than 5oz or 150ml per day) can cause diarrhea. Chronic diarrhea, sometimes referred to as 'toddler's diarrhea', has been linked to excess juice consumption.
- Fruit juice is often recommended as a treatment for constipation for young babies but amounts need to be limited to avoid diarrhea.
4. Poor growth
- Excessive juice consumption has been reported as a contributing factor in some children with non-organic failure to thrive. (In other words, where there is no medical reason for failure to thrive.)
- Juice can suppress a child's appetite. If juice consumption is not limited, there is a risk that juice may replace breastmilk, infant formula or other nutritious foods in the child's diet, which are necessary for healthy growth and development.
- In some children excessive fruit juice consumption (more than 12oz or 350ml per day) has been linked with an increased caloric intake and obesity.
- Fruit juice has a high glycemic index, meaning the high percentage of simple sugars in fruit juice raises blood sugar levels quickly. In turn, the rise in blood sugar triggers the release of insulin into the blood stream. High insulin levels promote the storage of fat as well as increased sense of hunger.
- A child can be underweight, overweight or within a healthy weight range and still be malnourished if their diet is poorly balanced. Fruit juice and fruit drinks are high in simple sugars and deficient in complex carbohydrates, protein, fat and fiber. They tend to be low in minerals, such as iron, calcium and zinc.
- If a child is not eating a balanced diet, they may be missing essential nutrients. While a child who drinks a lot of juice will still receive a lot of calories from the sugars contained in juice (and therefore may gain weight) drinking too much juice can lead to malnutrition and/or anemia.
- By drinking too much fruit juice children may not drink enough milk, which provides calcium and vitamin D. In some parts of the country, rickets (thinning of the bones) is on the rise.
7. Refusal of water
- We all know the benefits water provides to a healthy diet. Of concern are the increasing numbers of children who refuse to drink water, choosing to drink sugar-laden drinks instead.
- When babies start to eat solid foods, additional water is required to maintain the correct water balance in their body. Diluted fruit juice is often recommended to parents as a way to provide extra water because babies and children generally prefer the sweet taste of juice in favor of water.
- With encouragement healthy babies will accept water, especially if milk or water are the only fluids offered.
8. Reluctance to eat whole fruit
- Whole fruits offer many nutritional advantages over fruit juices (as mentioned above). Reliance on fruit juice to provide for the recommended daily fruit intake does not promote eating behaviors that encourage the habit of eating whole fruits.
- A study on the diet and nutritional habits of children aged between 4 and 18 years found that on average children ate less than half the recommended 5 portions of fruit and vegetables per day, and 1 in 5 children did not eat any fruit at all.
9. Waste of money
- Our bodies require a balance of different vitamins and minerals each day because many cannot be stored in the body. Minerals and water-soluble vitamins contained in fruit juices will pass into the urine if there is no need for our body to absorb more at that time.
- While a little can be good, a lot is not necessarily better. Drinking fruit juice is no more nourishing than drinking the same amount of sugar-water once our body's requirement for vitamins and minerals is exceeded.
- Sugar and water are the major components of 100% fruit juices and fruit drinks. The amount of sugar in 6 ounces ranges from 18 to 27 grams (depending on the type of fruit). This is equivalent to 4.5 to 7 teaspoons of sugar.
1. Is fruit juice a healthy choice?
Fruit juice can be a healthy part of your child's diet if it is used appropriately. Fruit juice can contribute to the recommended daily intake of vitamins and minerals if she does not eat enough fruit. However, drinking too much juice can negatively affect your child's health. Children can easily drink too much fruit juice and fruit drinks because they like to taste of sweetened liquids. Therefore, you may need to place limits on the amount your child drinks in order to provide a balanced diet.
2. Is it necessary to give a child fruit juice?
Fruit juice offers no nutritional benefit for babies younger than 12 months. Babies receive sufficient vitamins and minerals from breastmilk (provided maternal intake is adequate) or infant formula (which includes necessary vitamins and minerals). Because new foods* are more readily accepted between the ages of 6 and 12 months this is a good time to establish healthy eating habits for the future and fruit is recommended.
