Healthy drinks for kids-new guidelines for parents

Many parents are surprised that one of the first things I talk about when they come into my office is beverage choices. I generally go through a list of “how often do they have…” questions, including a variety of foods and different beverages. We also review the list of healthy drinks for kids.

Asking these types of questions gives me a general idea of what your kids are drinking and how much added sugar your child might be getting from those drinks.

More often than not, the kids I see in my practice are getting way more servings of sugary beverages than is ideal for their health and development. Too many added sugars, especially in young kids can affect their appetite and nutrition intake, so limiting added sugars is ideal.

**This is a sponsored blog post, however, all opinions on the topic are my own.

Why choosing healthy drinks for kids matters

If you have followed me for a while on social media or read my regular emails or blog posts, you know that I talk a lot about just how small the tummy size is of young kids.

Their small tummy means that there just isn’t much space to waste on foods and beverages that are not providing them with the key nutrients they need for growth.

Unfortunately, many children are consuming sugary beverages at a young age. In fact, many infants consume milk and 100% juice before their first birthday, which can increase their risk for nutrient deficiencies. When kids are drinking high amounts of beverages (aside from water) the beverages often take the place of whole, nutrient-dense foods. This is one of the ways nutrient deficiencies can occur.

Even more concerning is the amount of sugar-sweetened beverages — with close to half of 2-5-year-olds drinking one daily.

One of my big goals for parents is to educate them on the best beverage choices for their kids based on age. The new healthy beverage recommendations are a great start.

New kids healthy drink recommendations 

Research shows that what children drink from birth through age five has a big impact on their health – both now and for years to come.

Because of this, Healthy Eating Research convened an expert panel and scientific advisory board to conduct a review of 50+ existing documents from domestic and international bodies on recommendations and guidance for beverage consumption in early childhood. They also looked at reviews of existing literature (research) to develop a new set of recommendations, which I will discuss below.

I was really excited to hear about this research and the formation of official healthy beverage guidelines, especially for children 0-5 years.

This is the first time that groups like the Academy of Nutrition and Dietetics, the American Academy of Pediatric Dentistry, the American Academy of Pediatrics and the American Heart Association have made consistent recommendations for beverage consumption for children ages 0-5.

These recommendations are designed to help families establish healthy patterns in early childhood to prevent future health issues, like dental cavities or diet-related diseases like obesity and type 2 diabetes, and to ensure optimal development and overall health.

Having worked as an outpatient pediatric dietitian with several pediatricians over the past decade, I know how important guidelines are for families.

The new guidelines

The guidelines are recommendations on beverages to include and avoid for children from 0-5 years of age.

While many guidelines already exist they are not consistent and often have gaps in the ages they cover. Because of this, many parents, healthcare providers and others who care for young children have been confused.

I am going to dive into the guidelines below.

What should my baby drink?

Babies have especially tiny bellies and they are learning to develop the skills they need to chew and swallow. They are also learning to develop taste preferences for different foods. This starts in utero and is expanded through the introduction of flavors in breastmilk. Because of this, babies between 0-6 months should only have breast milk or formula as a beverage.

Once babies start solids around the 6-month mark, small amounts of water can be introduced. This should be done using an open cup with the primary goal of teaching them to close their lips around the cup and get them used to the feeling and flavor of water in their mouth.

No juice or any other beverage (aside from breastmilk, formula or small amounts of water past 6 mo.) should be provided to babies under 12 months of age.

Beverages for toddlers & preschoolers

As your baby transitions into the toddler stage (over 12 months) a slight shift occurs and the focus changes from breastmilk or formula as the significant nutrition source, to solid foods and other fluids. If you decide to keep breastfeeding past 12 months, that is great too!

The types of fluid you offer at this age is important, so is the quantity you are providing them. Starting around 12 months, your baby can start being exposed to milk or appropriate milk alternatives. According to the guidelines, juice can also be offered after 12 months (though I will give my opinion on that more below.)

What kind of milk should my kids drink?

Toddlers (after 12 months) can start being introduced to milk and equivalent milk alternatives (such as soy milk). For toddlers that do not have a milk allergy or intolerance and those not following a vegan/vegetarian diet, whole cow’s milk is the best choice for transitioning off formula or including alongside breast milk.

Parents should not give their toddlers between 12-24 months of age low fat or reduced-fat milk. The fat in whole milk is ideal for brain development and milk provides a good source of fat to toddlers. Flavored milk should be avoided for toddlers because of the high added sugar content.

As outlined in my detailed blog post on milk vs. milk alternatives, many of the plant-based milks are not nutritionally equivalent to cow’s milk. Some are also high in added sugars. The USDA currently recognizes unsweetened soy milk as an allowable substitute for cow’s milk in federal programs like WIC or school meals. Pea based milk alternatives are another option for those with dairy and soy allergies.

I always recommend that children following a vegan diet or those with food allergies or intolerances (such as to dairy, soy, etc.) work with their doctor and a pediatric dietitian to ensure all of their key nutrients are being met in alternate ways.

After your toddler turns 2 it is okay to switch from whole to lower fat milk. One important thing to remember is that as toddlers reach the 2-year mark, picky eating often starts to become more noticeable. When picky eating happens, milk intake often increases. Milk should be limited to 3-4 (4 oz.) servings per day to help reduce the risk of iron deficiency.

