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Are They Drinking the Right Stuff?

child drinking juice

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As parents, we constantly worry whether our children are eating right: Should I have let her eat that second cookie? Why won't he even try green vegetables? Will she ever outgrow her desire to dunk everything in catsup? But while these concerns are valid, many mothers and fathers are missing a much bigger nutrition problem. Here's a hint: It's staring you in the sippy cup. "The drinking habits of many kids are deplorable, putting them at risk for obesity, weak bones, and other serious health problems," says Karen Cullen, R.D., assistant professor of pediatrics at the USDA Children's Nutrition Research Center in Houston.

The eye-popping statistics:

  • The average 3- to 9-year-old consumes about 30% less milk than the minimum amount recommended by the American Academy of Pediatrics (AAP).
  • About 10% of 2- to 5-year-olds drink at least double the maximum amount of fruit juice suggested by the AAP.
  • The typical 3- to 5-year-old polishes off 9 ounces of soda, punch, or other sweetened beverages daily, while 6- to 9-year-olds guzzle about 11 ounces every day.
  • One- to 5-year-olds consumed 23% more fruit juice or fruit drinks in 1998 than a decade ago.

"Parents have to act now," urges William Cochran, M.D., associate professor of pediatrics at Geisinger Clinic in Danville, PA, and member of the AAP's committee on nutrition. "It's no coincidence that the rates of childhood obesity doubled when juice and soda consumption soared." Ready to make your move? Just follow this step-by-step plan -- developed with pediatric experts -- to help you rate your child's drinking habits and, if necessary, get her back on track. And check out our recipes for nutrient-packed beverages. After all, kids need liquids -- but, as parents, we need to ensure that these fluids are nutritious.

The Last Straw
Lisa Hubbard

To determine whether your child is drinking too much or too little fluid, you need to know approximately how much she requires per day. Figuring it out usually involves serious math; fortunately, Susan Baker, M.D., Ph.D., a Buffalo-based chairwoman of the AAP's committee on nutrition, has done all the work for you. Check out the chart below, designed for a healthy child in room-temperature conditions. Tack on an extra two to three ounces of fluid for every hour a toddler spends playing outdoors in warm weather; for older kids, add about four to six ounces. If your child is running a fever or has medical problems, consult your pediatrician to calculate her fluid requirement.


The Last Straw
Lisa Hubbard

For a few days, maintain a log of how much your child drinks. Note the beverage, the time it was consumed, and your child's appetite at the next meal. (If she attends daycare, request that her provider keep track for you.) Add up the total ounces for the day, and compare the amount to the chart entry for her weight. What did you find?

  • Just the right level. That's great news!
  • Coming up dry. If her intake is a few ounces low, don't sweat -- especially if she eats a lot of water-rich foods such as yogurt, pudding, produce, and soup. But if she falls far below the requirement, talk to her pediatrician because even mild dehydration can wreak havoc with the body. Plus, children can be dehydrated without feeling thirsty, says Dr. Cochran. Signs of mild dehydration are infrequent urination, dark urine, and a dry-looking tongue.
  • Drowning in drinks. If your child regularly exceeds her fluid requirement and drinks a lot of beverages besides water, chances are she's not eating enough. As a result, she's probably falling short on important minerals, like iron, zinc, and magnesium, that aren't found in most beverages, according to Dr. Baker. She may also suffer from frequent diarrhea. "I often see toddlers who drink more than 60 ounces of fluid a day. No developing GI tract can handle that amount," says Dr. Baker, a gastroenterologist at Children's Hospital of Buffalo. One caveat -- excessive thirst, especially when accompanied by frequent urination, weight loss, sunken eyes, and no tears when crying, can signal diabetes. Call your pediatrician immediately if your child experiences these symptoms.

The Last Straw
Lisa Hubbard

It's not good enough that your child drinks the appropriate amount of beverages -- quality counts as much as quantity. So return to her beverage log, and tally the amount of fluid your child consumes daily in each of these categories: milk (breast, soy, or cow's), water, 100% fruit juice, sweetened beverages (like lemonade and fruit punch), and soda. Check the results against these guidelines.

