Abstract

Background

To critically examine baby and toddler food products sold in Canada for their sugar and sodium content, and to assess these in light of current recommendations.

Methods

Baby and toddler foods (n = 186) were coded for various attributes, including ‘Nutrition Facts’ label data. Four ‘categories’ of baby/toddler foods were analyzed against their ‘adult’ counterparts for sugar and salt to reveal whether a ‘halo effect’ attributed to baby/toddler food is warranted.

Results

63% of products have either high levels of sodium or an excessive proportion of calories coming from sugar. Over 12% of products had moderate or high levels of sodium; over 53% of products derive >20% of their calories from sugar. Baby and toddler foods were not found to be nutritionally superior—in terms of sodium or sugar—to their adult counterparts.

Conclusions

Baby and toddler foods are currently overlooked in the public, and public policy, discussions pertaining to dietary sodium and sugar. Yet these products are clearly of concern and should be closely monitored, since they promote a taste for ‘sweet’ and ‘salty’ in our youngest consumers.

Dietary sodium and sugar have been the objects of much recent attention (by media, government bodies, public health advocates, etc.). High levels of sodium in the diet have been linked to hypertension, and identified as a “leading cause of premature death due to heart attack and stroke”.1 High levels of dietary sugar, conversely, contribute to the overconsumption of discretionary calories2 and have been implicated in dental caries and type-2 diabetes. Yet these “inexpensive palate-pleasers” permeate our processed foodstuffs.3 The situation has prompted a national strategy to reduce Canadians' dietary intake for sodium; Health Canada's Sodium Working Group recently announced the goal of reducing the daily adult dietary intake of sodium by 30%—to 2300 mg—by 2016.4 Since approximately 75% of an adult's daily intake of salt comes from processed food,5 reducing sodium levels in processed/packaged edibles is instrumental to achieving this goal. High levels of sugar in processed foods are equally of concern. In August 2009, the American Heart Association (AHA) released a scientific statement pertaining to added sugars in the diet, recommending that most women should limit their consumption of added sugars to 100 calories per day, while men should limit daily consumption to 150 calories.2 Particular culprits identified as contributing to excess sugar intake included soft drinks, desserts, cookies, candies, ready-to-eat cereals, sweetened yogurts and milks and certain grains such as cinnamon toast and honey-nut waffles.

Population-based strategies for reducing overall sodium and sugar intakes are important,5,6 as is both the recommendation of adult ‘targets’ for daily consumption, and the scrutiny of popular processed foods. Equally important, however, is the dietary intake—and the processed foodstuffs—of our littlest consumers. A wide range of baby and toddler foods are available for purchase; and since dietary habits are formed early on and persist over time,7–9 it is important to scrutinize the particular tastes (for sweet and salt) that are promoted to very young children. As the Journal of Family Health Care's article on nutrition for toddlers observed, ‘common pitfalls’ in a toddler's diet include ‘too much salt or sugar’.10 Moreover, research suggests that the composition of early childhood diet may directly impact metabolic pathways and health during adulthood.11 Given this, a profile of the sugar and sodium content of baby and toddler food—assessed in light of current recommendations—is warranted.

Contextualizing baby and toddler foods: current literature and dietary recommendations

Despite the increased concern regarding dietary sugar and salt, certain categories of food—such as toddler foods—have, to date, been overlooked by Canadian researchers interested in nutrition, health and policy. Health Canada's Sodium Working Group, for instance, is currently gathering data on sodium levels in packaged foods sold in Canada: its present list of 30 food ‘sub-categories’ contains no baby or toddler foods.12 Similarly, the Center for Science in the Public Interest's recent assessment on the sodium levels of 264 packaged foods available in the Canadian supermarket1 focuses on regular fare (i.e. tomato sauces, fries, cereals, cookies, crackers, cheese, bacon, etc.), and does not examine foods specifically targeted at children or toddlers. Although studies providing specific nutritional profiles and assessments of children's supermarket foods do exist, they tend to focus on child-oriented foods (such as children's cereals and ‘fun foods’),13–16 and do not address baby and toddler food products. (Note that two exceptions exist, both focused on Britain.17,18). In short, a clear knowledge gap exists when it comes to the types of products that comprise baby and toddler foods in Canada, as well as their nutritional content. The significance of bridging this gap becomes clear when one considers that some toddler foods sold today have over 500 mg of sodium per serving, while others derive up to 80% of their calories from sugar.

