What should children drink? Breast milk, formula, water and plain milk – not plant-based options, say experts

19 Sep 2019 --- Breast milk, infant formula, water and plain milk are part of a new set of comprehensive beverage recommendations for children, outlined by age (birth through age five). Indicated by prominent medical and nutrition organizations, the guidelines also note that sweetened beverages, including plant-based milks, are not recommended. The experts highlight that healthy beverage choices in childhood are just as important as food and the guide aims to offer policymakers and the beverage industry a clear set of objective, science-based recommendations for healthy drink consumption.

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).

A snapshot of the guidelines. “Early childhood is an important time to start shaping nutrition habits and promoting healthy beverage consumption,” says Megan Lott, Deputy Director of Healthy Eating Research, which convened the expert panel. She explains that the recommendations call for the combined cooperation of caregivers, education providers, policymakers and beverage industry representatives. “We can use this opportunity to work together and improve the health and well-being of infants and young children throughout the US.”

Overall, they caution against beverages that are sources of added sugars in young children’s diets, including flavored milks and sugar- and low-calorie sweetened beverages. These come in addition to a wide variety of beverages that are on the market targeted to children such as toddler formulas, caffeinated beverages and plant-based/non-dairy milks such as almond, rice and oat, which provide “no unique nutritional value.”

Breaking down the guidelines, the highlights include:

• From birth to six months, babies need only breast milk or infant formula. 
• From six to 12 months, parents should offer a small amount of drinking water once solid foods are introduced to help babies get familiar with the taste. Children younger than twelve months should avoid juice, even 100 percent fruit juice.
• From 12 to 24 months, parents should add whole milk, along with plain water. Unsweetened and fortified soy milk is an option for children who are allergic to dairy milk, are lactose intolerant or whose families abstain from animal products. A little 100 percent fruit juice is OK, but small pieces of real fruit are healthier.
• From ages two to five, milk and water are the preferred beverages. Flavored milks, toddler formulas, low-calorie and sugar-sweetened beverages, and milks made from almonds, rice or oats should be avoided.

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 the Academy, AAP, AHA, 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.

Where does plant-based stand?
“For the average child who isn’t intolerant to cow’s milk and doesn’t have an allergy, we came to the conclusion that cow’s milk really is the best choice,” Dr. Stephen Daniels, Chairman of the Department of Pediatrics at the University of Colorado School of Medicine says. For families that take a vegan approach, some plant-based milks ‘are maybe a reasonable choice,’ but parents have to be ‘very careful,’” he said.

Daniels made the remarks about the guidelines at a panel convened by the nutrition research organization Healthy Eating Research, a Robert Wood Johnson Foundation program.Overall, the guidelines caution against beverages that are sources of added sugars in young children’s diets. 

Plant-based milks may look and taste like dairy milk, but their nutritional value varies from product to product – and they just aren’t the same as cow’s milk, he says. Also, “many of those plant-based milks – they’re sweetened. So, they have extra sugars and extra calories, which kids do not need.”

Marie-Pierre St-Onge, an Associate Professor of Nutritional Medicine at Columbia Medical Center in New York, represented the AHA on the panel. She explained such milks are typically lower in protein and calcium, so they just aren’t as nutritious for growing children.

“Having relatively straightforward recommendations endorsed by so many organizations should make life easier for parents,” Daniels says.

“It’s really the basics that are the key here. Children from birth to five years don’t need anything in their beverages.”

In the infant formula and snacking space, experts similarly highlight the prominence of ingredients in the market that offer natural and clean profiles. 

By Laxmi Haigh