Leading Health Organizations Support First-Ever Consensus Recommendations to Encourage Young Children’s Consumption of Healthy Drinks

Leading medical and nutrition organizations recommend breast milk, infant formula, water, and plain milk as part of a new set of comprehensive beverage recommendations for children, outlined by age (birth through age 5). They caution against beverages that are sources of added sugars in young children’s diets, including flavored milks (e.g., chocolate, strawberry) and sugar- and low-calorie sweetened beverages, in addition to a wide variety of beverages that are on the market and targeted to children such as toddler formulas, caffeinated beverages, and plant-based/non-dairy milks* (e.g., almond, rice, oat), which provide no unique nutritional value.

“Early childhood is an important time to start shaping nutrition habits and promoting healthy beverage consumption,” said Megan Lott, MPH, RD, Deputy Director of Healthy Eating Research, which convened the expert panel. “By providing caregivers, health care and early care and education providers, policymakers, and beverage industry representatives a clear set of objective, science-based recommendations for healthy drink consumption, we can use this opportunity to work together and improve the health and well-being of infants and young children throughout the United States.”

The recommendations were developed as part of an unprecedented collaboration by experts at the Academy of Nutrition and Dietetics (the Academy), American Academy of Pediatric Dentistry (AAPD), American Academy of Pediatrics (AAP), and the American Heart Association (AHA) under the leadership of Healthy Eating Research (HER), a leading nutrition research organization, and with funding from the Robert Wood Johnson Foundation (RWJF).

“From the time children are born through those first few years, beverages are a significant source of calories and nutrients and can have a big impact on health long into the future,” said Richard Besser, MD, President and CEO of the Robert Wood Johnson Foundation. “Families deserve clear and consistent guidance on what their young children should drink and what they should avoid. These recommendations from our country’s leading medical and nutrition organizations will help families raise healthy children.”

Healthy Beverage Recommendations: A Snapshot

The recommendations outlined below by age are intended for healthy children in the United States and do not address medical situations in which specific nutrition guidance is needed to manage a health condition or specific dietary choices such as abstaining from animal products. (See infographic on the right column.)

Research shows that what children drink from birth through age 5 has a big impact on their health – both now and for years to come. While every child is different, the nation’s leading health organizations agree that for most kids, the following recommendations can help to set children on a path for healthy growth and development. As always, consult with your health care provider about your child’s individual needs.

  • All children 5 and under should avoid drinking flavored milks, toddler formulas, plant-based/non-dairy milks*, caffeinated beverages and sugar- and low-calorie sweetened beverages, as these beverages can be big sources of added sugars in young children’s diets and provide no unique nutritional value.
  • 0-6 months: Babies need only breast milk or infant formula to get enough fluids and proper nutrition.
  • 6-12 months: In addition to breast milk or infant formula, offer a small amount of drinking water once solid foods are introduced to help babies get familiar with the taste – just a few sips at mealtimes is all it takes. It’s best for children under 1 not to drink juice. Even 100% fruit juice offers no nutritional benefits over whole fruit.
  • 12-24 months: It’s time to add whole milk, which has many essential nutrients, along with plain drinking water for hydration. A small amount of juice is ok, but make sure it’s 100% fruit juice to avoid added sugar. Better yet, serve small pieces of real fruit, which is even healthier.
  • 2-5 years: Milk and water are the go-to beverages. Look for milks with less fat than whole milk, like skim (non-fat) or low-fat (1%). If you choose to serve 100% fruit juice, stick to a small amount, and remember adding water can make a little go a long way!

“As a pediatrician, I know what a child drinks can be almost as important as what they eat, in terms of a healthy diet. This is especially true for very young children,” said Natalie Muth, MD, who represented the American Academy of Pediatrics on the expert panel. “We know that children learn what flavors they prefer at a very early age—as young as 9 months—and these preferences can last through childhood and adulthood. That’s why it’s important to set them on a healthy course, and this guide will help parents and caregivers do that.”

“Nearly 40,000 people in the U.S. die each year from heart problems due to overconsumption of sugary drinks. This is unhealthy and unacceptable, and the seismic shift in our culture needed to change this status quo must start with our kids,” said Nancy Brown, CEO of the American Heart Association. “The American Heart Association is proud to endorse these guidelines and stand with parents, caregivers, medical professionals, restaurant owners and policymakers who can help ensure a healthier future for our kids.”