Current recommendations by the Institute of Medicine (IOM) set adequate intake (AI) levels for sodium for babies (7–12 months) and toddlers (12–24 months) at 370 mg and 1000 mg per day, respectively.19 An editorial in the 2009 Canadian Medical Association Journal, however, argued that sodium recommendations for all ages were too high, and thus advocated for ‘a new benchmark’. ‘No added salt in the diet appears to be a safe ideal,’ Flegel and Magner argued.5,20 This is worth considering, especially for our children, since data from the 2004 Canadian Community Health Survey revealed that the mean sodium intake for Canadian children aged 1–3 is 1903 mg/day. Almost 77% of this age group had intakes exceeding the tolerable upper intake level (UL).21 (Note that this is primarily due to the consumption of processed foods. About 75% of sodium in the Canadian diet comes from processed foods, whereas approximately 5% of the total daily sodium intake comes from salt added at the table.6)

Recommendations for sugar intake for babies and toddlers prove more difficult to establish. The America Heart Association's (earlier mentioned) recommendations to limit added sugars to six teaspoons a day for women and nine teaspoons a day for men do not extend to children or toddlers. In fact, the AHA has not published specific ‘added sugar’ recommendations for children or toddlers—even though high-sugar foods are deliberately created for, and targeted at, them.13,16,21–26 The AHA's 2005 ‘Dietary Recommendations for Children and Adolescents: A Guide for Practitioners’ simply recommends that parents ‘reduce the intake of sugar-sweetened beverages and foods’ for children under 2 years, and observes that the discretionary calories for sedentary 2–3 year olds is roughly 100–150 calories (‘less than that provided by a usual portion size of most low-nutrient-dense snacks and beverages’).27 Health Canada, similarly, offers no direct recommendations—or cautions—regarding sugar intake or upper limits on the intake of added sugar for very young children, or for toddlers, per se. The UK National Diet and Nutrition Survey provides more guidance, recommending that added sugars should comprise no more than 10% of total daily calories.7 Given a daily estimated calorie consumption of 900–1000 calories for children aged 1–3,27 this is a maximum of 100 calories.

The significant health impact of dietary salt and added sugars means that it is vital to remain alert to their presence in our foods. This study, as noted, seeks to fill an important research gap by examining the processed foodstuffs specifically targeted at our youngest consumers. It profiles, and critically assesses, the prevalence of ‘sweet’ and ‘salty’ in baby and toddler foods. This is particularly important, because early experiences with food direct future patterns of food consumption.28,29 Research has not only established a positive correlation between exposure and food preferences in children,30,31 but also suggests that ‘preferences formed in infancy and early childhood may have long-lasting effects on later food choice behavior’.32

Methods

Content analysis was used to create a profile of the baby and toddler food products currently available in the Canadian marketplace. Exactly 186 products were purchased for coding and 29 variables were recorded for each product. Each case was identified in terms of brand, product name, ‘target’ eater (i.e., baby food or toddler food), type of food and price. Sixteen variables pertained to the packaging itself (including front-of-pack nutrition claims, special manufacturers' ‘marks’ or ‘pledges’ and verbal claims) and the ingredient list. Nutritional information, drawn from the Nutrition Facts Table, was also recorded for each product.

Identifying baby and toddler foods is straightforward: such products are located in one section/aisle of stores, and self-identify (on the package) as baby or toddler foods. To provide a comprehensive profile of available baby/toddler foods, researchers visited and purchased baby and toddler food products from nine venues in Calgary, AB in August 2009: the venues included five grocery stores, two drug stores and two department stores (the specific venues were as follows: (i) supermarkets: Safeway, Co-op, The Real Canadian Superstore, Sobeys, Planet Organic Market; (ii) drugstores: London Drugs, Shoppers Drug Mart; (iii) department stores: Wal-Mart, Zellers). Duplicate products were not included in the study. Also excluded from the study were infant formulas and infant cereals designed to be mixed with breast milk or water, juices and beverages, and simple purées of vegetables and fruits. These aforementioned products were excluded for two reasons. First, the study is specifically interested in baby food and toddler food (not infant food). Second, simple purées of vegetables and fruits can be classified as pure foods (i.e., single ingredient, puréed fruits with no added sugar) rather than a prepared dinner or dessert, etc. (obviously, there are naturally occurring sugars in apricot, apple and other fruit purées. Excluding these items from the study, enbles the analysis to focus primarily on the products with added sugars—even though some of the total sugar content might also be from naturally occurring sugars (as is the case for baby food ‘desserts’ made out of fruit).

