Introducing Juice

Dear Lisa,

I have a six month daughter who is on formula and I'm wondering when is it safe to allow her to start drinking water alone and juices?

“Is it time for Juice?”

Dear "Is it time for juice?”,

At 6 months old it is okay to introduce juice to babies. Whenever you introduce a new food or drink to a child for the first time, you should wait three to five days from the introduction of the last new food and wait another 3 to 5 days before adding the next new item. During this time you should observe your infant for signs of a sensitivity or allergic reaction. If you introduce items too quickly or more than one item at a time, and your child has a reaction, you will not know what food or drink caused the reaction.

It is a good idea to start with ½ strength juice. You can add 1 ounce of water per 1 ounce of juice to make ½ strength juice. For a 4 ounce bottle, add 2 ounces of water to 2 ounces of juice. Some babies develop diarrhea or a diaper rash when they are given full strength juice, therefore, diluting the juice may prevent this from happening. If your baby does not have a reaction then you can gradually increase to full strength juice as your baby tolerates it.

Giving a baby juice is not meant to replace formula. By the time a baby is 6 months old, she should be taking 28 to 32 ounces of formula per day. If your baby is taking this amount of formula and has been gaining weight appropriately it is okay to give 4 ounces of half strength juice per day. You can start giving your baby juice when you introduce the cup. The sweet flavor of the juice will be an incentive for a baby to try drinking from a cup.

Developmentally a baby is ready to start using a cup at 6 months of age. A cup with a spout and handles will be easier for your baby to hold. The process of using a cup teaches coordination and strengthens the muscles in the mouth which are necessary for future speech development. This is achieved when a baby brings a cup to her mouth, pours the free flowing fluid, controls the flow of liquid with her mouth and swallows it. It is not recommended to use a spill proof cup or “sippy” cup when teaching a baby how to drink from a cup. A “sippy” cup requires that the baby sucks on the cup the same way that she sucks on a bottle. This does not exercise the muscles in the mouth that promote speech development.

When choosing a juice, stay away from juices with more than one ingredient, because you will not know which ingredient she is sensitive to if she has a reaction. Also juices with strawberries should not be introduced until 12 months of age, because strawberries tend to be an allergic item. White grape juice, apple juice and pear juice are good choices. The added benefit of choosing these light colored juices is that they won’t stain when your child makes a mess. Don’t be surprised if your baby cannot drink from the cup right away. It usually takes most babies weeks of practice to learn how to drink from a cup and in the beginning many babies just play with the cup.

I prefer that babies do not drink juice from a bottle because this may encourage the development of dental carries. Dental carries and “bottle mouth” occurs if a baby sucks on the bottle for a length of time, goes to sleep with a bottle or keeps the bottle in the mouth for comfort. Each of these scenarios causes the teeth to be exposed to the juice for a long period of time which can lead to cavities. (1) In addition the ingestion of excessive amounts of juice and sweetened drinks have been linked to obesity. Therefore 4 ounces of juice per day is sufficient.

Usually it is not recommended to give a baby water. Nutritionally, an infant needs the calories from formula or breast milk for proper growth and development. Water does not provide any calories or nutrition. If you feed a baby water she may take less formula and not receive the nutrition that she needs.

There are some instances when water is indicated. An infant needs water if she is exposed to extreme heat as in the case of a baby who is outside in the sun or at the beach. In this case 1 to 2 ounces of water should be given in between feedings in order to prevent infants from becoming overheated or dehydrated. Water is also indicated for infants who are constipated. For infants with hard stools it is a common recommendation to give 1 to 2 ounces of water or sugar water per day to help alleviate the constipation. Once a baby is 6 months old it is okay to give her a small amount of water in a cup in order to teach her how to swallow. It is important to remember that water should never be given in order to replace formula or a feeding.

(1)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Delmar Publishers, New York.2nd ed 1984; 683.

Lisa Kelly RN, P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Healthy Babies