1. Failure to thrive in the pediatric population is unusual.
2. The body of literature addressing fruit juice consumption and children's growth consists of three articles, none of which are randomized controlled trials.
3. In two year-old children who drink greater than 12 ounces per day of 100% fruit juice compared to those who drink less than this amount per day, there is no significant difference in body mass index (BMI) or ponderal index (PI).
4. In children with failure to thrive, asking about fruit juice consumption may be a simple screen for aberrant dietary habits, suggesting a nutritional component to the failure to thrive.
5. In children without failure to thrive, excessive fruit juice consumption does not appear to have a dramatically adverse effect on growth; therefore efforts surrounding nutrition during the limited time provided for a well-child check may be better focused on another aspect of diet. 

Summary of Key Evidence

1. In the first study, feeding histories, weight, length, head circumference, and anthropometric measurements of 8 children ages 14 to 27 months referred for FTT with negative H & P and lab work-up, all of whom consumed more than 12 ounces per day of juice, were gathered.  Growth parameters were followed before and after juice intake was restricted.  Follow-up data was available for 7 of the 8 patients. Mean weight gain increased from 0.08 +/- 0.05 kg/month before intervention to 0.36 +/- 0.16 kg/month after restricting juice (p< .05).¹
2. The second study was a cohort study in which dietary records, height, weight, BMI, and ponderal indexes of 94 two year-olds presenting for well child checks were gathered.  The children who drank greater than 12 oz/day of juice more often had height < 20th percentile for age (47% v. 14%) and were significantly shorter  (86.5 +/- 0.9 cm v. 89.3 +/- 0.4 cm (p < 0.003). There was no statistical difference in the BMI's 17.1 +/- 0.3 kg/m2 v. 16.7 +/- 0.1 kg/m².  The ponderal indexes had a borderline significant difference (19.9 +/- 0.5 kg/m3 v. 18.7 +/- 0.2 kg/m3) (p < 0.02).²
3. The relative risk for greater than 12 oz/day juice intake causing a height < 20th percentile is 3.35.  This is an absolute risk of 33%.  The number needed to harm is 3.  In other words, 3 children would have to drink more than 12 oz per day of juice for one child to have a height less than the 20th percentile.  However, statistically 1 in 5 children would be expected to fall in this range.
4. The last study was a cohort study, and gathered data on 105 children, ages 24 to 36 months, who were interviewed for diet history, height, weight, BMI, and ponderal index.  There was no significant difference in any of the above growth parameters between the children who drank more than 12 oz/day of juice and those who drank less.³

Additional Comments

• Neither of the large studies assessed growth velocity (i.e., growth rate over time).  Both studies defined poor growth as a height less than the 20th percentile.  This is not an accurate measure of poor growth, and therefore it is difficult to assess the results from either study.

• lBerry Www Vie En Tag Sexy Excessive Fruit Juice Consumption Alone in Two Year-Old Children Is Not Proven To Cause Failure to Thrivef q q Berry Juice nBerry Www Vie En Tag Sexy Excessive Fruit Juice Consumption Alone in Two Year-Old Children Is Not Proven To Cause Failure to Thrivex Juice Vie Cheap