Public Consultation: Improving commercial foods for infants and young children

Both the Australian Infant Feeding Guidelines and the New Zealand Healthy Eating Guidelines for Babies and Toddlers (0-2 years old) advise that if consuming commercially prepared foods, these should only be consumed from time to time and over-reliance on these products may reduce the variety of flavours and textures in a baby’s diet. The guidelines also advise that special complementary foods or milks are not required for young children and discretionary foods are not recommended due to infants’ and young children’s high nutrient needs relative to their energy requirements. The New Zealand Guidelines also specify that commercial teething biscuits (often called rusks) contain salt and sometimes sugars, so a teething ring or cold flannel/washcloth is a better option.

Evidence from Australia and New Zealand suggest consumption of commercial infant and toddler foods is commonplace. The Victorian Royal Children’s Hospital survey of caregivers of infants and young children (aged 4 month -<5 years) found that 1 in 5 (19%) of babies and young children eat commercially prepared ready-made foods most days of the week. For 2 in 5 (39%) babies and young children, ready-made foods made up at least half of their meals and snacks, and for 22% these products made up most or all of their diet.

The FFNZ study reported that 28% of infants (aged 7 to 10 months) surveyed frequently consumed commercial pouch foods. Usage appears to decline in older age, with only 11.1% of children surveyed in the Young Foods New Zealand Study (YFNZ) aged 1 to 3.9 years considered ‘frequent’ users, and of these children 65% always consumed the pouch from the nozzle. These findings are consistent with surveys in other high-income countries that found around 40 – 60% of infants consume commercial foods for infants, and that usage generally peaks at age 6 – 12 months.

The Nutrient Reference Values for Australia and New Zealand set out recommended intakes and limits for various vitamins and minerals, as well as energy, carbohydrate, and protein.

Australia
Studies from Australia suggest generally adequate nutrient intake among infants and young children, with an exception of the 2021 OzFits study which found a high proportion (90%) of infants, and a moderate proportion (25%) of young children did not meet the Estimated Adequate Require (EAR) for iron, and 20% of infants did not meet the EAR for zinc. The high prevalence of inadequate iron intake could indicate population risk of iron deficiency among Australian infants and young children. However, the authors note that, compared to other life stages, the EARs for iron and zinc are very high, and inadequate intakes are frequently reported for this age group in other high-income countries. It should also be noted that other studies have reported a lower, although in some cases still moderate, prevalence of inadequate iron and zinc intake among infants and young children in Australia.

Further, while there is a lack of recent data on the prevalence of iron deficiency in Australian children aged 6 months to 2 years old, studies conducted in the late 1990s found a high proportion of infants and young children with sufficient blood iron levels. However, there was significantly less reliance on commercial foods for infants and young children at the time these studies were conducted. These findings may not be applicable to Aboriginal and Torres Strait Islander people given several studies have reported concerning prevalence of anaemia in infants and young children.
While the cause of anaemia in Aboriginal and Torres Strait Islander populations is thought to be multi-factorial, inadequate intake of iron rich foods has been identified as a contributing factor. This is consistent with reportedly low dietary iron intake among young Aboriginal and Torres Strait Islander children.

Several studies have also reported excessive sodium intake among young children in Australia. Studies reporting on the main sources of sodium identified family foods, such as breads, cereals and cheese, as the largest contributors to sodium intake. In one study, discretionary foods accounted for approximately 35% of sodium intake. It is not reported whether the cereals, dairy or discretionary foods were commercial foods aimed at young children, or foods for the broader consumer base.

New Zealand
The New Zealand FFNZ and YFNZ studies are currently analysing the dietary intake data of infants and young children. An early paper from this study looking at the contribution of commercial infant foods to the diets of infants aged 6.9-10.1 months, showed that almost half of the infants surveyed consumed a baby food pouch on the day of recall. These pouches contributed 25.5% to total energy, less than 1% added sugar and greater than 30% carbohydrate and total sugars consumed from complementary foods that day. More broadly, in those infants that consumed any commercial infant foods, these foods contributed 21% to total energy and 40% of iron from complementary foods consumed that day.

Another paper from the FFNZ study investigated iron status in infants, with the estimated prevalence of iron deficiency found to be 14%. The prevalence of iron deficiency anaemia was 3%. The study also looked at the effect of feeding methods (frequency of pouch use vs baby-led weaning) on iron status, finding neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency.
A separate study conducted between May 2019 and May 2020 with New Zealand infants found that 92% of the study group had sufficient blood iron levels at 9 months of age.

The Nutrient Reference Values for Australia and New Zealand set out recommended intakes and limits for various vitamins and minerals, as well as energy, carbohydrate, and protein.

Australia
Studies from Australia suggest generally adequate nutrient intake among infants and young children, with an exception of the 2021 OzFits study which found a high proportion (90%) of infants, and a moderate proportion (25%) of young children did not meet the Estimated Adequate Require (EAR) for iron, and 20% of infants did not meet the EAR for zinc. The high prevalence of inadequate iron intake could indicate population risk of iron deficiency among Australian infants and young children. However, the authors note that, compared to other life stages, the EARs for iron and zinc are very high, and inadequate intakes are frequently reported for this age group in other high-income countries. It should also be noted that other studies have reported a lower, although in some cases still moderate, prevalence of inadequate iron and zinc intake among infants and young children in Australia.