The final 186 products were comprising pureed ‘dinners’ and ‘desserts’, toddler ‘entrées’ and ‘dinners’, ‘snacks’ (including biscuits, cookies, fruit snacks, ‘snack bars’ and yogurts) and some cereals. (It remains important to note that infant foods are subject to specific regulations in the Food and Drug Regulations. Section B.25.003 states that ‘no person shall sell infant food that contains (a) strained fruit, (b) fruit juice, (c) fruit drink or (d) cereal, if sodium chloride has been added to that food’.28 However, the regulation explicitly exempts desserts28 and fails to mention ‘dairy or vegetable-based frozen dinners, fast food, snack food or countless other products’.1)

Assessing the sodium and sugar levels in baby and toddler foods is challenging because there is currently no universally accepted standards. Given this, and in light of the recommended intake for sodium, products indicating <130 mg per serving were classified as ‘acceptable’ while those with >260 mg per serving were deemed high in sodium. These thresholds are a compromise between AI and UL reference intakes for children aged 1–3 years old. The corresponding thresholds for 9–50 year olds would be 200 and 400 mg sodium per serving which, when related to Canada's Food Guide, meet the AI level of 1500 mg for this age group.

Assessing sugar in processed foods requires a more nuanced approach. Recommendations for sugars pertain to added sugars, not naturally occurring sugars found in fruit or milk. However, product labels do not distinguish added sugars from naturally occurring sugars, which means that the Nutrition Facts table must be read at face value. Given this, the amount of total sugars displayed on the label was used to assess the nutritional quality.

Previous studies have classified foods as having high levels of sugar if they had more than 10 g sugar33—or 15 g sugar17—per portion or per hundred grams. This study, instead, draws from the AHA recommendations, as well previous research,24 that suggests foods are of poor nutritional quality if more than 20% of their calories derive from sugar. This criterion is more nuanced; it is used for the analysis because it assesses the percentage of sugars (rather than an absolute cut off regardless of portion size).

Part two of this analysis pertains to the presumed ‘halo effect’ around products specifically intended for very young children. Reasonably, one might expect baby and toddler foods to be nutritionally superior to adult fare; and so this study examined the sugar and sodium levels of particular baby/toddler food products in light of their comparable adult counterparts. Sugar and sodium content (from the Nutrition Facts Table) was documented for the adult equivalents to four types of products—toddler cereal bars, cookies/biscuits, fruit snacks and yogurts. Specific comparisons were made as follows: toddler cereal bars versus Kellogg's Nutri-Grain cereal bars; baby/toddler cookies/biscuits versus Mr. Christie Social Tea Biscuits; baby/toddler fruit snacks versus President's Choice Naturally Flavored Fruit Snacks; and toddler yogurts versus Danone Activia strawberry yogurt. Assessing these products for sugar and salt against their comparable adult counterparts allowed us to sidestep the more sensationalist, and less accurate, approaches of previous studies, which compared toddler biscuits and rusks to jam tarts and donuts.18

Results

Of the 186 baby and toddler foods analyzed, approximately 63% (118 products) could be classified as having high levels of sodium or a high proportion of calories coming from sugar (or both) (see Table 1).

Table 1

Summary of sodium and sugar content by product type

Type of product (number of items) Average sodium (mg) Average percentage of calories from sugar 
Puréed baby food ‘dinner’ (27) 48 19 
Puréed baby food ‘dessert’ (23) 19 48 
Toddler entrées or dinners (32) 244 13 
Snacks (67)a 26 30 
Cereals (37) 24 32 
Dinners combined (59)b 155 16 
Snacks, desserts and cereals combined (127) 24 34 
All of sample (186) 65 28 
Type of product (number of items) Average sodium (mg) Average percentage of calories from sugar 
Puréed baby food ‘dinner’ (27) 48 19 
Puréed baby food ‘dessert’ (23) 19 48 
Toddler entrées or dinners (32) 244 13 
Snacks (67)a 26 30 
Cereals (37) 24 32 
Dinners combined (59)b 155 16 
Snacks, desserts and cereals combined (127) 24 34 
All of sample (186) 65 28 

Notes: (1) 52% of products are high in sugar (i.e., more than 20% of the calories are from sugar).

(2) 12% of products are high in sodium (i.e., there is more than 130 mg per serving).

(3) three products are high in both sugar and sodium.

aIncludes biscuits, cookies, corn snacks, rice crackers/cakes, fruit snacks, yogurts.

bRefers to the combined results of both pureed baby foods (excluding desserts) and toddler entrées/dinners.

