Are They Drinking the Right Stuff?

3. Create a balance sheet.

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.

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