Clinical Inquiries

When is it OK for children to start drinking fruit juice?

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EVIDENCE-BASED ANSWER

Children should be at least 6 months of age (strength of recommendation [SOR]: C, expert opinion) and parents should provide only 100% fruit juice in a cup (not a bottle). Intake should be limited to 4 to 6 oz a day until 12 months of age (SOR: C, expert opinion). It’s important to reiterate to parents that breastfeeding is the preferred source of infant nutrition for the first 6 (preferably 12) months of life (SOR: A, systematic reviews).

Sugar-sweetened fruit drinks have been linked to excess weight gain and obesity (SOR: B, cohort studies with mixed results). Sugar-sweetened beverages provide little nutritional benefit to children and should be restricted (SOR: C, expert opinion). See the TABLE for definitions of fruit juice, fruit drinks, and sugar-sweetened beverages.

TABLE
What’s fruit juice and what’s not

TERMDEFINITION
Fruit juiceBeverage containing 100% fruit juice from the liquid naturally occurring in the fruit tissue; contains no artificial sweetener
Fruit drinkBeverage containing <100% natural fruit juice. Includes sweetened fruit juice reconstituted from concentrate and fruit-flavored drinks
Sugar-sweetened beverageFruit drinks, fruit “ades,” and carbonated beverages (including sodas and cola beverages) to which sweeteners have been added

Evidence summary

One of every 6 American children is overweight or at risk of becoming overweight.1 Overweight children are more likely than normal-weight children to be overweight as adults; they’re at significant risk for morbidity and mortality from hypertension, cardiovascular disease, and diabetes in adulthood. Establishing sound nutritional habits—including appropriate consumption of fruit juices, fruit drinks, and other sugar-sweetened beverages—early in life plays an important role in preventing overweight in later childhood and adulthood.2

Fruit juice/obesity link is controversial

During the transition to table foods between 4 and 11 months of age, the top 3 nonmilk sources of carbohydrate in an infant’s diet are infant cereal, 100% juice, and bananas.2 One in 5 infants routinely drinks juice before 6 months of age.3 Consuming 100% juice and fruit-flavored drinks can contribute to excess energy intake and displace other nutrient-dense foods in the child’s diet.

The role of fruit juice consumption in childhood obesity is controversial. In 1 group of 168 children 2 to 5 years of age, 9% of children who drank >12 oz of fruit juice per day were overweight, compared with 3% of those who drank <12 oz daily.4

A recent review of 21 studies found 6 (3 longitudinal and 3 cross-sectional) that supported a relationship between juice intake and weight and 15 (9 longitudinal and 6 cross-sectional) that suggested no link between 100% fruit juice consumption and overweight in children or adolescents.5

Regardless of the relationship between fruit juice and obesity, it is important to emphasize that breast milk provides essential nutrients and immune protection for the growing infant. Breast milk should remain the recommended source of nutrition through the first year of life.6,7

Evidence-based answers from the Family Physicians Inquiries Network

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