Toddler milk

Toddler milk is powdered cows’ milk fortified with vitamins and minerals. It’s marketed for children one year or older and manufacturers claim the milk’s specially formulated to ensure your growing child gets all the nutrients they need.

The milk is sold in cans that look like infant formula (see 1-2-3 and more) with similar brand names and marketing claims. But some health care professionals and breastfeeding advocates say the milk has been developed to get around the World Health Organization’s International Code of Marketing of Breast-milk Substitutes.

Do they need it?

Toddler milk cans are splashed with claims such as “supports healthy digestion”, “more than just cows’ milk” and “specially formulated with age-appropriate vitamins and minerals”. Many products are also stamped with scientific-sounding trademarks such as “DigestiPlus” and “Wyeth Biofactors System”.

All these claims make the product sound like a perfect nutrition insurance policy to ensure your little treasure gets off to a good start in life. But according to health authorities they aren’t necessary.

The Ministry of Health recommends breastfeeding to one year and beyond. For toddlers aged between one- to two-years-old who are not breastfed, whole (dark blue) cows’ milk (or alternatives such as goats’ or a calcium-fortified plant-based milk) as part of a balanced and varied diet are suitable. The extra nutrients in toddler milk generally provide no benefits. Australian guidelines also state toddler milks aren’t required for healthy children. The European Food Safety Authority says the use of “growing up” formula does not bring additional value to a balanced diet in meeting the nutritional requirements of young children.

There are also downsides to using toddler milk. Some health care professionals told us it was possible toddlers may fill up on these milks, discouraging them from eating solids.

And there’s the cost. At about $20 a can parents could be buying fruit, vegetables, lean meat and dairy products instead.

Dr Anne Louise Heath, from the Department of Human Nutrition at the University of Otago, agrees toddler milks may displace solid foods but told us there was evidence toddler milks might improve the iron status of toddlers. “The most recent studies looking at iron status in toddlers suggest that 14 to 33 percent of toddlers have suboptimal iron status. Ultimately, I’d see toddler milk as a useful vehicle for nutrients that we know many toddlers have problems getting enough of from their diets, such as iron, iodine and vitamin D. But apart from that, their nutritional and digestive needs should be met by solid foods and breast-milk for those who are being breastfed.”

The Infant Nutrition Council (INC), which represents the major infant formula marketers and manufacturers in New Zealand and Australia, says toddler milks can support nutritional requirements when the diet is inadequate, by being fed as part of a balanced diet but not as a replacement for nutrient-rich foods.

Building the brand

Infant formula is big business. According to the INC, sales of stage 1 infant formula were worth more than $23 million in 2013. The INC’s Code of Practice restricts marketing products that are suitable for infants up to the age of six months (see Restricted marketing. But it doesn’t cover other products.

That’s where toddler milks come in – these and follow-on formulas can be advertised on television, in parenting magazines and at point-of-sale.

According to Dr Judith Galtry, Adjunct Fellow at the Australian Centre for Economic Research on Health, one of the main concerns is toddler milk packages are almost identical to infant formula – they have similar visual branding, logos and claims. “Toddler milks have been invented by companies to circumnavigate the marketing restrictions and convince parents that breastfeeding together with normal food isn’t sufficient.”

Isis McKay, maternal and child health promoter for Women’s Health Action, is also concerned. Advertising products that look like infant formula but are for older children is undermining the curbs on formula marketing. “We are concerned about the use of ‘line marketing’, which means that products are labelled as stage 1 (infant formula), stage 2 (follow-on) and stage 3 (toddler). This implies that as an infant grows they should progress through these products”. Ms McKay also said line marketing could link infant formula products and toddler milks in the minds of consumers.

One qualitative Australian study published in the Breastfeeding Review in 2010 concludes toddler milk advertisements appear to be functioning as de-facto advertising for infant and follow-on formulas. A follow-up study in the Australasian Marketing Journal in 2012 found a clear indication ads for toddler milks are widely understood to be advertising infant formula.

Jan Carey, chief executive of the INC, says toddler milk drinks are not breast-milk substitutes and don’t compete with breast milk. “They are marketed as an alternative to cows’ milk in children aged over 12 months to complement their diet where they may be receiving insufficient nutrients, especially iron. There is no evidence that the marketing of toddler milks has had any effect on breastfeeding rates in New Zealand.”

Ms Carey also disputes toddler milks were invented to get around marketing restrictions. “Toddler milks were developed after studies had shown an insufficient intake of nutrients such as iron, vitamin D and calcium in toddlers’ diets.”

Dr Heath is concerned about the “1-2-3” approach but believes there’s a solution. “My suggestion would be that toddler milk could be packaged in a box without the ‘stage’ number. Complan, for example is packaged in a box, so the canning is not necessary from a food safety or shelf-life point of view.”

Is more regulation needed?

The Health Select Committee’s 2013 Inquiry into Improving Children’s Health Outcomes and Preventing Child Abuse stated the self-regulatory system for implementing the WHO’s international code should continue but if it was not working within the next 18-24 months regulation should be implemented. In response to the inquiry the Ministry of Health said it would continue with the system with improvements.

Some groups believe our voluntary self-regulatory system isn’t working and we should be doing more to ensure our international obligations are met. Only INC members are bound by its Code and breastfeeding advocates would like follow-on formula for infants over six months of age included in the code. This would put us in line with the Marketing in Australia of Infant Formulas Agreement which includes follow-on formulas.

Food Standards Australia New Zealand is reviewing regulation of infant formula products in the Food Standards Code in relation to composition and labelling requirements. The review includes infant and follow-on formulas but not toddler milk. The Codex Alimentarius Commission, which develops international food standards, is reviewing the Codex Standard for Follow-up Formula intended for children aged six to 36 months.

Top tips for a fussy eater

• Keep food items small and manageable. Offer a range of colourful bite-sized foods and let them choose what they want and how much.
• Keep offering foods to your child, even if they initially refuse. It can take up to 15 attempts before a child will eat a new food.
• Check how much milk they are drinking as too much can reduce appetite. Toddlers should consume no more than 500ml of milk each day.
• Don’t use sweets or desserts as bribes for eating other foods.
• Be a good role model. Eat a wide variety of foods yourself and eat with your child.

If you have concerns about your child’s diet you should seek advice from a GP or dietitian.

Report by Belinda Castles.