Toddlers’ diarrhea is a well-known and benign condition that often responds by simply removing excess juice from the diet of 1- to 4-yearolds. However, malabsorption of carbohydrate in juice, especially when consumed in excessive amounts, can result in chronic diarrhea, flatulence, bloating, and abdominal pain.Fructose and sorbitol have been implicated most commonly,but the ratios of specific carbohydrates may also be important. The malabsorption of carbohydrate that can result from large intakes of juice is the basis for some health care providers to recommend juice for the treatment of constipation, particularly in infants. The North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition constipation guideline suggests taking advantage of the sorbitol and other carbohydrates contained in some juices, such as prune, pear, and apple juices, to help increase the frequency and water content of stools for infants with constipation.A basic premise of the Dietary Guidelines for Americans, the most recent version of which was published in 2015, is to focus on nutrient-dense foods.Fruit is 1 of the key focus foods in the dietary guidelines.Fruit, along with vegetables, is recommended to provide necessary vitamins and minerals, reduce the risk of cardiovascular disease, potentially protect against cancer, and curb excessive caloric intake. For example, children consuming approximately 1000 kcal/day should have ∼1 cup of fruit per day, whereas those consuming approximately 2000 kcal/day should consume ∼2 cups of fruit per day. Although whole fruit is to be encouraged,plastic pot up to half of the servings can be provided in the form of 100% fruit juice . A 6-ounce glass of fruit juice equals 1 fruit serving. Fruit juice offers no nutritional advantage over whole fruit. A disadvantage of fruit juice is that it lacks the fiber of whole fruit. Kilocalorie for kilocalorie, fruit juice can be consumed more quickly than whole fruit.
Reliance on fruit juice instead of whole fruit to provide the recommended daily intake of fruit does not promote eating behaviors associated with the consumption of whole fruit. Because recent studies suggest that pure orange juice consumption has health benefits in adults, further research is needed to determine whether children and adolescents may derive similar benefits.Pediatricians play a central role in children’s health and nutrition by providing guidance to pediatric patients and their parents. Pediatricians can also advocate for changes in public policy, especially in schools, where improved fruit and vegetable intake has been associated with policies promoting healthier dietary choices.Open assessment and recommendations for appropriate dietary habits, including consuming whole fruit rather than fruit juice, can help encourage parental support of healthy rates of weight gain.Although other risk factors associated with obesity may be important to consider, a recent study suggests that special attention may be indicated for infants and children of women who are overweight before bearing children.Parents need to be informed that unpasteurized juice products may contain pathogens, such as Escherichia coli, Salmonella species, and Cryptosporidium species, which may be harmful to children. These organisms are associated with serious diseases, such as hemolyticuremic syndrome.If parents choose to give their children unpasteurized juice products, they should do so with caution and be advised that this is an unsafe practice. Commercially prepared unpasteurized juice must contain a warning on the label that the product may contain harmful bacteria.This guidance does not apply to certain modes of sale , but families should remain vigilant when providing unpasteurized juice products to children. Pasteurized fruit juices are free of microorganisms and are safe for infants, children, and adolescents.The American Academy of Pediatrics recommends that human milk be the only nutrient fed to infants until approximately 6 months of age.
For mothers who cannot breastfeed or who choose not to breastfeed, a prepared infant formula can be used as a complete source of nutrition. No additional nutrients are needed. There is no nutritional indication to give fruit juice to infants younger than 6 months. Offering juice before solid foods are introduced into the diet could risk having juice replace human milk or infant formula in the diet, which can result in reduced intakes of protein, fat, vitamins, and minerals such as iron, calcium, and zinc.Malnutrition and short stature in children have been associated with excessive consumption of juice.It is optimal to completely avoid the use of juice in infants before 1 year of age. When juice is medically indicated for an infant older than 6 months, it is prudent to give the juice to the infant in a cup. Dental caries have also been associated with juice consumption.Prolonged exposure of the teeth to the sugars in juice is a major contributing factor to dental caries. Recommendations from the AAP and American Academy of Pediatric Dentistry state that juice should be offered to toddlers in a cup, not a bottle, and that infants not be put to bed with a bottle in their mouth.The practice of allowing children to carry a bottle, easily transportable covered cup, open cup, or box of juice around throughout the day leads to excessive exposure of the teeth to carbohydrate, which promotes the development of dental caries. Infants can be encouraged to consume whole fruit that is mashed or pureed. After 1 year of age, fruit juice may be used as part of a meal or snack. It should not be sipped throughout the day or used as a means to calm an upset child. Because infants consume <1600 kcal/day, 4 ounces of juice per day, representing half of the recommended daily serving of fruit, is more than adequate. The AAP practice parameter on the management of acute gastroenteritis in young children recommended that only oral electrolyte solutions be used to rehydrate infants and young children and that a normal diet be continued throughout an episode of gastroenteritis.
