Nutritional Pearls: Are All Infant and Toddler Foods Created Equal?

Janet, the mother of a 2-year-old son and 13-month-old daughter, asks for advice on choosing from the vast array of ready-made infant and toddler foods on the market.

“They're created specifically for their growing bodies, so they must all be healthy, right?” she asks.

How do you advise your patient?

What is the correct answer?
(Answer and discussion on next page)

Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients. Resources include special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance.

Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen. He is an associate clinical professor of medicine and executive director of The Goldring Center for Culinary Medicine at Tulane University in New Orleans. Dr Harlan is the 2014 co-chair and keynote speaker at the Cardiometabolic Risk Summit in Las Vegas, October 10-12. 

Answer: Parents of infants and toddlers should read foods’ labels carefully

Good parents know how important it is to help their child develop healthy eating habits early in order to set them up for a healthier, longer life. This is also the time to influence their palate so that they don't develop a preference for overly salty or sugary foods, which can lead to overweight even in childhood. Indeed, almost 1 in 4 American children between the age of 2 and 5 are overweight or obese­­–and we know that overweight kids often become overweight adults.

At preschool age mealtimes can be a bit of a challenge for parents, when this might mean making one meal for their child and one for themselves, but at least when they're infants and toddlers it's a little easier: just make healthy choices from the wide range of ready-made infant and toddler foods. They're created specifically for their growing bodies, so they must be healthy. Right?
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The Research

Parents might want to start reading those labels carefully. Researchers at the CDC analyzed the nutrition information for nearly 1,100 foods labeled for infants or toddlers to assess their sodium levels and whether they contained added sugars.¹ For the purposes of their research, they defined a food as high in sodium according to the Institute of Medicine guidelines for children ages 1 to 3 years, resulting in a food being called "low sodium" with no more than 140 milligrams of sodium per child-sized serving. "High sodium" was defined as over 210 milligrams of sodium per serving.

High sugar content was defined as over 35% of calories from sugar - the same as the federal Nutrition Standards for Food in Schools. Further, they were careful to note those foods with at least one instance of sugar in its various forms appearing in the ingredients list.

The Results

The good news is that the vast majority of those foods marketed for infants (defined as 12 months old or younger) were determined to be low in sodium. On the other hand, over half of the ready-to-serve mixed grains and fruits contained at least one added sugar ingredient and 44% had over 35% of their calories from sugar.

The offerings for toddlers are somewhat more concerning. Nearly three-fourths of all toddler dinners were judged to be high in sodium (over 210mg sodium/serving), and one-third had at least one added sugar. Cereal bars and breakfast pastries had the most sugar, with about 1 in 3 having at least one added sugar and at least 35% of total calories from sugar. Nearly all (88%) of dried fruit snacks, like fruit "leather," contained at least one added sugar and derived at least 35% of their calories from sugar.

What’s the “Take Home”?

The good news is that foods marketed as being for infants are generally low in sodium and added sugars, and the bad news is that dry fruit-based snacks and breakfast pastries have about as much sugar and sodium in them as the foods marketed as being for adults.

Recommend that parents read nutrition information carefully when choosing meals for their toddlers. Tell them to look for foods that have no more than 210mg sodium per serving, and ideally under 140mg/serving. Avoid or minimize foods that have a sugar in the first 4 ingredients (variations include: sugar, sweetener, syrup, corn syrup, high fructose corn syrup, honey, fructose, malt, maltose, molasses, dextrose, glucose, lactose, sucrose, turbinado, and trehalose).

Note: Certainly foods such as fruit purees will have a fair amount of sugar in them because fruits are naturally higher in sugar. In these cases, parents should look for “no added sugar” varieties.

Reference:

1. Cogswell ME, Gunn JP, Yuan K, Park S, Merritt R. sodium and sugar in complementary infant and toddler foods sold in the united states. Pediatrics 2015;135(3).