Focus on sodium

Just over 12% of products—all targeted at toddlers—contain more than 130 mg of sodium per serving, a level that (proportionally) represents >10% of the AI based on the IOM's recommended Dietary Reference Intakes for Water, Potassium, Sodium Chloride and Sulfate.19 Sixteen products contain more than 260 mg of sodium per serving, a level that (proportionally) represents about >25% of the AI—and 11 ‘high-sodium’ products contain over 400 mg per serving. Such products included toddler entrées and dinners, where 63% could be classified as containing high levels of sodium. Gerber's Graduates for Toddlers Lil' Entrées Macaroni and Cheese and its Graduates for Toddlers Lil' Entrées Chicken Pasta Wheel Pickups both exceed 500 mg sodium per serving. A toddler consuming just one of these products would ingest 55% of the AI for sodium and exceed a reasonable per meal intake. Table 2 details the top 20 of the 186 products surveyed when it comes to sodium.

Table 2

Top 20 products with highest sodium content

Brand Product Sodium (mg) 
Gerber Graduates for Toddlers Lil' Entrées (Chicken Pasta Wheel Pickups) 550 
Gerber Graduates for Toddlers Lil' Entrées (Macaroni and Cheese) 520 
Gerber Graduates for Toddlers Lil' Entrées (Cheese Ravioli in Tomato Sauce) 480 
Heinz Toddler Chicken Cacciatore 470 
Heinz Toddler Vegetables, Beef Pasta Casserole 470 
Gerber Graduates for Toddlers Lil' Entrées (Creamy Vegetables, Chicken and Noodles) 420 
Gerber Graduates for Toddlers Lil' Entrées (Mashed Potatoes with Roasted Chicken) 420 
Heinz Toddler Beef Stroganoff 420 
Heinz Toddler Turkey Rice with Vegetables 410 
Gerber Graduates for Toddlers Lil' Entrées Pasta in Meat Sauce 400 
Heinz Toddler Country Casserole with Chicken 400 
Heinz Toddler Cuisine (Chicken and Stars) 340 
Heinz Toddler Cuisine (Veggie Stew with Beef) 340 
Beech Nut Good Evening (Vegetable and Turkey) 310 
Beech Nut Let's Grow Tummy Trays Mac and Cheese 310 
Beech Nut Good Evening (Vegetables and Beef) 300 
Beech Nut Let's Grow Noodles with Vegetables and Chicken 200 
Beech Nut Let's Grow Tummy Trays Tomato Risotto 200 
Beech Nut Let's Grow Tummy Trays Spaghetti Rings with Meat Sauce 200 
Beech Nut Let's Grow Tummy Trays Vegetables and Beef 180 
Brand Product Sodium (mg) 
Gerber Graduates for Toddlers Lil' Entrées (Chicken Pasta Wheel Pickups) 550 
Gerber Graduates for Toddlers Lil' Entrées (Macaroni and Cheese) 520 
Gerber Graduates for Toddlers Lil' Entrées (Cheese Ravioli in Tomato Sauce) 480 
Heinz Toddler Chicken Cacciatore 470 
Heinz Toddler Vegetables, Beef Pasta Casserole 470 
Gerber Graduates for Toddlers Lil' Entrées (Creamy Vegetables, Chicken and Noodles) 420 
Gerber Graduates for Toddlers Lil' Entrées (Mashed Potatoes with Roasted Chicken) 420 
Heinz Toddler Beef Stroganoff 420 
Heinz Toddler Turkey Rice with Vegetables 410 
Gerber Graduates for Toddlers Lil' Entrées Pasta in Meat Sauce 400 
Heinz Toddler Country Casserole with Chicken 400 
Heinz Toddler Cuisine (Chicken and Stars) 340 
Heinz Toddler Cuisine (Veggie Stew with Beef) 340 
Beech Nut Good Evening (Vegetable and Turkey) 310 
Beech Nut Let's Grow Tummy Trays Mac and Cheese 310 
Beech Nut Good Evening (Vegetables and Beef) 300 
Beech Nut Let's Grow Noodles with Vegetables and Chicken 200 
Beech Nut Let's Grow Tummy Trays Tomato Risotto 200 
Beech Nut Let's Grow Tummy Trays Spaghetti Rings with Meat Sauce 200 
Beech Nut Let's Grow Tummy Trays Vegetables and Beef 180 

Note that 100% of these products are targeted at toddlers.