Further, while there is a lack of recent data on the prevalence of iron deficiency in Australian children aged 6 months to 2 years old, studies conducted in the late 1990s found a high proportion of infants and young children with sufficient blood iron levels. However, there was significantly less reliance on commercial foods for infants and young children at the time these studies were conducted. These findings may not be applicable to Aboriginal and Torres Strait Islander people given several studies have reported concerning prevalence of anaemia in infants and young children.
While the cause of anaemia in Aboriginal and Torres Strait Islander populations is thought to be multi-factorial, inadequate intake of iron rich foods has been identified as a contributing factor. This is consistent with reportedly low dietary iron intake among young Aboriginal and Torres Strait Islander children.

Several studies have also reported excessive sodium intake among young children in Australia. Studies reporting on the main sources of sodium identified family foods, such as breads, cereals and cheese, as the largest contributors to sodium intake. In one study, discretionary foods accounted for approximately 35% of sodium intake. It is not reported whether the cereals, dairy or discretionary foods were commercial foods aimed at young children, or foods for the broader consumer base.

New Zealand
The New Zealand FFNZ and YFNZ studies are currently analysing the dietary intake data of infants and young children. An early paper from this study looking at the contribution of commercial infant foods to the diets of infants aged 6.9-10.1 months, showed that almost half of the infants surveyed consumed a baby food pouch on the day of recall. These pouches contributed 25.5% to total energy, less than 1% added sugar8 and greater than 30% carbohydrate and total sugars consumed from complementary foods that day. More broadly, in those infants that consumed any commercial infant foods, these foods contributed 21% to total energy and 40% of iron from complementary foods consumed that day.

Another paper from the FFNZ study investigated iron status in infants, with the estimated prevalence of iron deficiency found to be 14%. The prevalence of iron deficiency anaemia was 3%. The study also looked at the effect of feeding methods (frequency of pouch use vs baby-led weaning) on iron status, finding neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency.
A separate study conducted between May 2019 and May 2020 with New Zealand infants found that 92% of the study group had sufficient blood iron levels at 9 months of age.

Australia
Studies of Australian commercial foods for infants and young children have identified poor alignment with some aspects of dietary recommendations. The main areas of concern were related to iron, sweet flavour/sugar content, sodium content and texture.

Iron – Most products surveyed were poor sources of iron and few declared iron content, except for fortified cereals and snack foods. Some fortified cereals and finger foods and snack products declared iron content, however, these products accounted for a very small proportion of infant and young children foods available. For example, Moumin et al found only 12% of products surveyed declared iron content. The authors also identified that based on the declared meat content of commercial mixed main dishes, these products on average would provide only 2% of the recommended dietary intake of iron for infants aged 7 – 12 months.

This is consistent with findings from the database of commercial foods for infants and young children developed by The George Institute for Global Health and the Department of Health and Aged Care through the work of the Foods for Early Childhood Reference Group. The database showed only 9% of products were fortified with iron and only 6% included an iron claim. Fortification primarily occurred in the dry cereals (100%9) and finger foods and snacks (27%) categories, with only 8% of breakfast foods and 1 product in the dairy category being fortified. No main meals, drinks or fruit and vegetable based first foods were fortified. All products that were fortified with iron contained an iron-claim, except for the finger foods and snacks category where only 1 in 2 (48%) iron fortified products included a claim.

The Department of Health and Aged Care also conducted an analysis of the presence of iron-rich ingredients in main meals and breakfast food products based on the Dietitian’s Australia list of iron-rich foods. This analysis revealed less than a third (29%) of products in the main meals category, and under half (45%) of breakfast foods contained one or more iron-rich ingredient. The amount of iron provided from these foods was low, with no unfortified products having sufficient iron to make a claim.
Sweet flavour profile – Commercial foods for infants and young children frequently contained fruit ingredients such as purees as the primary ingredient. Where vegetables were present, they were often sweeter varieties such as carrot and sweet potato, or they were mixed with free sugars10. As a result, commercial foods were found to frequently have sweet profiles and contain added and/or free sugars. Australian surveys estimated between 40 – 75% of products contained added or free sugars.

Sodium content – Foods for young children were reported to contain above recommended sodium levels. Scully et. al. reported only 38% of toddler/young children foods surveyed were compliant with recommendations in the WHO Europe Nutrient Profile Model for Commercially Available Complementary Foods.
 

New Zealand
Two cross-sectional studies have analysed commercial foods for infants and toddlers in New Zealand and identified similar compositional and textural concerns as Australian products. These studies reported:

• The iron content of all forms of infant foods was very low, except for prepared “dry cereals” which were fortified with iron
• Most infant and young children foods had a sweet profile, were based on fruit, and generally contained sweet over bitter tasting vegetables 
• A considerable proportion (34%) of products surveyed contained added sugars
• Infant food pouches contained similar median amounts of energy, iron, and vitamin B12 to other forms of commercial infant foods but contained considerably more total sugars (8.4 g/100 g vs. 2.3 g/100 g).
• There was limited texture diversity among wet ‘spoonable’ products with the majority having low textural complexity (smooth, puréed, super smooth). Textural complexity increased along the age gradient for savoury (vegetable, meat, or poultry-based meals) but not for fruit-based meals and breakfasts.

Surveys conducted in Australia suggest that there are limited products that support texture progression even when marketed towards older infants. The survey by Moumin et. al. found almost half of all products aimed at infants 8 months and older were packaged in squeeze pouches and were predominantly smooth pureed foods. In another survey of pouch products only, Brunacci et. al. found almost 90% of products surveyed were categorised as smooth, and only 30% of products marketed as suitable for infants aged 8 months an older were of a developmentally appropriate lumpy texture.

New Zealand studies found limited texture diversity among wet ‘spoonable’ products with the majority having low textural complexity (smooth, puréed, super smooth). Textural complexity increased along the age gradient for savoury (vegetable, meat, or poultry-based meals) but not for fruit-based meals and breakfasts.