Expert Panel: Milk, Water, & Juice Recommendations
Juice recommendations & recommendations for other drinks for children have been updated by a health experts panel. Under the leadership of nutrition research organization Healthy Eating Research, this panel formed to update parents, caregivers and health care providers on what should be provided with drink-wise for a healthy start for children from birth through age five (5) years old. The panel consisted of experts from the Academy of Nutrition and Dietetics, the American Academy of Pediatrics, the American Academy of Pediatric Dentistry and the American Heart Association. They reviewed current domestic and international policy statements and evidence-based recommendations.
Breat Milk, Milk, Water & Juice Recommendations:
Birth to Five Years Old:
0-6 Months Old:
Breast milk or infant formula.
6-12 Months Old:
Breast milk or infant formula
Small amounts of plain drinking water introduced once solid foods become part of diet.
12-24 Months Old:
Plain drinking water.
Maximum 100% juice 4 oz daily.
2-5 Years Old:
Skim or low-fat milk
Plain drinking water. Maximum 100% juice 4 oz daily.
What About Soy Milk?
The panel did not recommend plant-based milk or non-dairy beverages for "exclusive consumption in place of dairy milk," unless there is a medical necessity. Non-dairy milks are missing of important nutrients that are typically obtained from dairy milk.
Fruit or Juice?
Are juice recomendations the same as for fruit? Fresh fruit is always preserved over 100% fruit juice. Furthmore, parents and children need to be educated about the benefits of the fruit as compared with juice. Fruit has natural dietary fiber and less sugar than juice. Juice has lots of sugar which has a tendency to add to excessive weight gain.
Fresh, Canned, or Dried Fruit?
Fruit recommendations are important. While fresh fruit is best, it is not always practical, in that it doesn't work for everyone. Fresh fruit is healthier, but it is more costly than canned or dried fruit. In addition, fresh fruit also takes time to ripen. Another thing to consider is that some young children have food texture issues that makes eating fresh fruit more difficult that eating softened canned fruit. Reality is that fruit in any form is healthier and preferred over drinking juice.
What About Flavored Water and Flavored Drinks?
The panel did not recommend offering young children any caffeinated beverages, beverages with low-calorie sweeteners, sugar-sweetened beverages, toddler milk or flavored milk – such as strawberry or chocolate milk – at any stage during early childhood as part of a healthy diet. Personally, I do make one exception to the recommendation against flavored milk. If your child has food issues, refusing unflavored milk and other dairy (cheese, yogurt), then flavored milk an acceptable alternative, so as to ensure your child has at least three calcium servings daily.
These sweetened drinks are the large daily source of added sugar for most children, resulting in excess calories and weight gain.
Other Times Not to Use Juice
In addition, unpasteurized juice products are not recommended for children as there is an increase of life threatening infections, such as E.coli O157 and O111, Salmonella, Cryptosporidium, norovirus, Vibrio cholerae, Clostridium botulinum, yeast, and hepatitis A.
Children who take specific forms of medication should not be given grapefruit juice, as it could make the medication less effective. There are many medications that can be less effective with grapefruit juice, many are for cardiac conditions. However, a common allergy medicine, Allegra (Fexofenadine) is weakend by grapefruit juice. It's a good practice to ask the prescribing doctor your child's medication could be negatively affected by grapefruit juice.
Tooth decay is common when anything other than water is kept in sippy cups, if they use them throughout the day. Constant exposure to non-water drinks leads to the carbohydrates in them to cause tooth decay, as well. Children should have their teetch brushed twice daily. And especially before bedtime. After brushing their teeth, they should only have water before bedtime to protect their teeth.
Lastly, it important to know that if your child is dehydrated, then juice will make it worse. Rehydration needs to be done without all the sugar in juice. Apple sauce is the only fruit product that is recommended depending on the cause of dehydration.
E-cigarette cancer chemicals have increased in teens. Before we get into the details, let's review the background of E-cigarettes. E-cigs are electronic cigarettes that have liquids that contain many chemicals including nicotine, and fruity and other flavors. They are battery-powered and mimic cigarettes, but don't have the smell of smoke. The liquid changes into a vapor due to the heat in an e-cig. Hence, it’s also called “vaping.”
What is Juuling?
There is a new teen trend called “Juuling.” Juuling is an e-cig that is thin, looks like a flash drive, and charge in a USB port. A juul produces less smoke which disappears more quickly. Hence, teens are able to juul at school and home without parents’ knowledge. In comparison to smoking cigarettes, one juul pod (cartridge) has as much nicotine as a pack of cigarettes.
Caffeine sensitivity - they decrease their caffeine intake.
Higher rates of pneumonia
E-Cigarette Cancer Causing Chemicals
Juul Looks Like a Flashdrive
They’ve been advertised as a safe alternative to cigarettes. They’ve also been advertised as an aid to stopping smoking. Since e-cigs don't burn tobacco, they don't burn the same amounts of tar ans carbon monoxide. However, e-cigarettes are unsafe, contain high levels of nicotine, and do not help in smoking cessation. E-cigs and juuls have many cancer-causing chemicals (acrylonitrile, acrolein, acrylamide, benzene and ethylene and propylene oxide, and crotonaldehyde).
