Toddlerhood is a crucial period for introducing healthy diets to children. Clinicians must understand drink guidelines because drinks have a large portion of the toddler's diet. Providing the right drinks prevents children from chronic diseases related to diets such as obesity, type 2 diabetes mellitus, and dental caries. Healthy drinks can also support children's physical and cognitive development.

Drinks for Toddlers: Recommended and Not Recommended

Types of Drinks that Can Be Consumed by Toddlers

Plenty of water, pasteurized cow's milk, and 100% fruit juice are drinks that can be consumed by toddlers besides breast milk and formula milk. However, these recommended drinks are vary depending on the age of each toddler. Clinicians need to understand clearly the definition of these drinks before learning and recommending beverages based on age.

Plenty of Water and Pasteurized milk

Plenty of water is water without flavorings, sweeteners, or carbonation. Pasteurized milk is plain cow's milk heated at a certain temperature and time so that the pathogen in it has died. This milk also does not contain artificial sweeteners, added sugars, or flavors. Examples are whole milk, reduced-fat milk (2%), low-fat milk (1%), and skim milk (fat-free).

100% Fruit Juice

The intended 100% fruit juice (by FDA approval) is made from 100% fruit extract. It means no added sugar or other artificial ingredients in those products. Products that do not contain 100% fruit juice should write down the fruit's percentage and provide additional composition information.

A. Recommended Drinks according to Toddler Age

Toddlers of various ages can consume various types of drinks. In general, beverage recommendations are categorized as follows: infants aged 0-6 months, infants aged 6-12 months, infants aged 12-24 months, infants aged 2-3 years, and infants aged 4-5 years.

Infants aged 0-6 months

Infants aged 0-6 months do not need other beverages besides breast milk. Give extensively hydrolyzed formulas or amino acid formulas to Infants aged 0-6 months who cannot get exclusive breastfeeding. Providing other drinks (including water of plenty) is not recommended.

Infants 6-12 Months

Besides breast milk and formula milk, toddlers in this age group can be given about 0.5-1 glasses of water per day. Giving other drinks is not recommended.

Infants 12-24 Months

Give about 1-4 glasses of water per day, pasteurized fresh cow's milk (whole milk type) around 2-3 cups per day, and 100% fruit juice <0.5 cups per day.

Infants aged 2-3 years

For this age group, give 1-4 glasses of water per day, pasteurized fresh cow's milk (skim type or low-fat type) cups2 cups per day, and 100% fruit juice as much as ≤ 0.5 cups per day.

Babies 4-5 years old

Give this group 1.5-5 glasses of water per day, pasteurized fresh cow's milk (skim type or low-fat type) ≤2.5 cups per day, and 100% fruit juice of ≤ 0.5-0.75 cups per day.

Toddler Nutrition Needs

There are special considerations in providing drinks or beverages for infants to ensure that their hydration and nutritional status remains balanced.

It is necessary for toddlers aged 6 months to 5 years to adjust the volume of plenty of water with the volume of other drinks consumed. For example, a 3-year-old toddler who does not drink pasteurized fresh milk can be given four water glasses per day. But if the toddler drinks milk, then the volume of water needs to be reduced. Doctors must know that plenty of water can only replace the amount of fluid and replace nutrients from cow's milk.

In infants aged 12-24 months, pasteurized fresh cow's milk with the type of whole milk is preferred over skim and low-fat types. The reduced-fat and low-fat type cow's milk is recommended for toddlers who have significant weight gain or have a family history of obesity, dyslipidemia, or cardiovascular disease.

The need for milk will decrease with age because toddlers will start consuming more solid food. However, cow's milk remains an essential source of calcium, vitamin D, and protein.

Which Better Fruit or Fruit Juice?

Whole fruit is recommended rather than 100% fruit juice because fruit juice's fiber content is lower than whole fruit, and fruit juice can cause weight gain if consumed excessively. However, 100% of fruit juice consumed according to the recommended portion does not cause weight gain.

100% fruit juice is recommended if parents have difficulty providing whole fruit. The amount of fruit juice needs to be limited in children with chronic diarrhea, flatulence, and abdominal pain.

Not Recommended Drinks or Beverages for Toddlers

Most of the not recommended drinks for toddlers are drinks that contain sweeteners, either in the form of added sugar or artificial sweeteners. Additional sugars are sucrose, glucose, high-fructose corn syrup, and fruit juices undergoing special processing.

1. Plant Milk

Plant milk only for toddlers aged 1-5 years (not allowed on toddlers under one year old) and certain medical indications such as allergies or intolerance of cow's milk. Plant milk is made from rice, beans, seeds, coconut, or oats. Most of these products contain added sugar and do not contain essential nutrients similar to cow's milk. Fortified plant milk may have nutrients similar to cow's milk, but these additional substances' bioavailability is still uncertain.

2. Flavored Milk

Flavored milk is cow's milk that has been added with sugar. Examples are chocolate milk and strawberry milk that are widely circulating in the market. This milk should be avoided to limit sugar intake and prevent the child's preference for sweet drinks.

3. Transitional Formula Milk

This milk is also known as toddler milk, transition formulas, or weaning formulas. These products are often marketed for children aged 9-36 months and often contain added sugar.

The risk of transition formula is consuming added sugar that is not needed. Nutrition from this milk is not unique and is not required because toddlers can already get complete nutrition from pasteurized fresh milk and cow's milk.

4. Low-Calorie Sweetener Drinks

These products include beverages that contain low-calorie artificial sweeteners such as saccharin, aspartame, acesulfame-K, sucralose, neotame, and advantame. The health risks that can arise from administering artificial sweeteners to toddlers are not known with certainty, so it should be avoided.

5. Sugar Drinks

This product is also called sugar-sweetened beverages (SSB). All drinks mixed with sugar are included in this category. Examples are soda, flavored water, sports drinks, fruit-flavored drinks, energy drinks, and sweet coffee or tea.

Risks that can be caused are weight gain to overweight or obese, dental caries, and type 2 diabetes mellitus, which is thought to occur due to insulin resistance. Other effects are poor sleep quality, headaches, and the appearance of depressive symptoms.

6. Caffeinated Drinks

Caffeine consumption can increase the risk of sleep disorders, fussiness, headaches, and concentration problems in toddlers, so it should be avoided.