Surveys show that many health care providers do not follow the recommended procedures for the management of diarrhea.The high carbohydrate content of juice , compared with oral electrolyte solutions , may exceed the intestine’s ability to absorb carbohydrate, resulting in carbohydrate malabsorption. Carbohydrate malabsorption causes osmotic diarrhea, increasing the severity of the diarrhea already present.Fruit juice is low in electrolytes. The sodium concentration is 1 to 3 mEq/L. The stool sodium concentration in children with acute diarrhea is 20 to 40 mEq/L. Oral electrolyte solutions contain 40 to 45 mEq sodium/L. As a replacement for fluid losses, juice may predispose infants to development of hyponatremia. Concern has been raised that infants exposed to orange juice had an increased likelihood of developing an allergy to it. The development of a perioral rash in some infants after being fed freshly squeezed citrus juice is most likely attributable to the chemical irritant effects of acid. 53 Diarrhea and other gastrointestinal symptoms observed in some infants were most likely attributable to carbohydrate malabsorption. Although allergies to fruit may develop early in life, they are uncommon.Most issues relevant to juice intake for infants are also relevant for toddlers and young children. Fruit juice and fruit drinks are easily over consumed by toddlers and young children because they taste good. In addition, they are conveniently packaged or can be placed in a bottle or transportable covered cup and carried around during the day.Because juice is viewed as nutritious,grow bag limits on consumption are not usually set by parents. Toddlers and young children can be encouraged to consume whole fruit instead of juice. Like soda, it can contribute to energy imbalance. Pediatricians should support policies that seek to reduce the consumption of fruit juice and promote the consumption of whole fruit by toddlers and young children already exposed to juices. This support should include policies of the Special Supplemental Nutrition Program for Women, Infants, and Children , provided that those policies do not have negative nutritional consequences for children without access to fresh fruit. In addition, high intakes of juice can contribute to diarrhea, over nutrition or under nutrition, and the development of dental caries. The dilution of juice with water does not necessarily decrease the dental health risks.Juice consumption presents fewer nutritional issues for older children and adolescents, because they consume less of these beverages. Nevertheless, juice intake should be limited to 8 ounces/day, half of the recommended daily fruit servings. It is important to encourage the consumption of the whole fruit for the benefit of fiber intake and a longer time to consume the same kilo calories. Excessive juice consumption and the resultant increase in energy intake may contribute to the development of obesity. One study found a link between juice intake in excess of 12 ounces/day and obesity.
Other studies, however, found that children who consumed greater amounts of juice were taller and a had lower BMI than those who consumed less juice or found no relationship between juice intake and growth variables.A more recent study suggested that varying intakes of 100% juice were not associated with obesity.More research is required to better define this relationship.Global production of pollinator dependent crops has increased by 300% in the past 50 years . At the same time, managed honey bee populations are declining due to a complex of factors including novel diseases, pesticides and habitat change . Pollinator deficiencies may precipitate significant yield reductions and increased food prices, ultimately jeopardizing food security . Unmanaged bees are highly effective pollinators of a variety of crops and act as insurance against loss of pollination function due to honey bee deficits . While proximity to natural habitat increases populations of such alternate pollinators , intensive agricultural landscapes often contain little remnant habitat. As a result, re-diversification of agricultural areas has been proposed as a means of bolstering pollination services from these alternate pollinators . Diversification of agricultural landscapes can take place at many scales, including within fields , along field edges , or bordering landscape features . One benefit of field edge techniques is that they create habitat without sacrificing arable land , and comprise a large portion of non-cropped area in farming regions globally . Farm bill conservation programs in the United States and agri-environmental schemes in the European Union prioritize on-farm habitat creation projects that target pollinators, providing incentives through cost-share programs . Despite the prominence of these programs, there is little information as to the effectiveness of field-margin diversification techniques, and specifically, whether they can bolster pollinator services and affect yields to the same levels documented in patches of natural habitats while simultaneously conserving pollinator species . One common field edge diversification technique, hedgerow restoration , has been found to increase pollinator richness within field edges and up to 100 m into nearby crop fields . Additionally, hedgerows show potential for increasing pollination function within adjacent fields. Using sentinel canola plants, Morandin, Long and Kremen found that wild bees enhanced seed set, once the contribution from managed honey bees was accounted for. However, the canola plants provided a highly attractive resource within an unattractive crop matrix of processing tomato, which provides few nectar rewards and requires buzz-pollination to release pollen stores. These conditions are not reflective of the field conditions created by monoculture plantings of pollinator-dependent crops, which generate hundreds of thousands of synchronous, though short-lived, blooms within a single field . Pulses of highly attractive floral resources can create dilution effects, drawing species away from adjacent seminatural habitat and reducing pollination services there . Yet in spite of the attractiveness of MFC fields, wild bee abundance and richness has been found to be higher in habitats, including hedgerows, in closer proximity to MFC fields . The effects of MFCs may be species-specific, with some exhibiting higher preference for MFCs over other resources . Specialist pollinators, such as the squash bee , seek out fields of their host plant, cultivated squash, in the landscape . While the influence of MFCs on pollinator populations and services has been well-studied, whether the presence of field-scale restorations can augment pollinator populations and pollination services within MFC fields remains an open question . We examine the ability of hedgerows to enhance pollination services in a simplified agricultural landscape when adjacent to a mass-flowering, pollinator-dependent crop, cultivated sunflower . We ask whether the identity of the pollinator species found within hedgerows during the crop bloom period is the same as those found within adjacent sunflower fields. Then, using an independent data set, we determine whether the most abundant wild sunflower visitors, sunflower specialist bees, also utilize hedgerow plantings in our study landscape.