Recommended Drinks for Children Age 5 & Younger

By: Natalie D. Muth, MD, MPH, RDN, FAAP

What you offer your child to drink in the first 5 years of life can shape taste preferences for a lifetime. But from plant-based and toddler milks to 100% juice, stevia-sweetened fruit drinks and flavored milk, the options and the marketing can be overwhelming.

Thankfully, the best-choice beverages are really simple: water and plain milk.

Plain water provides the hydration all of us need to live. Milk provides calcium, vitamin D, protein, vitamin A, and zinc―all essential for healthy growth and development.

*Children ages 12-24 months are advised to drink whole milk, and children 2 and older nonfat (skim) or low-fat (1%) milk.

How do young children develop unhealthy beverage preferences?

We know children who drink mostly water and plain milk from a young age tend to continue drinking them as they age. But we also know, bad habits form early. Young children who are introduced to sweet drinks at a young age develop a strong preference for them―making water and plain milk a harder sell. PS: The same goes for food preferences.

When can I give my baby water? How much is ok?

Around 6 months, you can start offering your baby a little bit of water (4-8 oz/day, 0.5-1 cup/day) in an open, sippy, or strawed cup. This helps develop cup drinking skills and familiarity with water. If you live in an area where the water is fluoridated, drinking water will also help prevent future tooth decay. Also see How to Safely Prepare Formula with Water.

Note that the actual water intake is unlikely to replace much breast milk or formula at this point. Remember, the American Academy of Pediatrics (AAP) recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. When you add solid foods to your baby's diet, the AAP supports continued breastfeeding for as long as you and your baby desire, for 2 years or beyond.

At 12 months, you can start giving your baby whole or reduced-fat milk.. For formula-fed babies 12 months and under, see Why Formula Instead of Cow's Milk?.

What about all of the other types of drinks?

While drinking only water and plain milk is the ideal, we know young children may be exposed to any number of other drinks at some point.

Here's why most of these other drinks should be avoided:

• 100% juice. it's very sweet tasting and lacks fiber, an important nutrient found in whole fruit. Once children are exposed to juice, it may be difficult to limit portions or get them to prefer plain water. In some cases where whole fruit is not available, giving your child a small amount of 100% juice (no more than 4 ounces per day in 2-3 year-olds and no more than 4 to 6 ounces in 4-5 year-olds) can provide some nutritional benefit. However, infants less than 1 year of age should not drink juice. Eating fruit is always preferred to drinking juice.

• Flavored milk. Chocolate, strawberry and other flavored milks contain added sugars. Added sugars should be avoided in children less than 2 years of age. Children aged 2-5 also should avoid flavored milk to minimize added sugars intake and avoid developing a preference for sweet tastes. An early preference for flavored milk may make it more difficult to get them to accept regular milk.

• Plant-based "milk." For some children, a dairy allergy or milk intolerance may make it difficult to drink cow's milk. But keep in mind, most plant-based milks are not nutritionally-equivalent to cow's milk and may be lacking in important nutrients such as protein, vitamin D and calcium. Other than soy milk, plant-based milks are not recommended for children to drink in place of dairy milk. Soy milk is nutritionally equivalent to cow's milk and is an acceptable alternative.

• Stevia- or artificially-sweetened drinks. The health risks of stevia or artificial sweeteners to children are not well understood. For this reason, it is best to avoid sweetened drinks, even if they are calorie-free. When children have a strong preference for sweet drinks, it can lead them to dislike or refuse plain water.

• Toddler milk. Toddler milks, often marketed by formula companies as "next stage" or "transitional" to wean from breast milk or formula, are unnecessary. For most children, they provide no nutritional advantage over a well-balanced diet that includes breast milk and/or cow milk. They're also more expensive and contain added sugars, which can fill up a baby's stomach so they are not hungry for healthier foods.

• Sugary drinks. Sugary drinks like sodas, sports drinks, fruit drinks, lemonade, sweetened water, and other drinks containing added sugars are harmful to a child's health. They increase the risk of excess weight gain, dental cavities, heart disease, diabetes and fatty liver disease.

• Caffeinated drinks. Caffeine in young children increases the risk of poor sleep, irritability, nervousness, headaches, and difficulty concentrating. All caffeine-containing beverages are best avoided.

Editor's note: These early beverage recommendations are drawn from a report published by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, and supported by the American Academy of Pediatrics along with the American Heart Association, the Academy of Nutrition and Dietetics, and the American Academy of Pediatric Dentistry.

More information

• Choose Water for Healthy Hydration

• Fruit Juice and Your Child's Diet

• How to Reduce Added Sugar in Your Child's Diet

• Beyond Chicken Nuggets: Protein-Rich Alternatives for Picky Eaters

• Sports Nutrition for Busy Families and Busy Lifestyles
  
  

About Dr. Muth

Natalie D. Muth, MD, MPH, RDN, FAAP, is a pediatrician and registered dietitian who practices general pediatrics and is the director of the W.E.L.L. healthy living clinic at Children's Primary Care Medical Group in Carlsbad, CA. She is author of the Family Fit Plan and co-author of Picky Eater Project, both published by the American Academy of Pediatrics (AAP). Dr. Muth is also a current executive committee member of the AAP Section on Obesity and lead author of the joint AAP/AHA statement on public policies to reduce sugary drinks consumption in children and adolescents. She is also the AAP representative to the expert panel that developed the above beverage recommendations for children ages 0-5. Follow Dr. Muth at @drnataliemuth, @howtoraisehealthyeaters, and visit her website drnataliemuth.com.