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When Can I Start Giving Water And Juice?

Thank you T.T. from Utah for your recent question about what age to introduce water and juice into a child’s diet.

When to introduce supplemental water and juice is a very common question.

The short answer is: 6 months.

Here is the reasoning. In the very early stages (first few months) of life, an infant’s kidneys are immature and don’t concentrate urine well. If you give a child a lot of extra water (many ounces) they can have something called “water intoxication.” The kidneys don’t function well enough to maintain an infant’s electrolyte balance where they should. I took care of an infant once who had seizures and brain swelling from water intoxication, the baby’s sodium was super low (mom was diluting the formula to make it last longer). Needless to say, you have to be very careful not to introduce water too early. Once a child is over 6 months it is a good idea to introduce a few sips a day (usually with solids) and get a child used to the “taste” of water. Most of the infant’s liquid source should be coming from breast milk or formula.

As for juice, infants don’t need it. The American Academy of Pediatrics recommends no more than 4 oz. a day if you do give it. Juice has a lot of empty calories and doesn’t have a lot of nutritional value (aside from vitamin C). Yes, this holds true even if it’s 100% natural juice. Given frequently, juice can cause cavities (it’s liquid sugar on teeth). It can also lead to poor nutrition (if an infant gets filled on juice and won’t eat other foods). Also, juice can cause bloating, gas, and diarrhea. This side effect, diarrhea, is about the only reason I recommend juice. It is a great natural laxative. So for the constipated infant, I often recommend ½ oz to 1 oz of juice (no more than 2 oz) to promote poop. (As an aside, prune juice works best. Pear juice and apple juice are options too).

STOP giving juice

The juice manufacturers are good. They have effectively marketed the idea to parents that kids need juice. The fact is: Kids DO NOT NEED juice.

Juice is empty calories. It doesn’t matter if it is 100% fruit juice (parent’s favorite rebuttal to me), it is still just fruit sugar. Kids do not need the extra sugar. They should drink milk or water. The official recommendation from The American Academy of Pediatrics is that a child should limit juice consumption to no more than 4 ounces a day (i.e., half-a-cup at the most).

The most common reason I recommend juice is as a natural laxative for children who are constipated. The fruit sugar causes an osmotic load to the digestive system. This means that the fluid shifts into the bowel, helping a kid have a bowel movement. The other reason I recommend juice is if a child will not drink milk and I need to increase his or her calcium. In that case I will recommend a calcium-fortified orange juice.