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New AAP Policy on Fruit Juice

The American Academy of Pediatrics will soon publish new guidelines on fruit juice intake for infants and children in the June issue of Pediatrics. The AAP released a policy statement originally in 2001 (and revised in 2006) that recommended no juice for infants less than 6 months of age, 4-6 ounces daily for children ages 1-6 and 8-12 ounces for children 7  years and older. However, with the rise in childhood obesity and dental caries, these amounts will be decreased considerably.

The new recommendations are:

– Infants under age 1 should not have any juice in their diet unless needed in the management of constipation.
– Toddlers between age 1-3 should be limited to 4 ounces of juice daily.
– Children ages 4-6 should be limited to 4-6 ounces of juice daily.
– Children ages 7-18 should be limited to 8 ounces of juice daily.

The new policy also stresses the importance of whole fresh fruit in children’s diets since whole fruits add much-needed fiber to combat constipation. Toddlers should also not be given juice in bottles or cups that can be carried around all day as this promotes dental caries. Fruit juice should not be given at bedtime or used to calm an upset child. Although some fruits juices may contain vitamin C, calcium and Vitamin D, there is minimal nutritional value to fruit juice in a child’s diet. Juice lacks fiber and protein that are critical for the optimal growth in children. Water and low-fat or non-fat cow’s milk are more than sufficient as
fluid sources for children after weaning from breastmilk or formula.

More information

Childhood Obesity, BMI, and a Healthy Tidbit

Adult and childhood obesity has been a major health concern for decades and continues to be so in 2016. Overall obesity rates in children have remained stable for the past several years, but are still very high. Approximately 17% of children ages 2-19 years are obese. This represents 12.7 million children nationwide and many millions more are overweight but not obese. Obesity is defined as having a BMI (Body Mass Index) of greater than 95th percentile. Overweight is defined as having a BMI of greater than 85th percentile but less than 95th percentile.

Body Mass Index is calculated by dividing one’s weight in kg by one’s height in meters squared. The formula for calculating BMI is: BMI = weight (in kg)/height2 (in meters). The actual BMI number is not a particularly useful concept in children because they are constantly growing and at certain times in their growth cycle, the height velocity and weight velocity are at different rates. A BMI of 24 in an adult might be a good BMI, but in an 8 year-old child would represent obesity. A more appropriate concept for children is BMI percentile, which compares the BMI in a child of a given age and gender with the BMI of the rest of the population of children of the same age and gender. Thus, a BMI of greater than 95th percentile represents a child whose BMI is greater than 95 percent of children of the same age and sex, and indicates obesity.

The causes of obesity are very complex and multifactorial, and include race, ethnicity, genetics, behavior, education, socioeconomic status, and outside influences such as food availability and advertising by the food industry.

Two of the most important known behavioral risk factors for childhood obesity are: 1) The consumption of high calorie, sugar sweetened drinks such as fruit juices, soda pop, and sports drinks, and 2) the decline in physical activity and outdoor play brought about by an increase in “screen time” which includes television, computers, phones, tablets, and video games. Elimination of sugar sweetened drinks from children’s diets, and limiting screen time to no more than two hours per day (and thus encouraging physical activity) have been shown to help prevent obesity in children as well as provide benefit in treating children who are already overweight or obese.

A very useful and informative website regarding obesity in both children and adults can be found by searching CDC Division of Nutrition, Physical activity, and Obesity, or go to www.cdc.gov/nccdphp/dnpao/index.html