To develop the evidence-based recommendations, HER conducted an extensive review of scientific literature, existing guidelines from national and international bodies, and reports on early childhood beverage consumption. It also convened an expert panel of representatives from AAP, AHA, the Academy, and AAPD and a scientific advisory committee whose members discussed and reviewed the preliminary and final recommendations. Panelists and committee members were experts in pediatrics, early childhood nutrition, dentistry, and dietary and nutrition guidance.

“Choosing healthful beverages for children is just as important as choosing healthful foods,” said registered dietitian nutritionist Terri J. Raymond, president of the Academy of Nutrition and Dietetics. “These consensus recommendations provide a strong base for registered dietitian nutritionists and health care practitioners to help educate children and parents alike, and create examples of healthy dietary patterns for children ages 0 to 5 in order to support optimal physical and cognitive growth and development as well as overall health.”

“Choosing drinks wisely for your child is crucial to good oral health; that’s why we talk about it during the age-one dental visit,” said AAPD president Dr. Kevin Donly. “A child with a healthy smile can eat, speak, play, and learn more easily than a child suffering from tooth decay.”

The full guidelines and accompanying technical report can be found at http://www.healthydrinkshealthykids.org. This site also contains a set of parent-focused one-minute videos, in English and Spanish, covering all the different topics included in the guidelines such as tips for swapping out sugary drinks and understanding different types of milk.

Source: American Heart Association

Pureed Peanuts Advised for Infants to Stave Off Allergy

Saumya Joseph wrote . . . . . . . . .

Feeding pureed peanut products regularly to babies before their first birthday could reduce their risk of developing peanut allergies later on, doctors advise.

In a practice guide for health care providers published in CMAJ, a team of pediatricians and allergy specialists encourage introducing peanuts in pureed or powdered form as early as age 4 months for most babies, and making sure the babies continue to get exposure to “substantial” amounts of peanut products in their first years of life.

However, the allergy status of the baby should be checked with a doctor in advance, said one of the guide’s authors, Dr. George du Toit of King’s College London in the UK.

He added that at-home introduction of peanut products is best suited for infants who do not have eczema, or have only a mild form of the skin disorder.

The hardest part of implementing the current guidelines regarding peanut exposure for babies is that they “are a complete reversal from the prior practice of delaying peanut exposure,” said Dr. Ruchi Gupta of the Northwestern University Feinberg School of Medicine in Chicago, a pediatrician and food allergy researcher who wasn’t involved in the practice guide.

“There’s also resistance from parents because they’re fearful about doing this at home with their infants and what may happen,” she told Reuters Health in a phone interview.

Peanut allergies typically develop before age 2. These allergies are a constant worry for parents, who need to closely monitor everything their kids eat inside and outside the home.

Allergic reactions to peanuts can include skin rashes and blisters, difficulty breathing, low blood pressure, nausea and vomiting, and swelling of the tongue, eyes or face. In severe cases, a peanut reaction can be fatal unless halted with an injection of epinephrine.

As a result, doctors previously advised parents to avoid giving peanut products to babies. But a 2015 study prompted a rethink of the guidelines.

The trial included 640 babies younger than 11 months with either egg allergy or eczema – both risk factors for developing peanut allergy. But researchers found that when these high-risk infants were fed a small amount of peanut butter 3 times a week, only 3% went on to develop peanut allergy after 5 years, while 17% of children who avoided peanuts during infancy became allergic.

In the practice guide, a team of pediatricians and allergy specialists recommends introducing peanut protein to babies aged between 4 and 6 months in the form of paste, butter or powdered puff as one of the first foods during the process of weaning off breast milk.

“A lot of people assume that this just means feed it to (babies) once but it is really important that you feed repeatedly and over a longer period of time so that the immune system actually learns to tolerate it,” said Gupta’s colleague Christopher Warren, also of the Feinberg School of Medicine, who joined her on the phone interview.

Guidelines from the U.S. National Institute of Allergy and Infectious Diseases recommend checking the allergy status of high-risk infants through the skin-prick method or specific immunoglobulin E (IgE) testing before introducing peanuts. The allergy societies of Canada, Australia and the UK don’t mandate this test, the authors write.

The method of early introduction has also been tested with other major allergenic foods such as milk, egg, sesame, fish and wheat, but the protective effect of early introduction of these foods in a child’s diet was most pronounced in the case of peanuts and eggs, experts noted.

Parents should look out for signs of vomiting, choking, rashes, swelling of the lips or an extreme dislike for the food, which could signal the onset of an allergic reaction. But very few infants develop the more severe symptoms such as breathing difficulty or low blood pressure, Gupta said, and doctors are likely to recommend consulting with an allergy specialist to see if the baby could try peanuts again under medical supervision.