Study Showed E-Cigarette Cancer Chemicals Increased in Teens
In a recent study of 100 teens from the San Francisco Bay area by the University of California-San Francisco study: 67 teens used e-cigs only, 16 used both e-cigs and conventional cigs and 20 didn't smoke or vape at all. Urine and salivary gland fluids tested positive for cancer-causing chemicals in teen smokers. It revealed that teens who used e-cigs and cigarettes had three (3) times higher amounts of these e-cigarette cancer causing chemicals in their body fluids as compared to the teens that used only e-cigs. It revealed that the teens that used e-cigs only had three (3) times higher amounts of these e-cigarette cancer causing chemicals in their body fluids as compared to the teens that didn't smoke at all. Lastly, the study also showed that teens who used fruit-flavored e-cigarettes had significantly elevated levels of acrylonitrile as compared with those who used other flavors, such as menthol.
The American Academy of Pediatrics (AAP) and its Maryland chapter, the Campaign for Tobacco-Free Kids, four other public health groups and five pediatricians filed a lawsuit against the FDA for delaying submission product-review applications for cigars and e-cigarettes until August 2021 and August 2022, respectively. This leaves children at increased risk of cancer and other negative side effects from e-cigs.
Learn & Talk About the Risks of E-Cigarettes with Your Kids
Of those children who committed suicide, 5 – 11 year olds were more likely to have Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD), as revealed in a recent study in Pediatrics revealed that. Teenagers 12 – 14 year olds, were more likely to suffer from depression or dysthymia, and one third (1/3) of children had a mental illness. In order to determine the cause of suicide of children 5 to 14 years old, the study reviewed data from the National Violent Death Reporting System from 2003 to 2012.
Of those children who committed suicide,young school aged children were more likely to have family or friend relationship problems. In contrast, teenagers were more likely to have boyfriends or girlfriend relationship problems. The study also revealed that there was a higher rate of suicides among black youth than young of other races. In addition, 29% of young children and teenagers told someone about their intention to commit suicide before they attempted to do so.
Suicide Warning Signs
Warning signs include, but are not limited to increased seclusion and alone time, increased time spent in their room alone, decreased time spent with friends, decreased time spent in school activities, poor grades or a drop in grades, poor communication, discussion of a desire to commit suicide, increased temper, increased frustration.
National Suicide Prevention Line
An excellent resource is The National Suicide Prevention Line. There are many tools available on their website, suicidepreventionlifeline.org. In addition, their Lifeline is 1-800-273-TALK (8255). Online Chat is also available. If Chat is unavailable, then please call the Lifeline, as help is available 24/7. It is anonymous and confidential.
Positivity during depression can be helpful, so that the child at risk does not feel so helpless and alone. For older children, they can call the hotline. They can text HOME to the Crisis Text Line at 741741. Also, consider having a professional and/or you do affirmation work with your child. Daily affirmations can be one of many tools that help. Lastly, a professional psychologist and/or psychiatrist may be beneficial as well.
It is important to (1) know the warning signs for suicide among young children and teens, (2) be aware that ADD, ADHD and depression place these children at a higher suicide risk, and (3) know where to call for help.
Children develop sleep problems when they use portable media devices, such as tablets or smartphones, before bed. They have more difficulty falling asleep, staying asleep, are more sleepy during the daytime, and are twice more likely to sleep less than children without access to their devices before bedtime. A JAMA Pediatrics review (reut.rs/2fkjL1j) of 20 studies that involved children using these portable media devices. The review excluded their use of PCs and TVs before bed. It included over 125,000 children between the ages of 6 and 19 years old.
Even more interesting, is the fact that sleep problems are also more likely in children who had their portable media device near them at bedtime, even if they didn’t use it before bedtime. If they receive texts or use social media, then they are more likely to check their devices throughout the night. Before you know it, after checking the texts, Facebook, Twitter, Snapchat & other social media, several hours of precious sleep may have been lost.
So many of us are guilty of using out smartphones in the middle of the night. We’ve commonly woken up, after a deep sleep REM cycle, checked our smartphone, and interrupted our sleep. A good amount of sleep for most children is 10 hours per night, for teens it lowers to 9 hours per night. For a child, this has a huge impact on their education the next day as well. If sleep problems exist, learning difficulties are more likely to occur when they are sleepy during the daytime.
Next time you use your smartphone before bed, think about how it could negatively impact your own sleep. Poor sleep is linked to many potential negative health consequences, including dementia.
Please consider protecting your child’s sleep by making sure they don’t use their smartphones or tablets before bedtime, turn them off or remove them from their bedroom at night.
