Toddler Formulas: Nutritional Value and Marketing Claims

Background A previous report found that toddler formula brands (fortified milks for children 1–3 years old) spent almost $17 million in adverting in 2015, an increase of 74% compared with 2011. Pediatric nutrition experts specifically recommend against serving these products due to lack of scientific evidence of advantage over whole milk and recommend adding a multivitamin if nutrient deficiencies are of concern. Parents may think that the Food and Drug Administration (FDA) enforces strict regulations for toddler formulas when the only regulation is in terms of ingredient safety. Several concerns have been raised concerning the use of structure/function claims (connections of nutrients or ingredients with effects on the human body) due to possible consumer confusion. Given the growing market for toddler formulas and the increase in marketing it is necessary to expose the nutritional content and ingredients in these products. Study objective To characterize the nutritional quality of toddler milk and determine prevalence of marketing structure/function claims. Methods Toddler milk brands identified in the previous report and toddler milks approved by WIC were included in the analysis. Ingredients, nutrients and packaging claims were obtained from company websites. Results A total of 20 toddler milks from nine companies were identified, 40% of which are approved by WIC and 25% were marketed towards infants (9–18 months old). The nutrient content of toddler milk ranges per 100 kcals are reported for total fat (3.89 – 5.6 grams), carbohydrates (6.9–12.8) and protein (2.6–5.3). Milk (nonfat or whole) was an ingredient in 65% of formulas, 85% had added sugars (corn syrup, sucrose, sugar, cane juice or lactose), and 90% had vegetable oils. Only one toddler milk used lactose as the only source of added sugars. Compared to whole dry milk, 80% of toddler milks had higher sugar content and 100% had less protein. All toddler milk package labels included structure/function claims. Examples of messages include “brain Nourishing DHA and iron to help support your toddler's brain development”, “prebiotics designed to help support digestive health.”, “DHA like that found in fish for brain,” “Lutein like that found in spinach for eyes,” “Vitamin E like that found in broccoli for development.”, “DHA and iron to help support brain development” and “probiotics to help support digestive health.” Conclusions The American Academy of Pediatrics (AAP) recommends children between 1 and 2 years of age drink whole milk. The nutritional quality of specially formulated toddler milk products was not superior to regular whole milk. The American Heart Association (AHA) recommends avoiding added sugars for toddlers, making most toddler milks inadequate. More research is needed to determine consumption frequency and parent's perceptions of these products to determine the effect marketing practices on offering unnecessary products to toddlers. Common health misconceptions promoted by the media have led some parents to believe that there is a higher prevalence of metabolic diseases like lactose intolerance or milk protein allergy and undernutrition. In addition, parents may assume that their toddler would benefit from a specialty formula instead of whole milk. Support or Funding Information Robert Wood Johnson Foundation 1 Toddler Formula Nutrient ContentProduct Manufacturer Serving size (g) Total Calories (Kcal) Calories/100g Total fat (g) Total carbohydrate (g) Total sugar (g) Protein (g) Sodium (mg)Happy Tot Grow & Shine Organic Toddler Milk Nurture Inc. 146.7 100.0 68.2 5.0 10.0 4.3 2.9 35.7 Enfagrow Toddler Next Step Mead Johnson Nutritionals 42.5 100.0 46.9 3.8 12.5 6.9 3.8 50.0 Nestlé Nido Fortificada (Fortified) Nestle S.A. 169.1 100.0 36.9 5.6 6.9 6.9 3.8 65.6 Earth's Best Organic Toddler Formula Hain Celestial Group, Inc. 138.8 100.0 72.0 4.1 11.2 7.1 4.1 47.1 Gerber Good Start Grow Nestle Infant Nutrition (Gerber) 158.0 100.0 48.7 3.8 12.3 7.7 3.1 38.5 Dry whole milk Genergic 152.2 100.0 65.7 5.4 7.7 7.7 5.3 74.8 Baby's Only Organic Non‐GMO Dairy Toddler Formula Nature's One, Inc 150.0 100.0 66.7 5.0 11.0 8.0 3.0 30.0 Nestlé Nido Kinder 1+ Nestle S.A. 169.1 100.0 36.9 4.4 11.3 9.4 3.8 59.4 Similac Go & Grow NON‐GMO Abbott Laboratories 181.1 100.0 36.8 5.3 10.7 10.0 2.7 30.0 Similac Go & Grow Sensitive Abbott Laboratories 181.1 100.0 36.8 5.3 10.7 10.0 2.7 30.0 Similac Go & Grow Vanilla Abbott Laboratories 181.1 100.0 36.8 5.3 10.7 10.0 2.7 30.0 Similac Go and Grow Milk Abbott Laboratories 181.1 100.0 0.0 5.3 10.7 10.0 2.7 30.0 Enfagrow Toddler Transitions Gentlease (Enfagrow Gentlease Toddler) Mead Johnson Nutritionals 170.4 100.0 58.7 5.3 10.5 10.5 2.6 40.0 Enfagrow Toddler Transitions Mead Johnson Nutritionals 170.4 100.0 58.7 5.3 10.8 10.8 2.6 36.0 Gerber Good Start 3 Soy Nestle Infant Nutrition (Gerber) 170.1 100.0 58.8 5.0 10.9 10.9 2.8 40.0 Enfagrow Toddler Transitions Soy (Enfagrow Soy Toddler) Mead Johnson Nutritionals 170.4 100.0 58.7 4.4 11.8 11.8 3.3 36.0 Target Up and Up Milk Based toddler begginings Formula with Iron PBM Products, LLC (Formerly Wyeth) 147.9 100.0 67.6 5.3 10.5 10.5 2.6 36.0 Puramino Mead Johnson Nutritionals 160.9 100.0 62.2 5.3 10.6 10.6 2.8 47.0 Alfamino Junior Children's Formula Nestle 100.0 100.0 100.0 4.4 12.2 12.2 3.3 48.0 Nutramigen with Enflora LGG Toddler Formula Mead Johnson Nutritionals 159.9 100.0 62.5 4.3 12.8 12.8Target Up and Up Milk‐Based Next‐Stage Formula with Iron PBM Products, LLC (Formerly Wyeth) Ingredients not listed