Beverage Guidelines Help Parents Steer Kids Toward Healthier Drinks

Beverages account for a sizable portion of calories ingested by children and adolescents, often without much, if any, benefit in the form of vitamins, minerals, fiber, or protein. With so many new and tempting beverage choices available, from “healthy sodas” to energy drinks, what’s a parent to do?  

“Confusion is rampant among parents,” said Megan Lott, MPH, RDN, and deputy director of Healthy Eating Research, where she recently led a project to create healthy beverage recommendations for children 5-18.  

Healthy Eating Research (HER), funded by the Robert Wood Johnson Foundation since 2005 and based at the Duke Global Health Institute, seeks to advance and disseminate research on policy, systems, and environmental strategies that promote healthy eating and improve nutrition and health equity among children and families. 

New Guidelines Clear the Confusion 

Lott convened experts and representatives from the Academy of Nutrition and Dietetics (AND), the American Academy of Pediatric Dentistry (AAPD), the American Academy of Pediatrics (AAP), and the American Heart Association (AHA) to conduct a deep dive into recent research and come up with evidence-based recommendations that all the groups could agree on. “We hope consistent guidelines will provide clearer messaging to families,” Lott said.  

According to the new guidelines, plain water and pasteurized milk are best for children and adolescents. And certain beverages should be avoided altogether -- those with added sugar, artificial sweeteners, and caffeine.  

If that sounds unrealistic in the real world, Lott can relate. She is the mother of 11-year-old twins and an eight-year-old. “These recommendations are the gold standard,” she said. “It doesn’t have to be 100% at once. Every step in that direction will have a positive health impact.” 

Caffeine Harms Developing Brains 

Lott said the expert panel uncovered multiple recent research studies highlighting the negative impacts of even small amounts of caffeine on sleep, anxiety, depression, and blood pressure in young people. For that reason, the guidelines suggest that people 18 or younger should not consume any caffeinated beverages. 

Lott said the trend among middle and high schoolers of hanging out at coffee shops may make this recommendation challenging for families, but that the research in this area was particularly consistent and compelling. 

“Adolescents have rapidly developing brains,” she said. “Even though they might be adult-sized, they are in a different developmental stage and caffeine’s impact on their brains is different.” 

Avoid Sweetened Drinks, Including Sports Drinks 

Not surprisingly, the guidelines suggest parents avoid giving children beverages with added sugar. “Sugar-sweetened beverages are the highest source of added sugars for children ages 2-19,” said Mary Story, PhD, RD, a professor in the Department of Pediatrics and the Department of Family Medicine and Community Health at Duke and director of HER “and added sugars are associated with diabetes and cardiovascular disease.” 

This category includes soda, fruit-flavored drinks, and sports drinks.  

“There is a caveat,” Lott said. “Sports drinks are appropriate for athletes participating in prolonged physical activity in high temperatures and humidity. Football players having two-a -day practices in August probably do need sports drinks because they are losing electrolytes. My eight-year-old playing a one-hour soccer game in those same conditions just needs water.” 

The guidelines also recommend that children avoid beverages with artificial sweeteners, because there isn’t enough data on their safety in children. 

Lott pointed out that many drinks sweetened with sugar or artificial sweeteners also contain other additives, from food coloring to caffeine to probiotics. “When you start to layer all these additives and supplements, you just don’t know how they are affecting rapidly developing bodies and minds,” she said. 

What about Juice and Everything Else? 

The panel’s recommendations include a category of drinks to limit rather than avoid: 100% juice, flavored milk, and plant-based milk alternatives. 

Juice, which contains vitamins and minerals, can be part of a healthy diet. But it is typically fiber-free and high in calories. “We know kids and teens are not getting enough fiber,” Lott said, “so encouraging them to eat whole fruits and vegetables is the goal.” The guidelines suggest that children and teenagers drink no more than one 4- to 8-ounce serving of 100% juice a day, depending on age.  

Chocolate milk and other flavored milks can contain as much added sugar as a soda and should be occasional treats rather than daily fair. Still, if you’re in a restaurant and your child wants something special to drink, Lott said flavored milk is better than soda because it provides protein, vitamins, and minerals. 

Plant-based milk alternatives may play a role for children with a dairy intolerance or food allergies, but they don’t offer the same nutrients as cow’s milk and many contain added sugar or additives whose effect on children isn’t well known. 

How Much Water and What Kind of Milk? 

Water gets a star-shaped “Best Option” tag on the panel’s recommendations for good reason. The human body needs water every day to survive. Tap water is safe, calorie-free, and inexpensive. (Flavored carbonated water, on the other hand, did not get a nod from the panel because its acidity can damage tooth enamel if consumed regularly.) 

The guidelines include recommendations for the amount of water and milk that children and teenagers need each day, with ranges for different ages. “For children who don’t like milk,” Lott said, “daily hydration needs can be achieved through drinking more water, while other nutrients provided from the dairy group can be gotten instead from products like cheese and yogurt.” 

Traditional guidelines suggest that children switch from full-fat milk to skim or low-fat milk at age two. New research hints that the saturated fat in milk might not be as bad for cardiovascular health as other types of saturated fat, but the scientific jury is still out, so the panel decided against changing the current recommendation. Lott said she is curious to see results of studies currently underway, adding that the guidelines could change in coming years. 

Recommendations Based on Evidence and Lots of It 

For this project, which grew out of a similar HER project for children ages 0-5, Lott and the panel of experts worked with a consultant and Duke librarians to gather scientific research from the last five to 10 years, totaling more than 15,000 articles.  

Subcommittees focused on different categories of beverages, such as caffeinated or sugar-sweetened, reviewing the relevant literature and proposing recommendations for the larger group, which then came to consensus on the final guidelines.  

The guidelines have been shared with parents and health care providers and media outlets, including NPR and the Washington Post. And all four of the national organizations involved in developing the guidelines (AND, AAPD, AAP, and AHA) are providing the guidelines to their members to use in clinical practice. There are also plans in the works to develop continuing medical education modules and to encourage state policymakers to include the guidelines in relevant legislation.  

“We didn’t develop the recommendations just to sit on the shelf,” Story said. “We are providing tools for parents, health care providers, and policymakers.” 

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Mary-Russell Roberson is a freelance writer living in Durham.