Bottoms Up: New Consensus Recommendations Highlight Best Beverages For Young Children’s Health

Duo photo of Photo of Stephen R. Daniels, M.D., Ph.D. and Emily A. Callahan, M.P.H., R.D.N.Stephen R. Daniels, M.D., Ph.D., Professor and Chair, Department of Pediatrics, University of Colorado School of Medicine; Pediatrician-in-Chief, Children’s Hospital Colorado
Emily A. Callahan, M.P.H., R.D.N., Owner, EAC Health and Nutrition, LLC

When it comes to beverages for children from birth through age 5, keep it plain and simple – breast milk or infant formula, water, and plain milk are best.

That’s the consensus of an expert panel that released recommendations today about what young children should drink as part of a healthy diet.

The panel included representatives from the Academy of Nutrition and Dietetics, American Academy of Pediatric Dentistry, American Academy of Pediatrics, and American Heart Association under the leadership of Healthy Eating Research, a leading nutrition research organization, and with funding from the Robert Wood Johnson Foundation.

As a pediatrician and a registered dietitian nutritionist, we served as the panel’s chair and research lead, respectively.

Why did we take on this effort?

In the midst of an increasingly crowded, diverse beverage landscape, it’s not surprising that parents and even health care providers may be confused about what and how much young children should drink. But research shows that what young children drink can have a big impact on their health, and this population’s current beverage habits are cause for concern: for example, many young children drink caffeinated beverages, toddler formulas, and other sweetened drinks. On a given day, close to half of 2-5 year-old children consume sweetened drinks, and beverages contribute 32 percent of the average daily added sugars intake among children in that age group.

Given the lack of comprehensive, consistent guidance on young children’s beverage intake, the expert panel was charged with developing a consensus statement on recommendations for what children from birth through age 5 should be drinking as part of a healthy diet. The statement and its supporting technical report are intended to help health care providers and practitioners communicate with parents and caregivers about healthy beverages.

How did we do it?

We began with an extensive review of more than 50 documents on existing guidance on this topic, finding inconsistencies in guidance for certain beverages as well as gaps in the age ranges included, amounts to be consumed, and types of beverages covered.

Consequently, we reviewed and synthesized literature on beverages for which there were no recommendations or recommendations were inconsistent. Through a series of virtual and in-person meetings, the panel discussed the findings, deliberated on recommendations, and incorporated input from a scientific advisory committee.

What did we conclude?

We’re confident that the recommendations, summarized in the graphic below, fill important gaps in beverage guidance for young, healthy children. For example, they provide quantitative recommendations for plain drinking water and include guidance on toddler formulas.

The recommendations recognize that early life is an important period for the development of flavor and food preferences, which is one of the reasons that we recommend young children avoid beverages sweetened with sugar and/or low-calorie sweeteners. There is no compelling nutritional reason to introduce these beverages, and minimizing children’s exposure to sweet-tasting foods and drinks during their early years might be one strategy to help reduce their preferences for sweetened products at older ages.

The recommendations also emphasize the importance of how and when beverages are consumed. Drinks that have sugars, whether natural or added, can increase the risk of cavities when they are in frequent contact with the teeth between meals. That’s why the recommendations advise serving milk and 100% juice from a cup, and only during meals and snacks. Water is the best choice for a portable cup that a child sips throughout the day.

What’s next?

We expect the recommendations to help public health practitioners, health care providers, and advocates develop tailored strategies and materials for various stakeholders including parents and caregivers, policymakers, industry, and early care and education providers. We hope that the recommendations also will:
  • Inform the research agenda, given that research on the health impact of many beverages during the first 5 years of life is limited – especially for specific racial/ethnic groups – and longitudinal studies are particularly scarce.
  • Inform policy decisions, such as beverage taxation proposals, standards for labeling and marketing beverages to young children, default beverages included in restaurant kids’ meals, and how beverages are included in federal feeding programs such as the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and Child and Adult Care Food Program (CACFP).
  • Impact the food supply; for example, by improving beverage packaging (such as clearer labeling and more proper sizing of juice containers) and spurring creative marketing techniques to encourage young children to drink plain water and milk.

We must capitalize on the early childhood window of opportunity, during which dietary patterns are both impressionable and capable of setting the stage for lifelong eating behaviors. Collaboration among national health and nutrition organizations represented in these recommendations has the potential to evoke meaningful change to improve beverage consumption patterns — and ultimately the health and well-being of young children in the United States.

Statements or opinions expressed herein reflect the views of the contributors, and do not reflect the official views of the AHA|ASA, unless otherwise noted.