Pediatricians Say No Fruit Juice in Child’s First Year

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The nation’s top pediatricians are advising parents to stop giving fruit juice to children in the first year of life, saying the drink is not as healthful as many parents think.

In the past, the American Academy of Pediatrics had advised parents to avoid 100 percent fruit juice for babies younger than 6 months. On Monday, the group toughened its stance against juice, recommending that the drink be banned entirely from a baby’s diet during the first year. The concern is that juice offers no nutritional benefits early in life, and can take the place of what babies really need: breast milk or formula and their protein, fat, and minerals like calcium, the group said.

This is the first time the pediatricians’ group has updated its guidelines on fruit juice since 2001.

“I think this is a fantastic recommendation for infants, and it’s long overdue,” said Dr. Elsie M. Taveras, chief of the division of general pediatrics at MassGeneral Hospital for Children in Boston, who was not involved in the new report. “Parents feel their infants need fruit juices, but that’s a misconception.”

The new recommendations may surprise parents who thought 100 percent fruit juice was healthy for babies, or nutritionally equivalent to fruit itself.

But whole fruit typically has more fiber than fruit juice and is less likely to cause dental decay, said Dr. Steven Abrams, a lead author of the new A.A.P. report and the chairman of pediatrics at the Dell Medical School at the University of Texas at Austin.

Whole fruit is “less of a pure sugar intake,” said Dr. Abrams. “We want kids to learn how to eat fresh foods. If you assume fruit juice is equal to fruit, then you’re not getting that message.”

Dr. Man Wai Ng, the dentist in chief at Boston Children’s Hospital, applauded the ban on juice for infants and took a hard-line stance for preschoolers and older children. “One hundred percent fruit juice should be offered only on special occasions, especially for kids who are at high-risk for tooth decay,” she said.

Four ounces of apple juice has no fiber, 60 calories and 13 grams of sugar. By comparison, a half cup of apple slices has 1.5 grams of fiber, 30 calories and 5.5 grams of sugar. The fiber in a piece of fruit also increases fullness.

In terms of sugar and calories, store-bought juice is similar to soda. For instance, four ounces of lemon-lime soda has 12.6 grams of sugar and 46 calories, both slightly less than apple juice.

The new report, published online in the journal Pediatrics, also advised restricting fruit juice to four ounces daily for 1- to 3-year-olds, and six ounces a day for 4- to 6-year-olds. The 2001 guidelines gave parents more wiggle room to decide if four or six ounces daily was appropriate for preschoolers. By contrast, the advice for 4- to 6-year-olds stayed the same.

The latest report curbed the maximum daily intake for older children, aged 6 to 18. It used to be 12 ounces; now only eight ounces are advised.

There’s not a convincing link between obesity and children drinking modest amounts of fruit juice. Still, the report said, juice “has no essential role in healthy, balanced diets of children.”

In a statement, Cathy Dunn, a spokeswoman for Gerber, said the company is supportive of the A.A.P.’s new advice for infants, and plans to update its website to reposition “all Gerber juices for the toddler milestone, which is 12 months or older.”

Stephanie Meyering, an spokeswoman for the Juice Products Association, a trade group, said that while “juice is not necessary for children under age 1,” real fruit juice “is a nutritious complement to whole fruit in a balanced diet” for toddlers and older children.

Some manufacturers, like Gerber, make juice for infants, marketing it as a way to add vitamin C and flavor variety to a baby’s diet.

But Dr. Abrams said, “You want to be careful about saying ‘Drink juice for vitamins’ because they can be added to anything.”

Another concern is that juice can be a gateway drink of sorts, Dr. Taveras said, adding, “We have studies that show infants who drink more juice in that early life period are more likely to go on to drink soda and sugar-containing beverages.”

Currently, the federal government’s advice on healthful eating, called the Dietary Guidelines for Americans, does not weigh in on juice for very young children. The guidelines, which are compiled by the Agriculture and Health and Human Services departments, make recommendations only for ages 2 and older. The guidelines count a cup of 100 percent fruit juice the same as a serving of fruit, but urge that at least half of the recommended amount should come from actual fruit.

It’s unclear if the next U.S.D.A. guidance will forbid juice for infants. But the very young will be included for the first time in the 2020 guidelines, according to Brooke Hardison, a U.S.D.A. spokeswoman.

Some federal assistance programs have already restricted juice for very young children. Since 2009, the Special Supplemental Nutrition Program for Women, Infants and Children, known as WIC, has stopped listing juice as an acceptable purchase on the checks given to new mothers and babies in their first year. A WIC check, voucher, or electronic benefit transfer (EBT) card specifies which foods in what quantities can be bought at stores, so once a baby becomes a toddler, 100 percent fruit juice can be purchased.

In 2010, the Institute of Medicine of the National Academies — a private nonprofit — called for the “omission of fruit juice of any type before the age of 1 year” in federally supported day care centers.

More than 4.2 million children, including those in Head Start, take part in the Child and Adult Care Food Program. By October, child care centers and day-care homes will be prohibited from providing fruit juice to infants as part of a reimbursable meal through that program.