Can my kids drink juice?

Based on the new guidelines, toddlers (12-24 months) can have a small amount of 100% fruit juice (4 oz. maximum per day). However, whole fruit is the preferred way to get fruit for toddlers and I typically recommend no juice before 2 years to my clients.

Children from 2-3 years can have up to 4 oz of 100% fruit juice per day and children 4-5 years up to 6 oz. per day. Again, whole fruit is the preferred source.

One recommendation I have to parents if they want to serve juice is to dilute it with water. This allows for some flavor and a higher volume of liquid without adding extra sugar.

Formula for 1 year olds and toddlers

I’ve been getting more and more questions from families about toddler formulas being used after their baby turns 1.

For most kids, toddler formulas are not needed or recommended. These should be used under the supervision of your child’s pediatrician or dietitian only.

One of the main reasons I recommend this is because toddlers who continue on toddler formula often end up drinking more formula and eating less food. When this happens, their key nutrient needs are often not met. It can also lead to more feeding problems down the road.

Breastfeeding past one year

The World Health Organization encourages breastfeeding for the first two (plus) years of life.

If you are breastfeeding your child and choose to continue breastfeeding after one, that is awesome! One thing to keep in mind is that breastmilk is lower in calcium than cow’s milk and milk alternatives like soy milk. Additionally, breast milk contains virtually no vitamin D.

You can choose to continue breastfeeding and still introduce cow’s milk or an appropriate milk alternative. However, if you don’t introduce cow’s milk or alternative, be sure to focus on alternate calcium sources and consider continuing a vitamin D supplement.

Summary of the new guidelines 

Age	Milk	Juice	Water
0-6 mo.	Breastmilk or formula only	None	None
6-12 mo.	Breastmilk or formula only	None	Small amounts to practice
12-24 mo.	Whole cow’s milk or appropriate alternative*	4 oz max /day (whole fruit is ideal)	Offer water regularly
2-3 yr.	Okay to switch to lower fat milk or appropriate alternative*	4 oz max /day (whole fruit is ideal)	Offer water regularly
4-5 yr.	Lower fat milk or appropriate alternative*	6 oz max/day (whole fruit is ideal)	Offer water regularly

Other beverages for kids

I often get asked about other beverages when working with families. The above guidelines recommend the only beverages that babies get are breastmilk/formula and water.  Children 1-5 only should only get milk, water and limited amounts of juice.

I do however recognize that life happens. We go to parties, family events and other places where sugary beverages are around. I feel that overall all things can fit into a nutritious diet for kids. Just be sure that those beverages do not become a routine part of your young child’s intake.

Beverages to LIMIT for kids 2-5 years:

• Fruit juice (even 100% juice)-target range is 4-6 oz/day

Beverages to AVOID** for kids 5 and under:

• Energy drinks
• Coffee/tea
• Other caffeinated beverages
• Soda
• Fruit punch
• Lemonade
• Kool-Aide
• Vegetable juices (high sodium)
• Sports drinks
• Other sugar-sweetened beverages

**Many of you know that I take an overall balanced approach to foods. No one food or ingredient is going to cause problems alone. However, it is good to know which items should not be a regular part of what your kids are eating and drinking. We know that being overly restrictive with children when it comes to sugar can lead to obsession. So use your judgment as a parent. Consuming the “Avoid” beverages every once in a while is not an issue, but remember that as the parent you need to be in control of when this happens.

How to reduce sugary beverage intake by kids

Whether you’re a first-time parent or a veteran with 2 or 3 kids under your belt, these guidelines can help you make changes to get your kids on a path to optimal health. And, the important thing to note here is that these guidelines are doable.

The HealthyDrinksHealthyKids.org website has a lot of practical tips for parents and caregivers to make implementing these healthy drinks for kids guidelines into your daily lives as easy as possible.

Simple ideas:

• If your kids are hooked on juice or flavored milk, you can wean them off by gradually making changes, such as adding water to juice or adding plain milk to flavored milk, so that their taste buds will gradually adjust and learn to like the less sweet varieties.
• You can also set boundaries about when kids can have certain beverages. For example, as kids age, the panel recommends that they only consume milk at mealtimes and water in between for thirst. This helps to limit the total amount of milk they’re consuming, while also ensuring they’re getting enough water every day.
• If you need some extra help getting your kids to drink more water, try adding fresh sliced fruit to plain water, or squeezing lemons/limes or other citrus juices into their cup or water bottle.
• Making fruit and herb-infused water is a fun way to change things up that kids enjoy!

DIY fruit-infused healthy drinks for kids

1. Pick a fun glass or water bottle & a colorful straw
2. Wash and slice fruit and or berries (you can use frozen fruit too!)
3. Get the kids involved, let them pick out their fruit and herbs
4. Fill a cup with water, ice & let your kids add their fruit choice (herbs like mint and rosemary work well too)
5. Add a colorful paper or re-useable straw or drink straight from the cup/bottle
6. Enjoy!

Disclosure: I was compensated for this blog post sponsored by the Robert Wood Johnson Foundation, to write about the new beverage recommendations however all opinions are my own.