Nutrition Note Series: Katja Rowell MD, Grace Wong RD, Jo Cormack PhD, Jennifer Berry OT
Different foods or liquids can prove helpful for a child on their feeding journey. But a caregiver or clinician’s fear that foods are “unhealthy” or even “dangerous” can mean missed opportunities. “Good” parents don’t serve “bad” foods. Many of the foods thought of as “bad” are those that children with feeding challenges enjoy, can safely eat, may rely on for energy intake, or may benefit from as they gain skills and comfort.
The focus of this Nutrition Note is on a commonly maligned option: Juice.
By addressing fears around juice, we aim to reassure you so you can reassure parents, and maybe even your colleagues! Then we’ll share potential benefits of juice. (Note that this is not a comprehensive nutrition guide.)
Virginia Sole-Smith shared how her fear of juice being “bad,” and ultimately her acceptance of juice and flavored milk, helped her daughter wean off her feeding tube.
Why does juice* have a bad reputation, and is it deserved?
Let’s look at common beliefs about juice, and some research that tells us that many of the purported negative health effects are overstated or just untrue.
- Juice is full of sugar and sugar is addictive.
While kids can seem preoccupied with sweets and it can feel like an addiction, a physiological addiction to sugar is not supported by research (Westwater, 2016). Restricting or forbidding a food often increases interest in it. And, in our clinical experience, with permission (not shame) around these foods, the preoccupation usually resolves. Much of the cited research on sugar addiction was done on rats with intermittent access to sugar. When unlimited access, the rats did not exhibit compulsive behaviors. Yes, sugar lights up “pleasure centers” in the brain as addictive drugs do, but so does a hug, and even donating money! (Harbaugh, 2007) - Juice (sugar) makes kids “hyper.”
Research says no (Wolraich, 1994). However, low blood sugar can lead to behavior and mood changes. Serving juice with food can help. - Juice leads to problematic weight gain.
A 2022 review of dozens of studies did not link juice consumption with higher weight or “obesity” (Sakaki, 2022). Neither did another large, earlier review (Crowe-White, 2016). (This point is meant to address the fear around juice and weight gain, but we recognize that higher weight is not by default concerning. Children grow in a range of sizes.) - Kids who drink fruit juice have worse nutrition.
In general, kids who drink fruit juice don’t appear to have worse nutrition. Some studies have even shown a link between 100% fruit juice consumption and higher intakes of fiber, vitamin C, magnesium, and potassium (Crowe-White, 2016). However, If appetites are small, filling up on fruit juice can decrease intake, and is something to watch out for. - Juice increases cavity risk.
If sipped throughout the day, cavity risk does increase. Serve juice at meal and snack times to lower this risk.
Particularly for the families you work with, juice has potential benefits.
Juice tastes good.
Probably the main reason children will drink or eat something (in addition to thirst or hunger, which your clients may currently have trouble tuning in to) is taste! Juice tastes good to many children, which allows for pleasurable experiences where there may have been few, if any, before.
Caregivers and children can connect with pleasurable feeding experiences.
A child learning to swallow liquids may enjoy juice from a bottle or straw or open cup while being held lovingly by a parent, which supports relationship and co-regulation.
Juice can provide more sensory input than water or flavored milks.
For children learning to coordinate drinking and swallowing, the sensory input can help.
Juice may be free from negative associations.
Especially if children have vomited (or felt pressure) with milk, formula, or supplement drinks, a drink that doesn’t have negative associations may be more readily accepted.
Juice can bridge to new flavors.
Fruit juice can help introduce new flavors and build familiarity. Juice can be used to mix into other foods or smoothies, or make refreshing frozen popsicles.
Serving juice at home can take away that “forbidden food” effect.
Serving juice at home can take away the “forbidden food” phenomenon where they drink it in an out-of-control way with access (like the six-year-old who snuck into her neighbor’s pantry and drank four juice boxes before she was discovered).
Other thoughts on juice:
- Juices can be fortified – with calcium for example. Though the nutritional benefits may be minimal in some cases (for example, the amount of DHA and protein in fortified juices is small), it may help parents feel better about serving juice.
- In general, juice should not be served before 6 months. Official recommendations on juice from medical and nutrition sources differ.
- For children with low oral intake, or who don’t enjoy other drinks and are working on increasing fiber intake, juice can help with hydration and constipation. Pear or prune juice especially, with guidance from their doctor, can help
Parents don’t need to introduce juice at all, but they also don’t need to fear it.
Our goal, whenever possible with our Nutrition Notes series, is to reduce anxiety, to reassure, and to center the RFT values. One of the five values of RFT is intrinsic motivation – the WHY kids want to eat or drink. And with juice, accessing good taste and pleasure can be major motivations!
🆓 We’ve also made a free Truth About Juice handout you can share with parents or colleagues to help address these concerns.
Check out Virginia Sole-Smith’s webinar, Diet Culture at the Family Table: The Impact of Weight Stigma and What Feeding Professionals Can Do to Help, where she explores these fears around food, fatness, how it impacts your clients, and how you can help.
*Note, juice-specific research cited refers to 100% fruit juice such as apple juice. Fruit squash or fruit-flavored drinks can also prove helpful and need not be feared.
selected references:
- Westwater ML, Fletcher PC, Ziauddeen H. Sugar addiction: the state of the science. Eur J Nutr. 2016 Nov;55(Suppl 2):55-69.
- Harbaugh WT, Mayr UB, Daniel R. Neural Responses to Taxation and Voluntary Giving Reveal Motives for Charitable Donations. 2007;316(5831)1622-1625.
- Wolraich ML, Lindgren SD, Stumbo PJ, Stegink LD, Appelbaum MI, Kiritsy MC. Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. N Engl J Med. 1994 Feb 3;330(5):301-7.
- Sakaki JR, Rodriguez NR, Fernandez ML, Puglisi MJ, Chen MH, Chun OK. Fruit juice and childhood obesity: a review of epidemiologic studies. Crit Rev Food Sci Nutr. 2022 Feb 28:1-15.
- Crowe-White K, O’Neil CE, Parrott JS, Benson-Davies S, Droke E, Gutschall M, Stote KS, Wolfram T, Ziegler P. Impact of 100% Fruit Juice Consumption on Diet and Weight Status of Children: An Evidence-based Review. Crit Rev Food Sci Nutr. 2016;56(5):871-84.
- Rollins B, Savage JS, Fisher J, & Birch L. Alternatives to restrictive feeding practices to promote self-regulation in childhood: A developmental perspective. Pediatric Obesity. 11(5), 326–332.
