New beverage recommendations for children to age 5 say to avoid all drinks with added sugar, and plant-based milks

By Melissa Patrick
Kentucky Health News

Health experts from four of the nation’s most prominent health organizations have created a new set of beverage recommendations for children under the age of 5 that basically recommends breast milk and infant formula for infants under the age of 1 and water and cows’ milk for older children.

The experts strongly caution against drinks with added sugar, including flavored milk, sodas and sugared fruit drinks, diet drinks, caffeinated drinks and plant-based and non-dairy milks — and says to limit fruit juice.

“As a pediatrician, I know what a child drinks can be almost as important as what they eat, in terms of a healthy diet. This is especially true for very young children,” Dr. Natalie Muth, who represented the American Academy of Pediatrics on the expert panel, said in the news release. “We know that children learn what flavors they prefer at a very early age—as young as 9 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 were created by the AAP, the American Heart Association, the Academy of Nutrition and Dietetics and the American Academy of Pediatric Dentistry, under the direction of Healthy Eating Research, a nutrition research organization, and funding from the Robert Wood Johnson Foundation.

As Kentucky’s children and adults continue to struggle with obesity, recommendations to cut back on empty calories match up with research showing that children who are obese or overweight often grow up to become obese and overweight adults.

“Overconsumption of unhealthy beverages along with inadequate consumption of healthy beverages in early childhood can contribute to risk of diet-related chronic diseases, such as obesity, type 2 diabetes, or dental caries,” says the Healthy Eating Research report. “This makes beverages a critical target for improving the health and well-being of infants and young children.”

Kentucky’s children from 2 to 4 years old rank 32nd in the nation for obesity, with 13.3% of them obese. Those between 10-17 have the third highest obesity rate, at 19.3%; and the rate for high-school students is at 20.2%, ranking them third as well.

The release notes that the recommendations are intended for healthy children and do not address medical conditions that require specific nutritional guidance. Here’s what the recommendations say:

• 0-6 months: Babies need only breast milk or infant formula.
• 6-12 months: In addition to breast milk or infant formula, offer a small amount of drinking water once solid foods are introduced to help babies get familiar with the taste—just a few sips at meal times is all it takes. Avoid fruit juices.
• 12-24 months: It’s time to add whole milk, which has many essential nutrients, along with some plain drinking water. A small amount of 100% juice is OK, which amounts to a half-a-cup a day. Better yet, the recommendation is to serve whole fruits instead.
• 2-5 years: Milk and water are the go-to beverages. Move away from whole milk to skim or 1% milk. And no more than a half-a-cup to 3/4 cup a day of 100% juice, with a recommendation to add water to make a little go a long way.

The recommendations are clear that plant based milks are generally not recommended unless there is a medical reason, like allergies or lactose intolerance, or a specific dietary preference.

The Healthy Eating Research report says, “Plant-based milks are growing in popularity, but it is important to note that they are not nutritionally equivalent to cow’s milk. They have varying nutritional profiles based on their plant source and many often contain added sugars. With the exception of soy milk, the [Dietary Guidelines for Americans] do not include these beverages as part of the dairy group because their overall nutritional content is not similar to dairy foods.”

Click on the chart to view a larger version

“By providing caregivers, health care and early care and education providers, policymakers, and beverage industry representatives a clear set of objective, science-based recommendations for healthy drink consumption, we can use this opportunity to work together and improve the health and well-being of infants and young children throughout the United States,” Megan Lott, deputy director of Healthy Eating Research, said in the release.

Mary Story and Tina Kauh report for the RWJF Culture of Health Blog that these recommendations grew out of a 2017 workshop convened by the National Academy of Sciences to identify policy strategies for reducing consumption of sugar-sweetened beverages among young children.

During the workshop, they report that they heard evidence that patterns of sugary drink consumption begin early in life—and disproportionately among black, Latinx, and American Indian children and among those from families with lower incomes — but they add that this is a problem that exist “across the board,” and “too many kids consume too many sugary drinks.”

“The Feeding Infant and Toddler study found that, on any given day, nearly one in three (29 percent) children ages 12 to 23 months and nearly half (46 percent) of children 36 to 47 months have a sugary drink. Further, sugary drinks are the number one source of added sugar from all foods and beverages for children 12 to 47.9 months of age,” they report.