Milk. It's chock-full of calcium, vitamin D, and B vitamins, all important nutrients for kids' growth and development. The AAP recommends that kids begin to drink cow's milk when they're about a year old. (The organization suggests that for the first six months, healthy infants get all their fluids from breast milk or iron-fortified formula. For babies between 6 and 12 months, continue with breast milk or formula, but four to six ounces of water is okay.) Start with whole milk. Don't be tempted to begin with skim because your baby needs fat for brain development. Once she turns 2, talk to her doctor about switching to skim or low-fat milk.

If your child is allergic to milk, your pediatrician may suggest soy formula (for those under age 1) or soy milk. While all soy formulas are fortified with vitamins and minerals, many soy milks are not. Be sure to choose a brand with at least 30% of the Daily Value (DV) of calcium and 25% of the DV of vitamin D per cup -- the same amount found in cow's milk, says Norman F. Carvalho, M.D., a pediatric hospitalist at Children's Healthcare of Atlanta.

In a recent study in Pediatrics, Dr. Carvalho noted a resurgence of rickets, a disease that weakens bones and causes deformities. Rickets was virtually wiped out decades ago when the U.S. government required that milk be fortified with vitamin D, a nutrient that helps in calcium absorption. But recently, Dr. Carvalho identified a case of rickets in a child drinking unfortified soy milk, and he found more than 30 cases in dark-skinned, breastfed babies. "Children with dark skin don't produce vitamin D as easily from sunlight, so they're more prone to rickets," he explains.

At press time, the Centers for Disease Control and Prevention in Atlanta had begun tracking rickets cases nationwide, and the AAP was examining whether to suggest a vitamin D supplement for all breastfed babies.

Recommended intake: Breast milk or infant formula on demand for children under 12 months; 16 to 24 ounces of milk daily for kids 1 to 8 (opt for whole milk for kids under 2).

The Last Straw
Lisa Hubbard

Water. H2O delivers nutrients and oxygen throughout the body, and it removes waste products. Body water protects organs, lubricates joints, regulates temperature, and provides the backdrop for many chemical reactions. So once your child's milk needs are met, the beverage of choice is clearly water. "Drinking water should be a given, just like brushing your teeth or putting on your seat belt," says Althea Zanecosky, R.D., a Philadelphia-based spokeswoman for the American Dietetic Association.

Ideally, your child's drinking water should contain fluoride, a trace mineral that is crucial for the proper development of teeth. More than 60% of communities in the U.S. have fluorinated tap water, and a few brands of bottled water, such as Dannon Flouride to Go, are fortified with the mineral. Contact your local water supplier to find out if fluoride is added to your tap water.

If you filter your family's tap water, refer to the manufacturer's literature to make sure fluoride isn't removed. In general, pitcher- or faucet-mounted filters leave in fluoride, but those mounted under the sink remove the mineral. If your child isn't receiving fluoride from water, talk to your pediatrician about supplements.

Recommended intake: No water for kids under 6 months unless advised by a pediatrician; consult a pediatrician for the amount for babies 6 to 12 months old; children 1 year and older, once they satisfy their milk requirement, can meet the rest of their fluid needs with water.

The Last Straw
Lisa Hubbard

Fruit Juice. Pediatricians used to push 100% fruit juice to make sure kids received enough vitamin C. But last May, the AAP urged doctors to recommend fiber-rich fruits instead because some children like juice so much that they refuse to drink anything else. "If given in a sippy cup or bottle, juice may increase the risk of tooth decay," says Dr. Baker. "Plus, constant juice drinking can make your child more prone to diarrhea, especially if she drinks a lot of apple or pear juice, both of which contain the indigestible carbohydrate called sorbitol." What's more, no juice, even the calcium-fortified kind, should be a substitute for milk because juice doesn't contain vitamin D.

So is 100% fruit juice off-limits? "There's no reason a moderate amount of juice can't be a part of the diet," says Baker. What's more, juices contain plant compounds that may help prevent heart disease and cancer.

Recommended intake: No juice for children under 6 months; serve no more than 4 to 6 ounces daily for children 1 to 6, and 8 to 12 ounces for children 7 and over.

Sweetened Drinks. Don't be duped by the fruity-sounding names or artificial colors: Most fruit punch and other similar beverages are simply sweetened water. Even if they're fortified with nutrients, they contain none or very little of the healthy plant compounds found in 100% juice.

