Fruit Juice Update

The American Academy of Pediatrics (AAP) recently updated guidelines for fruit juice consumption:

  • No juice in the first year of life.  If medically necessary, use a cup and not a bottle to limit risk of cavities (bottle rot)
  • For toddlers, 100% juice, max 4 oz, may be offered as a snack or part of a meal
  • 4-6 yrs max 6 oz/d; >7 yrs 8 oz
  • Watch for complaints of abdominal pain, flatulence and bloating, chronic diarrhea
  • Eliminate in children with EITHER excessive or inadequate weight gain

Now, why is this?  Well, nutrition science is complex, so its hard to explain it all here.  Firstly, the sugar load of fruit juice is almost identical to soda and sport drinks–12 coca cola has 140 calories, 40 gm sugar compared to apple juice with 165 calories and 39.8 gm.  Your body sees that as almost the same.  Then there’s fiber–fruit has it, juice does not.  The fiber fills the stomach giving a sense of fullness that juice does not.  Fruit must pass on to the intestine to be broken down allowing for sugar absorption whereas the juice containing sugar rapidly diffuses across the stomach lining into the bloodstream.  So you don’t feel full and keep drinking or eating more.  Juices, therefore, like all sugary drinks, are the emptiest of “empty calories.”

Studies support those conclusions, showing that those who consume fiber tend to compensate by cutting back calorie consumption elsewhere but no such decrease after drinking juice.  One study indicates a 60% greater risk of obesity caused by regular consumption of sugar sweetened beverages; given the similarity of sugar loads stated above its a safe bet that juice can have the same effect.

As stated, the sugar in juice is floating in fluid and is rapidly absorbed whereas in fruit the sugar is encased in fiber cells.  These cells must first be broken down to enable the body to get at the sugar.  This leads to more rapid sugar absorption with juice compared to whole fruit resulting in a stronger and more rapid insulin release from the pancreas.  The effects of that more robust insulin load are profound; in the short term insulin stimulates the appetite and leads to greater calorie consumption and longer term it can promote insulin resistance, excessive insulin production and metabolic syndrome.  Several studies found eating fresh fruit decreases the risk of Type II diabetes while drinking juice INCREASES it.

Additionally, large percentages of fruit juice sugar is in the form of fructose–indeed, many “100% juice” brands actually ADD fructose.  Excessive fructose intake has its own list of potential problems; given the more rapid sugar absorption, consuming it in juice can just multiply those effects.

So the AAP guidelines are a strong step forward in child nutrition.  Drink mostly water or sparkling water–squeeze in some lemon, lime or a bit of cranberry juice for taste.  Then enjoy some fresh fruit.  While you’re at it, make it locally grown from farmers markets–helps the local NJ agriculture industry and our entire state economy.

Thanks for following.


Stealing in younger children

Recently a mother brought concerns of her young school age child repeatedly stealing from family and school.  This is actually not too uncommon–teachers report about 5% of kids <10 years being caught taking from others.  There are lots of reasons for it to occur in otherwise well adjusted young ones–attention (my patient has a new sibling), anger if the offender judges some other who they think is rewarded unjustly or disproportionately, misplaced show of bravery to fit into a peer group, or as a way to impress and perhaps offer a gift to a desired friend.  Take note–it can even occur if your child mimics behavior that they witness in parents who might engage in something that people often view as small and innocuous like helping oneself to office supplies or keeping hotel towels and the like.

How should one react if confronted with an older toddler or young school age child who steals?  First, don’t panic or overreact.  Remember–children at this age have only limited impulse control and are not able to project out consequences too far beyond that moment.  Yelling, lecturing, and especially hitting (as almost always) are more typically counterproductive.  Be sure to discipline in a private one on one setting to avoid humiliating your child.  It is certainly proper to express great disappointment and also to require them to perform household chores as penance.  Explain this by saying that if he wishes to buy or own things of value then he needs to work for it.  Remove privileges like TV or video devices until all work is completed satisfactorily.  It can be good to do this work together and if able to praise his effort and performance since, as stated, sometimes these behaviors are manifestations of feelings of neglect or inadequacy.  Usually it is helpful to make your child return the stolen object and apologize.  This can even apply if objects are taken from stores or businesses however be cautious here as not all establishments will necessarily be forgiving even of these younger kids including with a first offense.

If you are concerned that these behaviors may be repeated try the following: make a written inventory of all of your child’s possessions and review it with her.  Explain that she is not allowed to own anything else beyond that list unless she has asked your permission first.  It will not be an acceptable explanation  that she “found” it or it was “given” to her unless she cleared it with you beforehand.  This can take some of the ambiguity out of these occurrences.

If these behaviors are repetitive, associated with poor or deteriorating school performance, or associated with any violence towards self, others, animals, or property it could indicate a more serious problem and should be brought to my attention. So give me a call.

Send along questions and comments and thanks for following.