Focus on sugar

Sugar, the assessment shows, is of particular concern. Over half (53%) of the products examined derive more than 20% of their calories from sugar. Examples include puréed baby food desserts (87% contain high {↑} sugar), teething biscuits and cookies (24%, ↑ sugar), ‘fruit snacks’ and ‘yogurt nibbles’ (100%, ↑ sugar) and cereals (76%, ↑ sugar). In fact, 40% of products listed sugar—or some variant thereof (e.g. corn syrup, cane syrup, brown sugar, dextrose, fructose, etc.)—in the first four ingredients on the label. Even worse, 36 products listed sugar (or some variant) as either the first or second ingredient. Unlike the high sodium products, which are all designed for toddlers, 53% of the high-sugar foods specifically target babies. As Table 1 illustrates, baby food desserts were the highest ranked, with an average of 48% of calories coming from sugar.

High levels of sugar in baby and toddler foods warrant sustained scrutiny. Table 3 lists the items with the highest percentage of calories coming from sugar on a product-by-product basis, revealing that certain packaged foods contain up to 80% of calories from sugar. Some of these products, such as unsweetened apple pear blends or freeze-dried fruit, derive their sugar content from naturally occurring fruit sugars. Yet many products contain added sugars. For instance, Gerber's Fruit Medley Dessert (with added sugar) derives 75% of calories from sugar—and although such fruit-based ‘desserts’ will obviously derive some of those calories from fruit sugars, it remains fair to ask why it is necessary to add sugar to these baby or toddler products in the first place. Gerber's Graduates for Toddlers Juice Treats Fruit Snacks (in both Fruit Medley and Tropical flavors) derive just under 70% of their calories from sugar. These ‘treats’ list corn syrup and sugar as the first two ingredients (see Table 3).

Table 3

Top 20 products with highest percentage of calories from sugar

Brand Product Percentage of calories from sugar 
Gerber Graduates for Toddlers Mini Fruit (Apple) 80* 
Parent's Choice Little Fruit (Strawberry Banana) 80* 
President's Choice Organic Apple Banana Prune Blend for Toddlers 80* 
President's Choice Organic Unsweetened Apple Apricot Blend for Toddlers 80* 
President's Choice Toddlers' 100% Real Fruit Snack (Banana Mango) 80* 
President's Choice Unsweetened Apple Pear Blend for Toddlers 80* 
Gerber Fruit Medley Dessert 75 
Heinz 100% Fruit Bites (Banana Strawberry) 69* 
Heinz 100% Fruit Bites (Tropical Blends) 69* 
Heinz Apple Plum and Raisins 69* 
Gerber Graduates for Toddlers Juice Treats Fruit Medley 68 
Gerber Graduates for Toddlers Juice Treats Tropical 68 
Heinz Apricot Dessert 68 
Gerber Graduates for Toddlers Mini Fruit (Banana Strawberry) 67 
Heinz Apricot Dessert 67 
Heinz Toddler 100% Fruit Bites (Apple) 64* 
Heinz Heinz Strawberry Dessert 63 
Other Simply Kids Strawberry Dessert 63 
Parent's Choice Strawberry Dessert 63 
Heinz Blueberry Desert (Junior) 58 
Brand Product Percentage of calories from sugar 
Gerber Graduates for Toddlers Mini Fruit (Apple) 80* 
Parent's Choice Little Fruit (Strawberry Banana) 80* 
President's Choice Organic Apple Banana Prune Blend for Toddlers 80* 
President's Choice Organic Unsweetened Apple Apricot Blend for Toddlers 80* 
President's Choice Toddlers' 100% Real Fruit Snack (Banana Mango) 80* 
President's Choice Unsweetened Apple Pear Blend for Toddlers 80* 
Gerber Fruit Medley Dessert 75 
Heinz 100% Fruit Bites (Banana Strawberry) 69* 
Heinz 100% Fruit Bites (Tropical Blends) 69* 
Heinz Apple Plum and Raisins 69* 
Gerber Graduates for Toddlers Juice Treats Fruit Medley 68 
Gerber Graduates for Toddlers Juice Treats Tropical 68 
Heinz Apricot Dessert 68 
Gerber Graduates for Toddlers Mini Fruit (Banana Strawberry) 67 
Heinz Apricot Dessert 67 
Heinz Toddler 100% Fruit Bites (Apple) 64* 
Heinz Heinz Strawberry Dessert 63 
Other Simply Kids Strawberry Dessert 63 
Parent's Choice Strawberry Dessert 63 
Heinz Blueberry Desert (Junior) 58 

Notes: (1) 80% of these products are targeted at toddlers.

(2) the first six products have an identical percentage of calories from sugar, but some have higher absolute sugar content. All products are sorted by: relative sugar content, absolute sugar content and finally brand (alphabetically). Products five and six have identical sugar content in both relative and absolute terms.

Products flagged with a ‘*’ contain no added sugar.

Comparative analysis: baby/toddler foods versus adult equivalents

Table 4 summarizes the product-by-product comparison between specific baby/toddler foods and their adult equivalents. Surprisingly, the baby/toddler foods were not nutritionally superior, and in some cases fared worse (or were roughly equivalent to) the adult equivalents when it comes to sugar. Toddler cereal bars, such as Heinz and Parent's Choice brands, derive (on average) more calorie content from sugar. The teething biscuits/rusks analyzed contain (on average) almost the same proportion of calories from sugar as the adult-targeted Social Tea Biscuit (19% versus 20%). Although the adult fruit snack, Sun Rype's Fruit To Go, has considerably higher sugar levels than the average baby/toddler fruit snack analyzed, it also has slightly lower levels of sodium. Fruit To Go (Strawberry) has 5 mg of sodium per serving, representing 2.5% of the nominal per-serving sodium intake for people aged 9–50. Baby/toddler fruit snacks are very similar, containing (on average) 9 mg of sodium per serving, which represents 7% of the nominal per-serving sodium intake for toddlers. For yogurts, the average 63 mg of sodium per serving represents 48% of the nominal per-serving sodium intake for toddlers. This is higher than Danone Activia's adult-targeted yogurt which, with 50 mg of sodium per serving, represents a substantially lower 25% of the ‘nominal’ per-serving sodium intake for people aged 9–50 (see Table 4).

Table 4

Comparison of nutritional content between baby/toddler and adult products

Product type Percentage of per-serving sodium
 
Percentage of calories from sugar
 
 Baby/toddler Adult Baby/toddler Adult 
Cereal bars 20 45 37 35 
Cookies/biscuits 26 75 19 20 
Fruit snacks 72 88 
Yogurt 48 25 42 53 
Product type Percentage of per-serving sodium
 
Percentage of calories from sugar
 
 Baby/toddler Adult Baby/toddler Adult 
Cereal bars 20 45 37 35 
Cookies/biscuits 26 75 19 20 
Fruit snacks 72 88 
Yogurt 48 25 42 53 

Discussion

Main findings of this study

The significant health impact of dietary salt and added sugars means that it is vital to remain alert to their presence in our foods. This is particularly the case for babies and toddlers who are developing both in body and in taste preference. This study revealed that 63% of the baby and toddler food products surveyed can be classified as having high levels of sodium or a large proportion of calories coming from sugar (or both)—a surprising figure, particularly since one might expect the foods aimed at our youngest consumers to meet a gold standard when it comes to nutrition.

Sodium, overall, is not problematic: only 12% of baby and toddler food products contain moderate to high levels of sodium. Sugar levels were of greater concern. Over 53% of products surveyed offer high levels of sugar (>20% of calories), and some derive up to 80% of their calories from sugar. And when compared against adult equivalents, the baby/toddler foods were not nutritionally superior. In fact, toddler cereal bars and baby and toddler biscuits/cookies contained sugar levels either higher than, or nearly equivalent to, their adult counterparts, while toddler yogurts and baby/toddler fruit snacks had higher levels of sodium than their adult counterparts.

What is already known on the topic

In 2000, a small British Food Commission Survey of 22 products targeted at babies and toddlers warned that baby and toddler foods were too sugary;18 9 years later, The Children's Food Campaign examination of 107 products concluded that ‘many products are a lot less healthy than they may appear,’ and flagged ‘high levels of sugar and saturated fat, and the presence of trans fats’ as of ‘serious concern’.17 This present study of 186 products reveals that the earlier warnings pertaining to sugar in baby and toddler foods prove justified, and that sodium, while not overall problematic, might be monitored in certain categories (e.g. toddler entrées).

Limitations

Products in this study do not represent all foods targeted at babies and toddlers. Beverages were excluded, as were infant formulas. Also excluded were simple purées of vegetables and fruit, although this is more of a study design choice than a limitation since simple fruit/vegetable purées do not contain any added salt or sugar and, more importantly, the study was specifically interested in meals, snacks and desserts.

As previously mentioned, assessing the sodium and sugar levels in baby and toddler foods is challenging because there is currently no universally accepted standard. Moreover, product labels do not distinguish added sugars from naturally occurring sugars, which means that the Nutrition Facts table must be read at face value.

These challenges are equally recognized by other studies of a similar nature. Needing to rely on the Nutrition Facts table, it should be noted, is something that consumers must also do.

What this study adds

High levels of sodium or sugar are not merely issues of AI or UL or even recommended intake levels. Equally bound up in these cut-offs pertaining to health outcomes are the ways such products steer our youngest consumers down the wrong path in terms of developing tastes for sweet and salty. Highly palatable foods stimulate the taste, and desire, for more highly palatable foods;34 as David Kessler, a former commissioner of the Food and Drug Administration, argues in The end of overeating, ‘American industrial food is meant to stimulate,’ not satisfy.34 In fairness, only 12% of baby and toddler food products contain moderate to high levels of sodium, but over 53% offer high levels of sugars (>20% of calories), and it remains important to monitor the particular product categories that work to ‘stimulate’ an early age. Particular irony resides in the fact that public policy initiatives are underway to put recommended limits on the consumption of added sugars for adults2 and also to encourage consumers to adjust their taste buds to lower sodium levels in packaged foods1—all while some products aimed at babies and toddlers work to encourage children to develop a taste for sugar and salt. Comparing particular baby and toddler food products with their adult counterparts reveals that it is wrong headed to presume a ‘halo effect’ around products specifically intended for very young children.

The significant health impact of dietary salt and added sugars means that it is critical to remain alert to their presence in our foods. This study, as noted, seeks to fill an important research gap by examining the processed foodstuffs specifically targeted at our youngest consumers. Profiling the prevalence of ‘sweet’ and ‘salty’ in baby and toddler foods suggests that it might be useful to consider revisiting sodium regulations in light of certain (newer) sub-categories of foods (i.e., toddler entrées), as well as the added sugars allowed in the range of cookies, biscuits and desserts targeted at very young children. As Joan Dye Gussow observed in The Feeding Web, ‘[c]hildren … like everyone else, eat what the culture makes acceptable to them’:35 this can stand as a reminder to ensure that the ‘acceptable’ foods are held to the highest of standards.

Overall, 63% of the products surveyed can be classified as having high levels of sodium or a large proportion of calories coming from sugar (or both)—a surprising figure, particularly since one might expect the foods aimed at our youngest consumers to meet a gold standard when it comes to nutrition.

Funding

This work was supported by a Center for Science in the Public Interest (CSPI) Research Grant [1013133]. Note: CSPI did not provide any input on the design, focus, or execution of the study, nor did CSPI provide input regarding the collection, analysis or interpretation of data, or the manuscript preparation. The views presented are solely those of the author.

Acknowledgements

The author thanks Dr. Martin Conlon for feedback on the project, and graduate students Brenda McDermott and Ray M'Optland for their excellent contributions to coding and data checking.

References

1
Jeffery
B
Cappello
N
‘Salty to a fault’: survey of 318 foods shows that many are too high in salt
2009
Ottawa, ON
Center For Science in the Public Interest
2
Johnson
RK
Appel
LJ
Brands
M
, et al.  . 
Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association
Circulation
 , 
2009
, vol. 
120
 (pg. 
1011
-
20
)
3
Shaking salt and sugar from your diet
2008
, vol. 
20
 
1
(pg. 
8
-
9
Consumer Reports Health
4
Health Canada
Sodium targets for Canadian Foods—Information on upcoming meetings
2009
 
[Email correspondence]
5
Flegel
K
Magner
P
He'bert
PC
, et al.  . 
Get excess salt out of our diet
Can Med Assoc J
 , 
2009
, vol. 
180
 
3
pg. 
263
 
6
Barr
S
Reducing dietary sodium intake: the Canadian context
Appl Physiol Nutr Metab
 , 
2010
, vol. 
35
 (pg. 
1
-
8
)
7
Lanigan
J
Turnbull
B
Singhal
A
Toddler diets in the UK: deficiencies and imbalances. 2. Relationship of toddler diet to later health
J Family Health Care
 , 
2007
, vol. 
17
 
6
(pg. 
197
-
201
)
8
Skinner
JD
Carruth
BR
Bounds
W
, et al.  . 
Children's food preferences: a longitudinal analysis
J Am Dietetic Assoc
 , 
2002
, vol. 
102
 (pg. 
1638
-
47
)
9
Birch
LL
Development of food acceptance patterns in the first year of life
Proc Nutr Soc
 , 
1998
, vol. 
57
 (pg. 
617
-
24
)
10
Williamson
C
Nutrition for toddlers: practical advice to give parents
J Fam Health Care
 , 
2006
, vol. 
17
 
1
(pg. 
19
-
22
)
11
Maurer
AD
Chen
Q
McPherson
C
, et al.  . 
Changes in satiety hormones and expression of genes involved in glucose and lipid metabolism in rats weaned onto diets high in fibre or protein reflect susceptibility to increased fat mass in adulthood
J Physiol
 , 
2009
, vol. 
587
 (pg. 
679
-
91
)
12
Health Canada
Sodium targets for Canadian Foods—Appendix A: food categories and example of sodium reduction targets
2009
 
[Email correspondence]
13
Harris
JL
Schwartz
MB
Brownell
KD
, et al.  . 
Cereal FACTS: evaluating the nutrition quality and marketing of children's cereals
2009
 
Report, Yale University, Rudd Center for Food Policy and Obesity
14
Consumer Reports
Better Breakfasts
2008
, vol. 
73
 
11
(pg. 
16
-
7
)
15
Elliott
CD
Marketing fun food: a profile and analysis of supermarket food messages targeted at children
Can Public Policy
 , 
2008
, vol. 
34
 
2
(pg. 
259
-
74
)
16
Elliott
CD
Assessing fun foods: nutritional content and analysis of supermarket foods targeted at children
Obes Rev
 , 
2008
, vol. 
9
 (pg. 
368
-
77
)
17
Haigh
C
Schneider
J
Junk food for babies? An investigation into foods marketed for babies and young children
2009
 
Report, Sustain, Children's Food Campaign
18
Sugar horror in baby bikkies
The Food Magazine
 
19
Institute of Medicine
Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate.
 , 
2005
Washington
IOM
20
Proulx
JR
Clarification re: amount of sodium per serving in a purchased product
Can Med Assoc J
 , 
2009
, vol. 
180
 
3
pg. 
263
 
21
Health Canada and Statistics Canada
Canadian Community Health Survey, Cycle 2.2, Nutrition (2004) Nutrient Intakes from Food Provincial, Regional and National Summary Data Tables
2008
, vol. 
Volume 1
 
22
McGinnis
JM
Gootman
J
Kraak
V
Food Marketing to Children and Youth: Threat or Opportunity?
2009
Washington, DC
National Academies Press
23
Lobstein
T
Davies
S
Defining and labelling ‘healthy’ and ‘unhealthy’ food
Public Health Nutr
 , 
2008
, vol. 
12
 
3
(pg. 
331
-
40
)
[PubMed]
24
Harrison
K
Marske
A
Nutritional content of foods advertised during the television programs children watch most
Am J Public Health
 , 
2005
, vol. 
95
 
9
(pg. 
1568
-
74
)
25
Gantz
W
Schwartz
N
Angelini
JR
, et al.  . 
Food for thought: television food advertising to children in the United States
2007
 
Report, Menlo Park, CA: Kaiser Family Foundation, Program for the Study of Media and Health
[PubMed]
26
Bell
RA
Cassady
D
Culp
J
, et al.  . 
Frequency and types of foods advertised on saturday morning and weekday afternoon English- and Spanish-language American Television Programs
J Nutr Educ Behav
 , 
2009
, vol. 
41
 
6
(pg. 
406
-
13
)
27
Gidding
SS
Dennison
BA
Birch
LL
, et al.  . 
Dietary recommendations for children and adolescents. A guide for practitioners: consensus statement from the American Heart Association
Circulation
 , 
2005
, vol. 
112
 (pg. 
2061
-
75
)
28
Birch
LL
Children's food acceptance patterns
Nutr Today
 , 
1996
, vol. 
31
 
6
(pg. 
234
-
40
)
29
Skinner
JD
Carruth
BR
Bounds
W
, et al.  . 
Do food-related experiences in the first 2 years of life predict dietary variety in school-aged children?
J Nutr Educ Behav
 , 
2002
, vol. 
34
 (pg. 
310
-
5
)
30
Horgen
KB
Choate
M
Brownell
KD
Singer
DG
Singer
JL
Television food advertising: targeting children in a toxic environment
Handbook of Children and the Media
 , 
2001
Thousand Oaks, CA
Sage
 
editors
31
Wadden
TA
Brownell
KD
Foster
GD
Obesity: Responding to the Global Epidemic
J Consult Clini Psychol
 , 
2002
, vol. 
70
 
3
(pg. 
510
-
25
)
32
Reverdy
C
Schlich
P
Köster
EP
, et al.  . 
Effect of sensory education on food preferences in children
Food Quality and Preference
  
advance access publication 23 March 2010
33
Fitzhugh
K
Lobstein
T
Children's Food Examined: An Analysis of 358 Products Targeted at Children.
 , 
2000
London, UK
The Food Commission
34
Kessler
DA
The End of Overeating: Taking Control of the Insatiable American Appetite.
 , 
2009
New York, NY
Rodale
35
Gussow
JD
The feeding web: issues in nutritional ecology
1978
Boulder, CO
Bull Publishing Company