Source: Reuters

When is the Right Time to Start Infants on Solid Foods?

The first study of a nationally-representative group of U.S. infants reports that more than half of babies are currently introduced to complementary foods, that is, foods or drinks other than breast milk or formula, sooner than they should be. Babies who were never breastfed or breastfed for less than four months were most likely to be introduced to foods too early. These findings are reported in the Journal of the Academy of Nutrition and Dietetics and emphasize the need to introduce foods at the proper time to get the most benefit from breast milk or formula.

“Introducing babies to complementary foods too early can cause them to miss out on important nutrients that come from breast milk and infant formula. Conversely, introducing them to complementary foods too late has been associated with micronutrient deficiencies, allergies, and poorer diets later in life,” explained lead investigator Chloe M. Barrera, MPH, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.

Current recommendations stipulate that infants should be introduced to complementary foods at around six months of age. Analyzing data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES), investigators assessed the food intake of 1482 children aged six to 36 months, gathered during household interviews with the child’s proxy, typically a parent. The survey asked how old infants were when they were first fed anything other than breast milk or formula. This includes juice, cow’s milk, sugar water, baby food, or anything else that the infant might have been given, even water.

This analysis shows that only one-third (32.5%) of babies in the U.S. were introduced to complementary foods at the recommended time of about six months; 16.3% were introduced to complementary foods before four months, 38.3% at four-five months, and 12.9% at seven or more months of age. These data help understand the current state of infant feeding practices in the U.S.

Over the last 60 years, recommendations for when to introduce complementary foods have changed dramatically. The 1958 guidelines suggested solid foods in the third month, the 1970s brought a delay until after four months, and the 1990s pushed the introduction of solid food out to six months. These changing recommendations have influenced many past studies of infant nutrition, most of which show a general lack of adherence to current professional guidelines, whatever they may be. The U.S. Department of Agriculture (USDA) and Department of Health and Human Services (HHS) are currently developing the first federal dietary guidelines for children under two years, to be released in 2020.

“Efforts to support caregivers, families, and healthcare providers may be needed to ensure that U.S. children are achieving recommendations on the timing of food introduction,” commented Chloe Barrera and her co-investigators from CDC. “Inclusion of children under two in the 2020-2025 Dietary Guidelines for Americans may promote consistent messaging of when children should be introduced to complementary foods.”

Source: Science Daily

Parents Should be Cautious When Feeding Plant-based Beverages to Young Kids

Public health dietitians are concerned about a rise in parents feeding plant-based beverages (e.g. rice, coconut, almond, hemp, potato) to their infants and young children. Following reports of infants and young children becoming malnourished and one death after being fed plant-based drinks as a main beverage, Dietitians of Canada is joining with the Canadian Paediatric Society to urge parents to select beverages carefully for their children.

“The challenge for parents is conflicting messages. They read that these drinks are considered ‘healthier’ on social media or hear misinformation about cow milk or fortified soy beverage,” says Becky Blair, public health dietitian and spokesperson for Dietitians of Canada. “The reason children can become malnourished is that these beverages contain very little protein and are very low in fat and calories.”

Current recommendations for children two to eight years who are not breastfed are to give 2 cups of cow milk or fortified soy beverage each day to support protein, calcium and vitamin D requirements. In Canada, full fat homogenized (3.25% M.F.) cow milk is recommended until age two.

“What parents often don’t realize is that some plant-based beverages are not fortified with any minerals or vitamins; these drinks are low in all nutrients except carbohydrates, in fact sugar is often the second ingredient after water,” says Catherine Pound, paediatrician and spokesperson for the Canadian Paediatric Society. “In the case of allergies, or other concerns, I recommend parents speak with a dietitian to ensure all nutrient needs, including protein, fat and calories are being met with an age-appropriate diet.”

Fast Facts:

1. Breastfeeding – exclusively for the first six months, and continued for up to two years or longer with appropriate complementary feeding – is important for the nutrition, immunologic protection, growth, and development of infants and toddlers.

  • Soy, rice, or other plant-based beverages, whether or not they are fortified, are inappropriate alternatives to cow milk in the first two years.
  • For infants who cannot or should not be fed their mother’s breastmilk, pasteurized human milk from appropriately screened donors and commercial infant formula are suitable alternatives.
  • Commercial infant formula may be the most feasible alternative if it is not possible for an infant to be exclusively fed their mother’s breastmilk.
  • Cow milk is not recommended before nine to 12 months of age.

