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At what age is it okay to give children sugar substitutes?
Q: At the day care where I work they have sugar-free juice for the kids. My question is at what age is it okay to give children sugar-free products?
Marlene Girard
A: Marlene, the children you care for are lucky to have both their parents and their child care providers concerned about their nutrition, health and safety. You’re right that it’s healthier to limit the amount of sugary snacks that children eat to help prevent tooth decay and overweight.

The term “sugar free” can be a little confusing, though. Fruit juice does have sugar in it. Pure or 100% fruit juice contains the natural sugar in fruit, fructose, although the juice might be labeled “no added sugar.” If you give children fruit juice, it’s best to give them 100% fruit juice because it’s the most nutritious, but limit juice to only one cup a day.

Try to avoid giving the children juices that are called fruit drink, punch, or cocktail, since these have only a small percentage of juice and consist mostly of added sugar and water. These juice drinks have little nutritional value and fill the children up with unnecessary calories, which can take away their appetite for more healthy foods. Read the nutrition labels on the juice drinks—you’ll see that sugar (which might be listed as high fructose corn syrup, corn sweetener, sucrose, glucose, or dextrose) is in the top two ingredients; and there might even be more than one different kind of added sugar.

Some other foods such as soda and desserts may in fact be “sugar-free.” Typically, they are labeled “sugar-free,” “light/lite” or “diet,” and have a non-sugar sweetener such as saccharin, aspartame, acesulfame potassium, or sucralose. They are lower calorie since the sugar substitutes are several hundred times sweeter than sugar and only a very small amount is needed to sweeten the food. The sugar substitutes have undergone extensive testing to ensure they’re safe to eat. But saccharin carries a warning label questioning its safety since tests found that laboratory rats who were fed large quantities of saccharin developed bladder cancer. And another sweetener, cyclamate, was banned for the same reason.

In general, it’s probably safest to avoid giving children foods and drinks with unnecessary chemicals such as these sugar substitutes. Since children’s bodies are small and developing rapidly, it’s best not to take any unnecessary risks. Child care programs should give foods and drinks with sugar substitutes only if they’ve been requested by a child’s parents and doctor for a child with special dietary needs, such as diabetes or severe obesity.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician