Experts question nutritional value of toddler ‘formulas’

According to a recent review carried out by the American Academy of Pediatrics (AAP), while there is a growing array of toddler “formulas” being advertised as a nutritious next step following human milk or infant formula, the drinks have been found to “lack standard composition and nutrition requirements”.

In fact, the AAP has said that toddler “formulas” that are promoted as nutritious drinks for the older infant or preschooler are “generally unnecessary and nutritionally incomplete, and the marketing practices that promote them are questionable”.

Currently the US has no regulatory oversight to ensure that formulas for this age group adhere to any set of uniform standards.

Published in its new clinical report “Older Infant-Young Child ‘Formulas’“, the AAP has reviewed the growing array of drinks aimed at children ages six-36 months and found that they “lack standardisation or regulatory oversight”.

“Products that are advertised as ‘follow-up formulas,’ ‘weaning formulas,’ or ‘toddler milks and formulas,’ are misleadingly promoted as a necessary part of a healthy child’s diet or, for those directed at young infants, equivalent to infant formula,” said Lead Author George J. Fuchs, III, MD, FAAP, a member of the Committee on Nutrition.

“These drinks should not replace a balanced diet and are inferior to standard infant formula in children less than 12 months of age and offer no benefit over much less expensive cow’s milk in most children older than age 12 months. Some children may have special nutritional needs, as well, and so as with any child, it is always best to check with your pediatrician,” continued Dr Fuchs.

However, the AAP has highlighted that it does support continued breastfeeding along with appropriate complementary foods introduced at about six months, as long as mutually desired by mother and child for two years or beyond. It went on to advise that, if the infant is not breastfed, the Academy recommends whole cow milk as suitable for infants beginning at 12 months of age as part of a nutritionally complete, balanced diet.

“It’s understandable that families and caregivers may be confused by the different names, compositions, and purported benefits of these so-called ‘formulas’. Some of the toddler drinks are high in sugar.  And to top it off, they are typically more expensive than cow’s milk,” said Steven A. Abrams, MD, FAAP, Co-Author of the report.

Advising parents and caregivers, the AAP recommends that for infants younger than 12 months, the liquid portion of the diet should be provided by human milk or standard infant formula, which in the US have been reviewed by the US Food and Drug Administration (FDA) based on the Infant Formula Act.

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Meanwhile, for toddlers (children 12 months and older), caregivers should provide a “varied diet with fortified foods to optimise nutritional intake”. The AAP has said that older infant-young child “formulas” can safely be used as part of a varied diet for children but “do not provide a nutritional advantage in most children over a well-balanced diet that includes human milk or cow milk”. 

“Marketing of these drinks should make a clear and unambiguous distinction from standard infant formula in promotional materials, logos, product names, and packaging. They should not be placed alongside infant formula on store shelves,” warned the AAP, before continuing: “Pediatricians should complete a focused nutritional assessment of children and offer adjustment of solid food intake or vitamin supplementation as needed. 

“We are all familiar with picky eaters. And there may be reasons why some families avoid cow’s milk and dairy products. That’s why it’s important to ask your pediatrician to evaluate if children are getting all the nutrients they need. Together, you can discuss a plan to address any potential deficiencies,” concluded Dr Fuchs.