In the July 7, 2014 issue of People magazine, there was an article called, "6-Year-Old Football Players, Too Young to Tackle?" The article discusses the Tri-County Titans, a competitive tackle football team in the Texas Youth Football Association. What makes the Tri-County Titans so unique? They are a team comprised of 6 year olds. They were highlighted on Friday Night Tykes, a TV show on Esquire Network. There's been a lot of controversy regarding these elementary kids playing football. So what's wrong with 6 year olds playing football? Nothing, except, these young kids are playing tackle football. While the article discusses the potentially negative impact of competitive football among elementary school kids, I would like to focus on an important issue, concussions in football and children.
Concussions & Concussion Symptoms
A concussion is a type of traumatic brain injury that typically occurs when there is a sudden movement of the brain due to an injury such as a blow to the head, a jarring of the head, or a fall. Concussion symptoms can be various and linger. Symptoms may include disordered thinking, memory loss, dizziness, headaches, blurred vision, tiredness, nausea, vomiting, difficulty sleeping, and more. There are new guidelines for returning to sports after a concussion. These serve to promote brain healing and prevent additional injury.
Concussions in Children
Concussions and other injuries are more likely to occur with tackle football than flag football. Concussions have a huge impact for children. The reality is that once someone has had a concussion, they are more likely to have additional concussions. Repeated concussions are repeated brain injuries. What does that mean for the brain? It increases the likelihood of chronic lifelong brain damage. What does that mean to our youth? The younger the child has a concussion, the more likely they are to have more concussions in their sports lifetime. The growing brain in the child with repeated concussions is uniquely susceptible to brain damage with prolonged effects, especially if the family and child are planning a life with many years of football or high-impact sports participation.
If your child suffers a sports related injury, make sure to go to his or her doctor. Also, make sure your child receives an extra exam that clears him or her to return to their sport. More importantly,even before a potential injury occurs, make sure you know the facts about concussions. Make sure your children's school and coaches know the facts as well. The CDC has many concussion education resources available, such as "Concussion Fact Sheet for Teachers, Counselors, and School Professionals." They've even created an "Heads Up" app to help parents identify concussion or traumatic brain injury symptoms. For more support and resources about concussions, concussion symptoms, and treatment, please refer to the CDC concussion support website.
It is never easy to see a child who has possibly been sexually abused. It's especially not easy when the family tells you that no one other than family members have every been with, cared for, or babysat the child. As a pediatrician, I have had to see the pain on a mother's face that not only does she need to consider her child may have been abused, but also it may have been by someone close to her, someone she loves. It's heart wrenching for everyone involved. Such was the case today. It moved me to write this, as many people need help or information.
Unfortunately, child abuse is common. The news frequently has reports about sexual and physical abuse. We often don't think someone we love could hurt our children. Unfortunately, they can and they do. The reasons why are complex. The reasons don't really matter. The reality is that families are under a great deal of stress. In addition, children often have special needs. This puts children at an even higher risk of abuse. Counseling may be helpful for some families or children. However, it's important to know the warning signs. Because even if you are not a family with stress, you undoubtedly have people in your life that are dealing with stressful events in their lives. This may impact you if they have access to your children. Protect your children at all costs possible.
What matters is that you prevent it from happening in any way, shape, or form. Although we constantly hear about horrendous child abuse, we don't hear or discuss the just as potentially paralyzing cases of emotional and verbal abuse, or even neglect. Whether it is your child or not, if you see or even think you know of a possible case of child abuse, consider calling in a report. Even if you are not sure, it will not be held against you. Chances are you could save a life. It is anonymous. You will not be tracked in any way. Every state has an emergency abuse hotline. In Florida, it is 1-800-FL-ABUSE. As a pediatrician, I am under a legal and ethical obligation to report any possible child abuse. Yet, if each of us were more involved with what we see around us, we could help protect all of our children.
The U. S. Consumer Product Safety Commission (CPSC) has released a warning regarding magnets and children. Much care should be taken when considering giving children toys that have mini-magnets. If these magnets become dislodged or if children swallow them during play, then injury and death can occur. If two (2) or more of these magnets are swallowed, they may not pass in the stools. They can attach to each other in the gastrointestinal tract. As a result, various injuries can occur, including perforation, twisting, and blockage of the intestines. In addition, the magnets can cause infection, blood poisoning, and death.
The CPSC has stated that it is aware of at least 53 children who have suffered after having ingested magnets: 33 were injured, 19 required surgery, and one died.
So what precautions can you take with your child? Injury prevention is the key. Carefully decide which toys your child can play with & what toys you even allow into your home. Regularly check any toys that have magnets for missing pieces. These magnets can either be a part of toys or they can be the toy itself. A building set of mini-magnets is a perfect example of a toy that although advertised for children, should not be used without strict constant direct one-on-one supervision.
Lastly, if you think you child has swallowed magnets, contact your doctor immediately. Signs and symptoms of a problem can include nausea, vomiting, diarrhea, and/or abdominal pain.
To listen to an audio regarding injury in children who swallowed magnets by accident, please go to http://bit.ly/sLFGxR.