2.Young children (aged two to eight years) require 13 to 19 grams of protein per day.

  • Two cups of cow milk (16 grams of protein) or two cups of fortified soy beverage (13 grams of protein) pretty well meet their protein needs.
  • Almond, coconut or rice drinks contain little to no protein. To meet their protein needs, children consuming these beverages would need to eat two child-sized servings of meat (30-45 grams) or two servings of lentils (one half cup each).
  • Almond drinks only contain about 4 almonds per cup.

3. Drinking too much low-nutrient beverage, other than water, can displace hunger and cause children to eat less food.

4. Other than soy-fortified beverages, plant-based drinks, whether available in the dairy section of the store refrigerator or in shelf-stable containers, are not appropriate choices for young children as their main beverage since they are not nutritionally adequate if the child has only small servings of high protein foods.

5.Parents wishing to feed their infants and children plant-based beverages as a main beverage should speak with a dietitian to ensure nutrient needs including protein and fat are being met with an age-appropriate diet.

Source: Dietitians of Canada

Infants Should Share Parents’ Room, but not Bed to Help Prevent SIDS

Infants should sleep in the same room as their parents — but not in the same bed — to reduce the risk of sudden infant death syndrome (SIDS), new guidelines from the American Academy of Pediatrics advise.

The recommendations call for babies to share their parents’ bedroom for at least the first 6 months of life and, ideally, for the first year.

This could reduce the risk of sudden death by as much as 50 percent, the guideline authors say.

“Room sharing makes a lot of sense,” said Dr. Paul Jarris, deputy medical officer at the March of Dimes.

The rationale is that having the infant within view and reach makes for easier monitoring, comforting and feeding. Because the baby is nearby, parents might notice any potential difficulty, Jarris said.

“If we look at how strong the evidence is, parents will be well advised to adopt room sharing,” Jarris said.

It’s important, however, that infants have their own separate sleep surface, such as a crib or bassinet. They should never sleep on a soft surface like a couch or armchair, the doctors’ group warns.

Nor should babies sleep in the same bed as their mothers, the guidelines say. But, since infants do feed throughout the night, the doctors recommend that mothers feed the baby in bed.

“Babies should be brought to bed for feeding, but following feeding they should be returned to a separate sleep surface,” said report co-author Dr. Lori Feldman-Winter, a professor of pediatrics at Cooper Medical School in Camden, N.J.

“Breast-feeding can reduce SIDS by as much as 70 percent,” added Feldman-Winter.

Because moms may sometimes fall asleep during feeding, the AAP recommends keeping the parents’ bed free of pillows, loose sheets, blankets and other soft bedding that could suffocate the baby, she said.

Each year in the United States, some 3,500 babies die from sleep-related deaths, including SIDS. The number of infant deaths dropped in the 1990s after a national safe-sleep campaign that emphasized placing infants on their back. However, momentum has stalled in recent years, Feldman-Winter said.

Besides room sharing and breast-feeding, the academy’s recommendations to create a safe sleep environment also include the following:

  • Put the baby on his or her back on a firm surface, such as a crib or bassinet, with a tight-fitting sheet.
  • Keep soft bedding, including crib bumpers, blankets, pillows and soft toys, out of the crib. The crib should be bare.
  • Avoid exposing the baby to smoke, alcohol and illicit drugs.
  • Never use home monitors or other devices, such as wedges or positioners, to reduce the risk of SIDS.

Although SIDS risk is greatest from 1 to 4 months of age, evidence shows that soft bedding is still a hazard for older babies.

One pediatric specialist thinks room sharing might be difficult for some parents to accept.

“Room sharing is probably the most controversial recommendation,” said Dr. David Mendez, a neonatologist at Nicklaus Children’s Hospital in Miami.

Parents have strong feelings one way or the other, Mendez said. “Some parents want the baby in the bed right next to them; some parents want the baby to have its own room,” he said.

Mendez said he’s more concerned with other risk factors for SIDS, such as smoking and excess bedding.

“I would rather have the parents put the baby in a separate room if they’re smokers than room share,” he said.

“Having the baby on a firm surface on his back and keeping soft pillows and loose bedding that the baby can get tangled up in out of the bed or crib — those things probably play a much bigger role in preventing SIDS than being in the same room with the baby,” Mendez added.

The new recommendations, published online in the journal Pediatrics, were to be presented Monday at the academy’s annual meeting, in San Francisco.

Source: U.S. Department of Health and Human Services