Recommended intake: As an occasional treat, if at all.

Soda. You know soda isn't exactly healthy for kids -- the caffeine, the sugar, the empty calories. But you may be surprised about just how bad it is: A study in the Journal of the American Dietetic Association documented that when children ages 2 to 18 consumed an average of 9 ounces of soft drinks daily, their total daily calories rose, while key nutrients such as folate, vitamin A, vitamin C, and calcium took a nosedive. And in another report, Harvard University researchers identified a link between carbonated beverages (particularly the phosphorus-rich colas) and the risk of bone fractures in a group of 460 teen girls.

Recommended intake: As an occasional treat only.

The Last Straw
Lisa Hubbard

Now that you've identified the weak spots in your child's beverage habits, you're ready to help patch them up. Your first goal: Set a good example. "Environment is the key," says Dr. Cullen. "What's in your house, what you are drinking, dictates what your kids will consume." Institute changes gradually (for instance, tackle soda before moving on to juice), and be patient, stressing why milk, water, and a little 100% fruit juice are healthier. Here are some tips to make the transition smoother.

  • Perk up milk. You could stir in chocolate or strawberry syrup. But first, see if you can get away with lower-calorie flavorings like cinnamon, peppermint extract, or vanilla extract.
  • Make juice sparkle. Check out this trick to cut your child's juice intake in half: Mix it 50-50 with carbonated water. She'll love the bubbles.
  • Switch sodas. Make Italian soda by mixing a little bit of cherry, grape, or orange syrup (you can buy it at the grocery store) with sparkling water.
  • Flood'em with water. Keep water in the fridge, in the backpack, in the lunchbox -- anywhere that's handy. A new product that makes it hassle-free: Brita's Fill & Go plastic sports bottle, which filters the water for taste but leaves the fluoride content alone. For information on where to buy it, go to www.brita.com.

Strawberry Fruit Blend

In a blender, combine 2 cups sliced strawberries, 1 1/2 cups low-fat or skim milk (use whole milk for children under age 2), and 1/2 cup ice. Process until smooth, about 1 to 2 minutes. Makes 4 cups.

Each cup: 57 calories, 4 g protein, 10 g carbohydrate, 0 g fat (0 g saturated), 1 g fiber, 2 mg cholesterol, 124 mg calcium, 0 mg iron, 48 mg sodium.

Berried Treasure

Place a small strawberry or a few berry slices in 8 slots of an ice cube tray. Cover with water, and freeze at least 45 minutes or until the ice cubes are completely frozen. Pour 16 ounces of sparkling water into two large glasses. Add 4 ice cubes to each glass. Serve immediately.

Two-Fruit Shake

In a blender, combine 2 peeled peaches (cut in chunks), 1 cup raspberries, and 2 cups low-fat or skim milk. Process until smooth, about 1 to 2 minutes. Makes 4 cups.

Each cup: 77 calories, 5 g protein, 14 g carbohydrate, 0 g fat (0 g saturated), 2 g fiber, 2 mg cholesterol, 159 mg calcium, 0 mg iron, 63 mg sodium.

Blueberry Fizz

In a blender, combine 3/4 cup red or green seedless grapes, 3/4 cup blueberries, 1 1/2 cups sparkling water, and 1/4 teaspoon ground ginger. Process until smooth, about 2 to 3 minutes. Makes 3 cups.

Each cup: 49 calories, 1 g protein, 12 g carbohydrate, 0 g fat (0 g saturated), 1 g fiber, 0 mg cholesterol, 7 mg calcium, 0 mg iron, 3 mg sodium.

Chocolate Banana Dream

In a blender, combine 1 1/2 cups low-fat or skim milk (use whole dairy products for children under age 2), 1 cup low-fat vanilla yogurt, 1 large sliced banana, and 4 tablespoons chocolate syrup. Process until smooth, about 1 to 2 minutes. Makes 3 cups.

Each cup: 162 calories, 8 g protein, 34 g carbohydrate, 1 g fat (0 g saturated), 1 g fiber, 4 mg cholesterol, 240 mg calcium, 1 mg iron, 134 mg sodium.

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Copyright © 2001. Reprinted with permission from the September 2001 issue of Childmagazine.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.