PRINCETON, N.J. — Medical and nutrition organizations on Sept. 18 recommended children up to age 5 drink breast milk, infant formula, water, plain milk and 100% juice. Plant-based milk alternatives joined flavored milks, sugar-sweetened beverages and low-calorie sweetened beverages as drinks to avoid.
Experts from the Academy of Nutrition and Dietetics, the American Academy of Pediatric Dentistry, the American Academy of Pediatrics, and the American Heart Association collaborated on the recommendations, which may be found here. Healthy Eating Research, a nutrition research organization, led the research. The Robert Wood Johnson Foundation provided funding.
“As a pediatrician, I know what a child drinks can be almost as important as what they eat, in terms of a healthy diet,” said Natalie Muth, M.D., who represented the American Academy of Pediatrics. “This is especially true for young children. We know that children learn what flavors they prefer at a very early age, as young as nine months, and these preferences can last through childhood and adulthood. That’s why it’s important to set them on a healthy course, and this guide will help parents and caregivers do that.”
The recommendations come as the Dietary Guidelines for Americans for the first time plans to include recommendations for pregnant women and children from birth to age 2 in the 2020-2025 version.
Plant-based milk alternatives are not nutritionally equivalent to dairy milk, according to the recommendations from the medical and nutrition organizations, and sweetened varieties usually have added sugar. Fortified soy milk is the only plant-based milk alternative recognized as an acceptable substitute for dairy milk in federal nutrition programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Unsweetened and fortified non-dairy milk drinks may be a good choice if a child is lactose-intolerant or allergic to dairy milk, according to the recommendations.
Examples of sugar-sweetened beverages were soft drinks, fruit drinks and fruit-flavored drinks, fruit punch, fruit or juice cocktail, and lemonade. Drinks with added sugar offer little to no nutritional benefits, often take the place of healthier foods and drinks in the diet, and do not make people feel full, according to the recommendations.
Low-calorie or reduced-calorie sweetened beverages may contain sweeteners such as saccharin, aspartame, acesulfame potassium (Ace-K), sucralose, neotame, advantame, stevia and monk fruit, according to the recommendations. There is not consistent evidence on the long-term health impact of low-calorie sweetened beverages, but beverages with low-calorie sweeteners are a better choice than sugar-sweetened beverages, according to the recommendations.
Toddler milks also were not recommended. Marketed in Europe for years and more recently in the United States, toddler milks usually are made up of powdered milk, corn syrup solids or other calorie-containing sweeteners, vegetable oil, and added vitamins and minerals. They tend to have more sodium and less protein than cow’s milk, according to the recommendations.
Only breast milk and infant formula are recommended for children up to 1 year of age. Serving cow’s milk to a child before age 1 could put the child at risk for intestinal bleeding. Cow’s milk has too many proteins and minerals for a baby’s kidneys to handle. After a baby reaches age 1, cow’s milk becomes an important source for many nutrients, including protein, calcium, vitamin A, vitamin D, vitamin B12, potassium, phosphorus, riboflavin and niacin.
Flavored milk like chocolate or strawberry have added sugars and no nutritional benefits over plain milk. Children under age 2 should avoid added sugars, according to the recommendations.
Whole fruit and 100% fruit juice also are recommended, but not until a baby reaches age 1. It is best for children to get fruit servings from fresh canned or frozen forms since 100% fruit juice is lower in dietary fiber.
Water should be the “go-to drink” to quench children’s thirst, according to the recommendations. The daily amount that children need may change based on the weather, how active the children are and the amount of fluids they get from other drinks as well as food.
Developing the recommendations involved a review of scientific literature, existing guidelines from national and international bodies, and reports on early childhood beverage consumption.
“From the time children are born through those first few years, beverages are a significant source of calories and nutrients and can have a big impact on health long into the future,” said Richard Besser, M.D., president and chief executive officer of the Robert Wood Johnson Foundation. “Families deserve clear and consistent guidance on what their young children should drink and what they should avoid. These recommendations from our country’s leading medical and nutrition organizations will help families raise healthy children.”