Fruit juice also offers no nutritional benefit over whole fruit for children older than 12 months. Children do not need to drink any fruit juice if they eat the recommended daily intake of fruit (i.e. 2 servings for children under 4 years of age and 4 servings for children over 4 years).
* Babies often refuse a new food the first time it is offered. Sometimes a new food may need to be offered up to 10 times before it will finally be accepted.
3. How much fruit juice is too much?
Limit your child's fruit juice consumption to no more than the following...
6 - 12 MONTHS
4oz or 120ml per day = 1/2 cup
1 - 4 YEARS
6oz or 180ml per day = 3/4 cup
4 - 12 YEARS
8oz or 240ml per day = 1 cup
12 - 18 YEARS
12oz or 360ml per day = 1 1/2 cups
These recommendations are maximum amounts to be offered, there is no minimum amount of juice to offer a child, as it is not necessary to offer juice at all.
4. What types of juice are best for babies?
Not all 100% fruit juices are equal in nutritional value. The actual nutrition in fruit juices varies by kind and among brands. The most nutritious juice for your money is 100% juice with the pulp retained. One that is either naturally high in vitamin C or is fortified with vitamin C. (Check labels to compare nutritional content.)
Orange juice is lower in sugar than other juices. It is also high is vitamin C and potassium and is therefore a good choice. However, some babies do not tolerate citrus juices well and may develop an upset stomach or break out in rashes when fed orange juice. In which case it may be best to wait until your child is 1 year to offer orange or grapefruit juice.
Some babies and young children have difficulty digesting apple, pear and prune juice because they contain sugars with a high fructose-to-glucose ratio. In small amounts these juices can be very effective in treating constipation. In larger amounts they can cause restlessness, gas, abdominal discomfort and diarrhea.
Because white grape juice contains a balance of sugars and no sorbitol it may be digested more easily and therefore less likely to upset little tummies. However, grape contains only small amounts of vitamin C and is higher in sugar than most other fruit juices.
5. Do I need to buy baby juice?
Baby juice is already diluted with additional water. It contains more vitamin C than regular juice. It doesn't contain added color like some regular juice but it may contain flavors.
Although convenient, baby juice is more expensive than regular juice. You can save money by buying regular adult juice and diluting it yourself. Only buy 100% juice and make sure it's pasteurized.
6. Is it better to choose fortified juices?
Both calcium and vitamin C are important to a child's diet but they can be provided by food. Calcium fortified juices provide approximately the same amount of calcium as milk but lack other nutrients present in milk.
A fortified juice may be helpful in the following situations. If your child does not drink enough milk or eat calcium rich foods. Or if your child does not eat the daily recommended servings of fruit.
7. Is it necessary to dilute juice for infants?
If you buy commercial baby juices, they don't need to be diluted. However, regular juice does need to be diluted for babies to get sugars down to a level they can manage.
When you first introduce juice to your baby, dilute 1 ounce (30ml) of juice to 3 ounces (90ml) of water, offering no more than 4 ounces total for the day. Over a period of a month, gradually increase the concentration of juice to half juice and half water. Don't forget to give water rather than juice, at least sometimes.
Diluting juice for older children can be a way of reducing consumption and adding more water to their diet. If your child loves her juice, start by diluting it just a little and keep increasing the water content over time.
8. Can a baby be allergic to fruit juice?
Although allergies to fruit may develop early in life, they are uncommon. The development of a rash around the mouth can occur after drinking freshly squeezed citrus juice (orange or grapefruit). This is most likely a contact dermatitis, due to the oils from the peel. Diarrhea and other gastro-intestinal symptoms are most likely due to carbohydrate malabsorption rather than an allergic reaction.
9. How can I limit the amount of juice my child drinks?
- Serve fruits as snacks instead of juice.
- Serve milk or water instead of juice.
- Offer juice less often or dilute the juice with water.
- Let your child see you enjoy drinking water and eating fruit.
Written by Rowena Bennett.
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