Four major health and nutrition groups come together for brand new guidelines for birth to age 5. Here's what you should know.

By Sally Kuzemchak, MS, RD
September 19, 2019
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For the first time ever, four leading health organizations have come together to make recommendations on what young kids should drink—and you may be surprised by some of their advice.

The guidelines were a collaboration between the Academy of Nutrition and Dietetics, the American Academy of Pediatric Dentistry, the American Academy of Pediatrics (AAP), and the American Heart Association, under the leadership of Healthy Eating Research and funded by the Robert Wood Johnson Foundation.

"There are a lot of recommendations out there about food, but we know that young kids are also getting a lot of calories from beverages," says Natalie Muth, M.D., who represented the AAP on the panel. "Drinks have a big impact on health and contribute to rates of childhood obesity."

New guidelines for kids from birth to 5

0-6 months: breast milk or infant formula only

6-12 months: breast milk or formula, plus small amounts of water offered in a cup once solid foods are introduced

12-24 months: whole milk, water, and small amounts of 100 percent fruit juice (but whole fruit is preferred). No more than 4 ounces of 100 percent juice per day.

2-5 years: Milk (skim or 1 percent) and water. Small amounts of 100 percent fruit juice (diluting it with some water is a good approach), no more than 4 oz of juice for 2- to 3-year-olds and no more than 4 to 6 oz for 4- to 5-year-olds.

5 years and younger: avoid drinking the following beverages:

  • toddler formulas
  • flavored milks (e.g., chocolate, strawberry)
  • plant-based/non-dairy milks (e.g. almond, rice, oat)
  • caffeinated beverages (e.g. soda, coffee, tea, energy drinks)
  • sugar- and low-calorie sweetened beverages (e.g. "diet" or "light" drinks, including those sweetened with stevia or sucralose)

Answers to questions you might be having

Why no plant-based milks?

The reason plant-based milks are singled out is because they're not one-for-one swaps, nutritionally, with dairy milk, says Dr. Muth. For instance, many have hardly any protein. Only soy milk is considered an even trade for dairy. For families who are vegan or have allergies and intolerances, they suggest being mindful of the plant-based milks you serve and checking in with your doctor or dietitian to make sure your child is getting the nutrients she needs.

What if my kids prefer whole or reduced-fat milk?

The reason that low-fat and fat-free milk are recommended beginning at 24 months is to limit calories from saturated fat. But there has been some research suggesting that full-fat dairy might actually be beneficial for kids and adults, perhaps because other fats in milk have health benefits or because it’s more satisfying than fat-free. If your kids prefer whole milk, check in with your pediatrician to see if there are any concerns, look for other places in your family's diet to limit saturated fat (like fast food), and remember that kids don't need lots and lots of milk: Young kids need only 2-2.5 cups a day of dairy (or dairy equivalents like soy milk and yogurt), older kids need 3.

Why shouldn't kids have flavored milk?

Though flavored milk does deliver nutrients like protein, calcium, and vitamin D, the groups hope parents will focus on serving plain milk in these early years so kids learn to like beverages that aren't sweet. "If you don't do flavored milk now, hopefully, they'll still like the taste of plain milk later," says Dr. Muth. Avoiding them also cuts back the amount of added sugar young kids get too.

Earlier this month, six members of Congress proposed banning chocolate milk in New York City schools. The proposed ban was met with support since chocolate milk can have up to double the sugar as plain. It also faced some criticism due to the protein and other nutrients that kids avoiding plain milk might get by drinking chocolate milk. Around the country, schools in Washington, D.C., San Francisco, and Rochester, Minnesota have banned flavored milk.

What's wrong with artificially sweetened drinks?

Though these drinks usually don't contain calories, they get kids used to super-sweet flavors (and don't provide any nutrients). That makes it harder for kids to like plain water and other less-sweet beverages. Dr. Muth also adds that there's not enough data to prove that artificial sweeteners are totally safe for kids.

My advice

My two cents as a dietitian and mom: Keep in mind that these are guidelines. An occasional birthday party punch for your toddler or flavored milk at a restaurant for your preschooler isn't a deal-breaker—and it's also reality! It's what you do most of the time (and what you keep in your house on the regular) that matters.

And remember to always talk to your child's doctor about what's best for your own child based on individual needs, such as allergies or other health issues.

For more on the guidelines and how to make healthy changes around drinks, visit Healthy Drinks Healthy Kids.

Sally Kuzemchak, MS, RD, is a Contributing Editor for Parents magazine and a registered dietitian who blogs at Real Mom Nutrition, a "no-judgement zone" all about feeding a family. She is the author of The 101 Healthiest Foods For Kids and Cooking Light Dinnertime Survival Guide. You can follow her on Facebook and Instagram. In her spare time, she loads and unloads the dishwasher. Then loads it again.


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