Balanced diet is best for healthy children
For infants younger than 12 months, the AAP recommends that the liquid portion of the diet should come from human milk or a standard infant formula that has been reviewed by the FDA based on the Infant Formula Act, Dr. Fuchs said.
Children aged 12 months or older should receive a varied diet with fortified foods. Formula can safely be used as part of a varied diet; however, it offers no nutritional advantage for most children over a well-balanced diet that includes human milk and/or cow milk, “and should not be promoted as such,” Dr. Fuchs noted.
“The category of these toddler drinks has grown and the landscape has changed quite a bit; we thought it was appropriate that we review this category,” Dr. Fuchs said in an interview.
Dr. Fuchs advised pediatricians in practice to follow the AAP’s guidance for breastfeeding infants if possible and progression to formula as needed for infants up to age 1 year, followed by transition to cow milk (or alternatives for those with cow milk allergies) and the addition of a healthy mixed diet.
Formula choices pose practice challenges
In an interview, Cathy Haut, DNP, CPNP-AC, CPNP-PC, a pediatric nurse practitioner in Rehoboth Beach, Del., pointed out that not only are parents often baffled by formula choices, but many are also hesitant to make a switch to regular milk as children get older because they worry that cow’s milk is inadequate for nutrition or is not as “clean” or “sterile” as formula.
In some cases, parents may have had difficulty in acquiring genuine infant formulas, which were relocated to locked cabinets in stores during recent shortages and began using toddler formulas as an alternative for infants younger than 1 year, she added.
“If breastfeeding is not possible, using approved infant formula is preferred, switching to whole cow milk at 1 year of age,” she said. “Nutritional assessment is an important part of well-child visits, with caregiver counseling regarding importance of intake of variety of fortified foods [that] offer vitamins, calcium, iron and zinc,” Ms. Haut added. Although toddler formulas are safe additions to the diets of most young children older than 1 year, supplementation of specific nutrients such as vitamin D if needed is a more effective option, she said.
“National health studies indicate that U.S. toddlers have nutritional gaps in their diet often related to picky eating,” an Abbott spokesperson said in an interview. “When [toddlers] don’t do well transitioning to table foods or won’t drink milk, our toddler drinks contain many of the complementary nutrients, such as vitamins and minerals, that they may be missing in their diet. Toddler drinks may be an option to help fill nutrient gaps for these children 12-36 months of age. Abbott does not recommend or indicate its toddler drinks for infants under 12 months of age,” according to the company.
Dr. Fuchs had no financial conflicts to disclose. Dr. Haut had no financial conflicts to disclose.
A version of this article first appeared on Medscape.com.