Healthy Drinks for Healthy Kids: New Beverage Recommendations for Ages 0-5

Dec 3, 2019
young child drinking milk

The first expert recommendations for healthy beverages for children ages 0 to 5 were just released in September within a new consensus statement, “Healthy Beverage Consumption in Early Childhood.” 

Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, convened a panel of experts from four leading health organizations – including the American Academy of Pediatrics (AAP), Academy of Nutrition and Dietetics (AND), American Heart Association (AHA) and the American Academy of Pediatric Dentistry (AAPD). The group was tasked with reviewing the best available evidence and developing comprehensive recommendations for beverage consumption for children from birth to age 5.

Beverages play a key role in young kids’ health – composing a significant percentage of their daily caloric intake. Additionally, the calories kids consume are critical to support growth and development, leaving little room for nutrient-poor, energy dense beverage options. 

So, what are the recommendations, and what do they mean for you as a practitioner?

Key Recommendations

While the experts acknowledge that each child is unique, the following recommendations can help set most kids on the path to healthy growth and development.

  • Breast milk or infant formula is recommended for infants 0 to 12 months of age. Whole milk is recommended for most children ages 12-24 months and fat-free (skim) or low-fat (1%) milk for children ages 2 years and older.
  • Milk is one of only two “go-to” beverages recommended for children ages 1-5. The other recommended beverage is water. The report recognizes that milk and the dairy food group are an important source of calcium, phosphorus, vitamins A and D, B vitamins and protein. In fact, milk is the number one source of energy, calcium, vitamin A, vitamin D and zinc for infants and young children, making it a “critical component of a healthy diet.”
  • Water is the best way to quench a child’s thirst. It is recommended that parents wait until kids are between 6 and 12 months of age before offering small amounts of water at meals, as solid foods are introduced.
  • 100% fruit juice is not recommended until after age 1 and should be limited to less than ½ to ¾ cup per day, dependent on age.
  • No sugar-sweetened beverages, flavored milk or plant-based alternatives (except for fortified soy beverages) are recommended in the diets of children ages 0-5.

Q&A for Health Care Providers

I’ve heard the phrase “milk with meals, water in between.” From your clinical perspective, does this recommendation hold weight? 
As the report indicates, fluids can displace nutrient-rich calories during meals and snacks. With that said, we know that milk is an integral part of a well-balanced meal and should not be seen as taking away from the solid food offered on the plate, but rather enhancing the nutrient quality of the meal. I often teach the MyPlate method, considering milk a food that should be part of the whole meal, while also recommending water with meals. I also agree strongly with the recommendation of water between meals and snacks for hydration. Water also helps children learn to recognize hunger versus thirst. So, perhaps the new phrase should be “milk with meals, water anytime.”

The report recommends fat-free or low-fat milk after age 2. Is there a place for whole milk in a well-planned diet for kids 2 and older? 
As a practitioner with over 30 years of experience in pediatric nutrition, I still recommend whole milk if a child prefers to drink it rather than changing to low-fat or skim milk. Sometimes the change can cause a child to stop drinking milk altogether. Milk is an important source of underconsumed nutrients as well as a source of fat, and fat is essential for growth and development. So, unless there is a clinical reason for low-fat, I continue to recommend whole milk as part of a balanced diet. 

Why recommend dairy over plant-based alternatives?
The report acknowledges that nondairy milks are not recommended as a replacement for cow’s milk because the nutrient content of these plant-based alternatives varies widely. It states, “non-dairy milk beverages should not be considered adequate nutritional substitutes for cow’s milk until nutrient quality and bioavailability are established.” The one exception to this is soy milk, which is currently the only acceptable substitute for cow’s milk, as recommended by the Dietary Guidelines for Americans. 

The recommendation for 100% juice is surprising, given the fact that 100% fruit juice has no added sugar. Can you shed some light?
If a child is not eating solid food well, carbohydrate beverages – such as juice, sugar-sweetened beverages or sports drinks – between meals can complicate feeding therapy and progression by interfering with the child’s appetite regulation, while offering only limited nutritional benefit. I do not recommend 100% juice for this population, except in clinical amounts to manage constipation or deliver oral medication. 

The report recommends against flavored milk for children under 5. Are there any instances when flavored milk may be of benefit to this population? 
Milk is such an important source of essential nutrients that I regularly use flavored milk to improve intake when consumption is low. The report relates no concern for weight issues or obesity. I recommend flavoring milk with fruit within a smoothie, with breakfast drink mixes (such as Ovaltine or Breakfast Essentials) for micronutrient deficiencies, or using chocolate or strawberry milk for improved intakes with a meal (going back to the MyPlate model I use for meal planning). Taking away a strategy for milk consumption just because flavoring has been added limits the tools parents and professionals have to improve overall child nutrition.

Bottom Line

Plain and simple – the recommendation for parents of young kids should include only milk (breast, formula or cow’s milk, dependent on age) and water as the go-to beverages for children up to age 5. Teaching kids to love healthy beverages now will have a lasting impact on their decisions down the road and their health in the future.

Learn more and find patient education resources, messaging and talking points, visit the report website.