First-Ever Guidelines on Early Childhood Beverages Take Aim at Sugar and More

Lilo H. Stainton | September 18, 2019 | Health Care
New Jersey-based foundation funds healthcare collaboration that delivers first comprehensive instructions on healthy beverages for young children

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Child drinks milk
Young children should not be given flavored milks, almond, rice and other plant-based milks, sodas and other sugar-sweetened beverages. Instead, they should drink breast milk or infant formula only for the first six months, followed by cow’s milk, water and — eventually — small amounts of unsweetened fruit juice for the best chance at healthy growth and development.

Those are among the recommendations released today by a handful of national professional organizations and other healthcare experts backed by the Robert Wood Johnson Foundation (RWJF); the group joined forces to create the first comprehensive guidelines on healthy beverages for children from birth through age 5. Their goal is to educate parents, caregivers, healthcare providers and policymakers.

“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 foundation. (New Jersey-based RWJF also provides financial support to NJ Spotlight.)

The guidelines were developed by the Academy of Nutrition and Dietetics in collaboration with the American Academy of Pediatric Dentistry, the American Academy of Pediatrics, and the American Heart Association, and led by Healthy Eating Research, a national program funded by the foundation. Given the important role beverages play in nutrition for young children — and growing concern over the effects of sugar-sweetened drinks — the group wanted to create a clear strategy to help reduce the rates of obesity and diet-related chronic diseases, like diabetes, tooth decay and heart problems.

Among other details, the group stressed the important nutritional value of whole, or full-fat cow’s milk for children between 12 and 24 months and said soy, almond or other plant-based milks lack many of the same critical vitamins, fats and other benefits.

The healthy drinks and the ones to avoid

Fruit juice without added sugar is appropriate starting at 12 months, but in limited amounts. Water can be introduced at 6 months and increased as toddlers age. Babies under 6 months need breast milk or infant formula only. All children should avoid sugar-sweetened beverages entirely.

“It’s so confusing to know which drinks are healthy and which to avoid” as a parent, said Jamie Bussel, a senior program officer at RWJF who oversaw the project. “I think that is the magic here. It can’t just be, ‘don’t do this, don’t drink that’,” she said.

Bussel said that sugary drinks — including sugar-sweetened fruit juices, teas and sports drinks, which may be marketed as healthier than soda — are the largest source of added sugar for young children; nearly half of kids age 2 to 5 years have at least one of these beverages daily. And marketing of many products is targeted to black and Latino families, she noted, groups more at risk for obesity.

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“This is so needed right now because so many kids are not drinking what they should,” Bussel said. In addition, positive nutrition patterns start early; children who are at a healthy weight when they enter kindergarten are much more likely to remain that way through adolescence, she added.

While Americans are getting heavier — obesity rates now top 35 percent in nine states — New Jersey fares pretty well, with the fourth-lowest obesity rate in the nation (tied with Massachusetts), according to findings recently released by the State of Obesity, a national nonprofit that monitors these trends.

Obesity rates

That said, more than one in four Garden State adults was overweight in 2018, up from 17 percent in 2000, the organization found. And data for young children (ages 2 to 4 years) who were part of a federal feeding program showed that while obesity levels dropped in New Jersey from nearly 19 percent in 2010 to 15.3 percent in 2014, they remained above the national average (14.5 percent) for that year.

The Healthy Eating Research program, which is based at Duke University in North Carolina, has worked for more than a decade on food-related policies and created feeding guidelines for young children last year, Bussel said. The beverage recommendations involved a similar process, but also engaged experts from the four national professional organizations, believed to be the first time these entities have come together to endorse a single policy.

“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,” said Dr. Natalie Muth, a panelist from the American Academy of Pediatrics.

“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,” she said. “That’s why it’s important to set them on a healthy course, and this guide will help parents and caregivers do that.”

In New Jersey, the Nicholson Foundation launched “NJ Sugarfreed” last year, a targeted public awareness campaign designed to reduce consumption of sugar-sweetened beverages, particularly among families in certain low-income communities. Early results suggested it had succeeded, to some degree, to drive down the sales of these products in Passaic County.

Spreading the message

Those involved with creating the new beverage guidelines spent months reviewing scientific literature, studies and existing policy guidance. They hope their recommendations will be useful to parents and other caregivers for young children, as well as pediatricians and other healthcare providers.

Child drinks logo
The professional organizations involved are now working to spread the message through their members and on social media, and videos aimed at parents have been created in Spanish and English. They also encourage parents to consider their own beverage choices, because modeling healthy behavior is a powerful way to encourage children to do the same.

“Our little ones watch everything we do,” Bussel said. The outreach effort is “a full-court press,” she added.

In addition, the group hopes these concepts will be incorporated into public policies at all levels, influencing the design of school lunches or other government food programs, and national frameworks like the federal nutrition guidelines that are due to be updated next year.