New Recommendations for Water, Fruit Juice in Early Childhood

Posted & filed under Children's Oral Health, Children's Oral Health and Fluoride.

Guest Blog Post by Laura Vollmer, RD, MPH, Nutrition Policy Institute

A February 2017 expert panel report, “Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach” from Robert Wood Johnson Foundation’s Healthy Eating Research program, provides new direction on healthy nutrition for children aged 0-2. Early life diet and feeding practices are important to establishing healthy habits and preferences that can prevent obesity, oral health problems, and other chronic diseases. The report concludes that water is the best option to quench young children’s thirst and should be introduced as soon as babies start solid food.juice; water; new recommendations

Many parents and caregivers provide 100% fruit juice with misplaced confidence, relying on its nutritional value as a potential serving of fruit. But for children aged 2 to 5, guidelines now suggest that juice should be limited to no more than 0-4 ounces per day and sugar-sweetened beverages, including juice drinks, should not be offered at all. This represents an important change from earlier beliefs and practices. The recommendations note that excessive intake of 100% juice and juice drinks can actually displace nutritious food in young children’s diets and can lead to dental cavities. The report also suggests that water and juice be served in cups, not bottles and also cautions against putting toddlers to sleep with bottles, as this causes tooth decay and other oral health problems.

A new policy statement from the American Academy of Pediatrics, “Fruit Juice in Infants, Children, and Adolescents: Current Recommendations” adds to recommendations on beverage intake for very young children. The policy statement’s recommendations include avoiding juice altogether for the first 12 months and then limiting it to, at most, 4 ounces of juice for children aged 1-3 and 4-6 ounces for children age 4-6. The association between tooth decay and juice is also highlighted; the recommendations include a note that juice consumption should be included when evaluating dental caries risk. The recommendations also note that, to meet fluid intake requirements, breastmilk or infant formula is sufficient for infants and low-fat/nonfat milk and water are sufficient for older children.

Teeth are forming under the gum until about 8 years of age. That’s why it is so important to introduce water with fluoride early. Fluoride strengthens teeth both as they grow and in the mouth. And baby teeth matter! Start early to prevent tooth decay and set children up for a lifetime of healthy teeth.

The table below summarizes guidance from Healthy Eating Research and the American Academy of Pediatrics on beverages for children aged 0-5.

juice; water; new recommendations
















For more on healthy hydration, including water and oral health, see the National Drinking Water Alliance’s new factsheet.


  • Pérez-Escamilla 2017, Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach
  • Healthier Beverage Recommendations, Healthy Eating Research 2013
  • Holt 2011, Bright Futures Nutrition Pocket Guide, American Academy of Pediatrics
  • Fruit Juice in Infants, Children, and Adolescents: Current Recommendations Melvin B. Heyman, Steven A. Abrams, Section on Gastroenterology, Hepatology, and Nutrition, Committee on Nutrition. Pediatrics Jun 2017, 139 (6) e20170967; DOI: 10.1542/peds.2017-0967