With new dietary guidelines on the horizon for the youngest children, new research examines harmful marketing practices aimed at getting babies and toddlers hooked on sugary drinks
Earlier this month, an advisory committee released an assessment of nutrition science that will inform the upcoming 2020 Dietary Guidelines for Americans. Updated every five years by the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS), the guidelines provide advice to everyone in America, and act as the foundation for several key federal nutrition programs.
For the first time, those guidelines will include nutrition advice for children from birth to two years of age. One of the conclusions of the advisory committee is that infants and toddlers under age 2 should avoid drinking sugar-sweetened beverages, a recommendation supported by leading health organizations.
Health experts currently recommend breastfeeding until a child is at least one year old, and from about 6 months, teaching children to eat a healthy family diet, including a variety of fruits and vegetables and plain water and milk to drink.
Yet, many caregivers find it difficult to implement this advice—from the many challenges of breastfeeding to picky toddlers whose favorite word is “no.” Often conflicting advice from family, friends, pediatricians, social media and others confuses things even more.
But formula manufacturers claim to offer the solution: Infant formula that is “closest to breastmilk” and milk-based drinks for toddlers (known as toddler milk or toddler formula) that claim to promote young children’s nutrition, development and growth. These claims, however, directly contradict expert recommendations and are not backed by scientific evidence.
Furthermore, companies spend a lot of money in marketing to convince parents that they have young children’s best interests in mind. And according to recent research from the Rudd Center for Food Policy and Obesity at the University of Connecticut, these marketing claims work. Sixty percent of toddler caregivers surveyed agreed with unsupported claims that toddler milk provides nutrition toddlers don’t get in other foods.
Researchers recently took a closer look at infant formula and toddler milk marketing claims and how they influence caregivers. Their study, which was funded by the Robert Wood Johnson Foundation, surveyed 1,645 U.S. parents and other primary caregivers of infants and toddlers to measure their agreement with common marketing claims on these toddler drinks, identify products they served their child, and assess the relationship between agreement with claims and whether they served the products to their child.
We talked to Jennifer Harris, PhD, MBA, one of the study’s authors and a senior research advisor, marketing initiatives, at the UConn Rudd Center, to find out more about their findings—and what the implications are for young children’s health. Harris is also an author of a research brief published by Healthy Eating Research that examines opportunities to address some of the harmful marketing practices behind these drinks.
1. What’s so important about infant and toddler nutrition?
The infant and toddler years are a critical period for developing healthy eating habits. What a child eats at ages 1 to 3 can have an enormous effect on their preferences for healthy foods and beverages for the rest of their lives. Unfortunately, the diets of most American toddlers aren’t as healthy as they should be. They often include added sugar, including sugary drinks like fruit drinks. And we know that sugary drinks can lead to many long-term health risks, including obesity, diabetes and other chronic diseases.
Teaching young children to enjoy eating a variety of healthy foods takes time and perseverance, and many parents worry that their young child isn’t eating enough. That’s an opportunity that companies have seized upon with toddler drinks – they seem to promise parents a simple solution to getting their child to eat more and get better nutrition. In focus groups, parents have told us that they provide toddler milks to fill a gap in their child’s nutrition when they don’t eat enough healthy fruits and vegetables.
2. What are toddler drinks and why don’t experts recommend giving them to young children?
Everyone has probably heard of infant formula, but the idea of toddler drinks is a fairly new one. With increasing breastfeeding rates (and associated declines in infant formula sales), formula companies needed to find new ways to grow their business, so they invented a new product –a “formula” for young children who are too old for infant formula. In 2015, manufacturers in the United States spent $17 million to advertise toddler milks, a four-fold increase from 2006.
There are two kinds of toddler drinks – both are marketed as the “next step” after infant formula. “Toddler milks” are labeled as a nutritional drink for 1 to 3-year-olds. Another type – “transition formulas” – are marketed for infants and toddlers from 9 to 18 or 24 months.
Both raise substantial concerns among health and nutrition experts. Toddler milks consist of non-fat powdered milk, vegetable oil and added sugar (like corn syrup solids). Since they are a sweet milk drink, serving them can actually backfire and make it more difficult to teach young children to like the taste of healthy drinks, such as plain unsweetened milk or water. Plus they can cost four times as much as plain milk, which experts recommend for children this age.
Transition formulas are actually the same ingredient composition as infant formula, which is not appropriate for children over 12 months — but companies market them for the “transition” from infant formula to the family diet for children up to 18 or 24 months old.
The marketing of toddler drinks is extremely effective, though. Toddler milks are the fastest growing “formula” category. Here in the United States, the volume of sales of toddler milks increased by 133% from 2006 to 2015. And worldwide, their sales increased by more than 50% from 2008 to 2013.
