Series on todders and nutrition

20 July 2017
child eating

A special edition of the journal Nutrition Today explores good nutrition for toddlers, in particular the role of sugar in the diet of today’s youngsters.

The special edition includes a range of articles which explore toddler feeding, the development of palate preferences, the intake of added sugars, the oral and dental health considerations, and the impact of caregiver and child feeding behaviours.

The introduction to the edition states that the diet and behavior of toddlers can set them on the pathway to optimal health and reduce the burden of obesity and other chronic degenerative diseases in adulthood.

It says that in recent years, sugar has become one of the most contentious topics in nutrition, in particular the role of “added” or “free” sugars rather than “naturally occurring” sugars found in fruits, vegetables, and milk.

Articles in the series include:

  • A Perspective: Toddler feeding, science and nutrition policy

A discussion of the role food plays in the lives of infants and children, aside from nutrition. In infancy, food can sometimes be a milestone and sometimes be a stressor.  

Toddlers view food as play and may use it to develop a sense of autonomy, and begin to develop specific preferences about what foods agree or do not agree with them (ie, pickiness).

  • Developmental readiness, caregiver and child feeding behaviours and sensory sciences as a framework for feeding young children

Very little consideration has been given to how foods actually taste to young children, but new research shows how multiple senses coordinate to tailor child taste preferences.

This article also raises the question of whether adding small amounts of sugar to bitter-tasting foods such as vegetables could help toddlers accept these foods, even when the sugar is subsequently reduced or removed.  More research is needed to establish whether this strategy would be effective in the long term, and if so, on how to effectively communicate it to caregivers.

The authors say for parents and caregivers, food presents a simultaneous opportunity to improve health and set a course for a healthy relationship with food, but it can also create stress and anxiety because feeding occasions become a dreaded routine of the day.

  • Intake of added sugars during the early toddler period

The World Health Organization (WHO) suggests less than 10% of total energy from “free” sugars among children (and adults) to prevent dental caries and excessive weight gain.

This article examines data which shows that added sugars provided an average of 8.4% of energy for toddlers and that the leading source was sweetened fruit juices and fruit-flavored drinks.

The researchers also note that added sugar intakes increased progressively across the second year of life, from approximately 6% in those aged 13 to 15 months to almost 12% in those aged 22 to 24 months.

They says this suggests that the second year of life may be a key period for educating parents and caregivers about potential risks of excessive added sugars intake.

  • Characterising the dietary landscape of children 12 to 35 months

This article examines data on toddler food intake and determines that added sugars provided an average of 10% of energy intake in the diets of toddlers aged 12 to 35 months.

The authors also found that 100% fruit juice provided an average of 6% of total energy. Furthermore, among the 53% of toddlers who consumed 100% fruit juice on the day of the recall, 100% fruit juices provided an average of approximately 11% of total energy. In other words, fruit juice alone led these children to exceed the WHO recommendation of less than 10% of energy as “free” sugars.

  • Oral and dental health considerations in feeding toddlers

This article explores concerns about added sugars in young children and the risk of dental caries. It provides insights around the timing of sugar exposure relative to the number of cariogenic exposures and looks at the combinations of other nutrients with sugars (eg, bacterial interactions in the mouth) which are more likely to promote caries than simply the amount of sugar.

The researchers also emphasise that naturally occurring and added sugars are equally cariogenic and that fluoridation and oral hygiene are key elements to prevent caries.

  • Influences on the initial dietary pattern among children from birth to 24 months

This article looks at the importance of establishing sound nutrition practices from infancy to promote a lifelong healthy dietary pattern. This is particularly salient in an environment where obesity is a concern.

Accordingly, limiting the intake of foods/beverages that provide large amounts of added sugars and little, if any, other nutrients makes intuitive sense. What is less clear is whether efforts to substantially limit added/free sugars (eg, the WHO conditional recommendation that free sugars comprise <5% of energy) in infancy and early childhood will lead to long-term improvement in health or whether it is possible that a more nuanced approach could be used to build a strong foundation for lifelong healthy eating.

You can read all of the articles on toddler nutrition here.