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What young children should and shouldn’t drink: experts’ new guidelines

milk bottle baby
Photo by Rainier Ridao on Unsplash
As for plant-based milks, the experts do not recommend them as a substitute for cow’s milk unless a child has been diagnosed with an allergy or an intolerance to dairy products or the child’s family follows a vegan diet and avoids all foods from animal sources.

A panel of experts from four leading U.S. medical and nutrition organizations released new guidelines on Wednesday that offer the latest evidence-based recommendations on what children should — and should not — drink from birth through age 5.

Most parents won’t be surprised to learn that the panel recommends only breast milk, infant formula and water for babies under 12 months old, at which point, say the experts, milk can be added.

Nor will they be surprised that the panel says sugar- or artificially sweetened beverages — including chocolate and other flavored milks — should not be given to young children.

What may startle some parents are the panel’s recommendations about fruit juice and plant-based beverages, such as almond, rice or oat milk.


The experts say children aged 1 to 5 should drink no more than half a cup (4 ounces) a day of fruit juice, and that it must be 100 percent juice — no fruit “drinks” or fruit “punches.” But even that recommendation is lukewarm. A much better choice, the panel stresses, is to skip the juice and give the child a piece of whole fruit instead.

As for plant-based milks, the experts do not recommend them as a substitute for cow’s milk unless a child has been diagnosed with an allergy or an intolerance to dairy products or the child’s family follows a vegan diet and avoids all foods from animal sources. In those cases, the panel recommends fortified soymilk.

Milk-based products lack some of the key nutrients essential for healthy growth and development that are found in cow’s milk, most notably protein, calcium and vitamin D, the experts stress. Some plant-based milks are fortified with those missing nutrients, but it’s not known how effectively added nutrients are absorbed into children’s bodies. In addition, many plant-based milks are sweetened with added sugar.

The guidelines also recommend against giving children “transition” or “weaning” formulas, also known as toddler milks, growing up milks or follow-up formulas.

“Toddler milks don’t offer any nutritional benefit over a healthy, balanced diet,” the experts write. They point out that these products often contain corn syrup solids or other calorie-containing sweeteners and tend to have more sodium and less protein than cow’s milk. Toddler milks are also more expensive than cow’s milk.

Long-term effects

The new recommendations are a collaborative effort by the American Academy of Pediatrics, the American Heart Association, the American Academy of Pediatric Dentistry and the Academy of Nutrition and Dietetics. The project was led by Healthy Eating Research, which conducts nutrition-related research.

“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 Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation, which funded the development of the guidelines, in a released statement. “Families deserve clear and consistent guidance on what their young children should drink and what they should avoid.”

As the guidelines point out, the “overconsumption of unhealthy beverages along with inadequate consumption of healthy beverages in early childhood can contribute to an increased risk of diet-related chronic diseases, such as obesity, type 2 diabetes, or dental caries.”


Yet, a large proportion of young children in the United States drink unhealthy beverages on a daily basis. For example, many infants drink both cow’s milk and 100 percent fruit juice before their first birthday, “which can increase their risk for nutrient deficiencies, such as anemia,” the guidelines points out.

And almost half — 44 percent — of American children aged 1 to 5 drink a sugar-sweetened beverage daily.

Sugar-sweetened beverages are considered a major factor behind the growing rate of obesity among young people. More than a third of U.S. children and teens, aged 2 to 19, are either overweight or obese, according to government data.

Key recommendations

Here is the panel’s “snapshot” version of their new recommendations. As the experts point out, these recommendations are intended for healthy children, not for children with medical conditions that have specific nutritional requirements.

All kids 5 and Under: All kids 5 and under should avoid drinking flavored milks, toddler formulas, plant-based/non-dairy milks, caffeinated beverages and sugar- and low-calorie sweetened beverages, as these beverages can be big sources of added sugar in young children’s diets and provide no unique nutritional value.

0 – 6 Months:  Babies need only breast milk or infant formula to get enough fluids and proper nutrition.

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. It’s best for children under 1 not to drink juice. Even 100% fruit juice offers no nutritional benefits over whole fruit.

12 – 24 Months:  It’s time to add whole milk, which has many essential nutrients, along with plain drinking water for hydration. A small amount of juice is OK, but make sure it’s 100% fruit juice to avoid added sugar. Better yet, serve small pieces of real fruit, which are even healthier.

2 – 5 Years:  Milk and water are the go-to beverages. Look for milks with less fat than whole milk, like skim (non-fat) or low-fat (1%). If you choose to serve 100% fruit juice, stick to a small amount, and remember adding water can make a little go a long way!

FMI:  You can read the guidelines — and the reasoning behind them — in full at HealthyDrinksHealthyKids.org.

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