3. What are some of the main marketing claims about infant formula and why are they a problem?
Infant formula is an important option for many families, particularly those who cannot or choose not to breastfeed. But infant formula marketing implies that these products provide health and nutritional benefits for infants above and beyond breastmilk. Packages claim that product formulations reduce gas or fussiness, provide DHA for brain development, or prebiotics for baby’s immune system—but none of these so-called benefits are backed by scientific evidence.
Despite this lack of scientific support, 52% of infant caregivers agreed that infant formula is better for babies’ digestion and brain development and 61% agreed that it can provide nutrition not present in breastmilk. Furthermore, 71% indicated that infant formula claims mean that infant formula is as good as breastmilk for babies. And that directly contradicts child nutrition experts and substantial research demonstrating that breastmilk is superior for infants up to a year.
We’ve also seen research that shows continued widespread marketing of infant formula directly to American consumers. In addition to traditional advertising on TV and in magazines, companies provide free infant formula to new parents in the hospital and pediatrician offices, provide free formula to mommy bloggers to write about the formula they give their own child, and offer feeding advice for each stage of babies’ development on company websites. These are just a few examples of a marketing strategy to position formula companies as “experts” on the nutrition and health of babies.
4. What about for toddler milks?
Similarly, toddler milk marketing claims many benefits for young children’s nutrition, cognitive development and growth that are not supported by scientific evidence—such as “DHA and iron to support brain development”, “Lutein like that found in spinach for eyes,” or “prebiotics to help support digestive health.” And caregivers believe these claims. In our research, 60% of those surveyed agreed that toddler milks provide nutrition not available in plain milk or other foods. These marketing claims even imply that toddler milks are necessary for toddlers to have correct nutrition—which approximately a third of parents believed.
Another issue with toddler milk marketing is that parents find it difficult to tell the difference between infant formula and toddler drinks. The packages look very similar, with the same or similar brand names, colors and package shapes, and they are often stocked side-by-side on store shelves. Toddler milks are also less expensive than infant formula. But what’s in them is very different, and in fact it can be dangerous to serve toddler milk to infants because the ingredients don’t meet their nutritional requirements. We found that 11% of infant caregivers mistakenly served a toddler milk most often to their child.
5. Are there any notable differences either in who is exposed to this kind of marketing, or how people respond to it?
We think our research demonstrates how incredibly powerful marketing can be. For example, we found that even though 80% of our study participants agreed with expert recommendations to serve breastmilk to infants and plain whole milk to toddlers, the majority of them still agreed with common marketing claims that compare infant formula favorably to breastmilk and toddler milk to healthy foods. And when caregivers believed these claims, they were significantly more likely to serve infant formula or toddler milk to their children.
Furthermore, our research indicated that higher levels of education didn’t lead to a decreased likelihood to believe marketing claims. In fact, it was the opposite—caregivers with a college degree were more likely to agree with such claims and serve toddler milks to their children.
Some brands of toddler milks are also advertised extensively in Spanish-language media. However, we found that Hispanic and non-Hispanic parents were equally likely to provide toddler milks to their children.
6. What can be done from a policy perspective about the marketing of transition formula and toddler milk, both in the United States and abroad?
In the U.S, infant formula is highly regulated by the FDA, but there are still some loopholes. For example, most claims on infant formula qualify as “nutrition” or “structure function claims”, meaning that they link a product ingredient with a bodily function (e.g., “lutein for eyes”). Unlike health claims, these types of claims do not require significant scientific agreement and preapproval by the FDA. Furthermore, there are no specific requirements for toddler drink labels, product names or formulations. That needs to change. There should be regulation of the marketing of infant formula and toddler drinks and improved product labelling. There should also be stricter FDA requirements for all claims on foods intended for children under the age of 3.
In fact, a group of 30 public health experts, including the UConn Rudd Center, recently petitioned the FDA to establish regulations for labeling products sold as toddler milks. The petition asks FDA to develop regulations so that caregivers are not misled
Globally, the World Health Organization’s International Code of Marketing Breastmilk Substitutes directly prohibits all marketing of infant formula and toddler drinks directly to consumers, as well as other forms of marketing. The United States is one of only six countries that has not enacted any regulations to limit infant formula or toddler drink marketing in any way.
That would be an important step toward ensuring that caregivers are able to make the best decisions about feeding their child – without influence from the millions that companies spend in marketing to directly contradict child health expert recommendations. Our research shows that this marketing misleads parents and benefits only companies’ bottom-line.
What comes next: USDA and HHS will hold a public meeting on their assessment on August 11 and take public comments until August 13. Members of the public can submit comments.