Formula may be right for infants, but experts warn that toddlers don't need it

Formula may be right for infants, but experts warn that toddlers don't need it

Infant formula is a booming business in the United States: Sales of the drinks have more than doubled in recent years as companies convinced parents that their little ones needed the fluid boost. However, many experts warn that these products, designed for children ages 1 to 3, do not meet nutritional needs beyond what is available in a typical toddler formula, are less regulated than infant formula, and are expensive.

Additionally, some parents feed infants the toddler versions even though they do not meet federal standards for infant formula and may not provide babies with sufficient nutrients to sustain their growth.

Pediatricians and federal health authorities say that by the time most children turn 1 year old, they can start drinking cow's milk or an unsweetened plant-based milk substitute. In a 2019 “Consensus” statement., the American Academy of Pediatrics and other health and nutrition organizations recommended against the use of infant formula, saying, "They do not provide unique nutritional value beyond what could be achieved with healthy foods; in addition, they may add additional sugar to the diet." Infant formulas often contain sweeteners and fats that add calories.

Some of the same companies that make infant formula—including Enfamil, Gerber, and Similac—also make infant formula, as do some smaller boutique brands that advertise that they are organic or other special qualities. Infant formula is available almost anywhere infant formula is sold and is marketed as providing additional nutrients that support children's brains, immune systems, and eye development, among other benefits. They are different from medical formulas prescribed to children with special needs.

A Study 2020 found that U.S. infant formula sales increased from $39 million in 2006 to $92 million in 2015.

According to a study conducted by , parents are often confused by formula marketing Jennifer Harris, a marketing and public health researcher at the University of Connecticut. This is what she found 60% of family caregivers mistakenly believed that infant formula contains nutrients that infants cannot obtain from other foods.

Dr. Anthony Porto, a pediatric gastroenterologist and professor of pediatrics at Yale University, said he is concerned that these products may give young children more nutrients and calories than they need. Unlike what was developed for infants, there are no nutritional regulations for toddler formula: experts say that standardizing a supplement for toddlers is impossible because no two children are the same.

In the Focus groups Harris said parents report turning to their children for toddler formula to fill nutritional gaps when a child isn't eating enough, a common concern among parents.

“Toddlers are often voracious eaters,” he said Dr. Stephen Daniels, Chair of Pediatrics at Children's Hospital Colorado. But around a year old, children's growth plateaus, and "they suddenly aren't hungry like they used to be." That can worry parents, he added, but "it's a completely normal phenomenon."

If parents have concerns about their children's diet, they should consult a pediatrician or family doctor, Daniels said.

Blanche Lincoln, president of the Infant Nutrition Council of America, which represents the makers of Enfamil, Gerber, Similac and store brands, said in an email that the formula can be helpful because it can "fill nutritional gaps during this transition period to bring to the table." Lincoln, a former U.S. senator from Arkansas, said the drinks "help contribute to the specific nutritional needs of young children by providing energy and key nutrients, as well as essential vitamins and minerals, during this important period of growth and development."

But infant formula isn't just consumed by toddlers - it's also fed to infants. In one Recent study, Porto and colleagues found that 5% of parents of infants reported giving their babies drinks marketed to the older age group. And Harris' research indicated this 22% of parents of infants older than 6 months fed their babies formula in the previous month. Both studies were conducted before the recent infant formula shortage, which may have exacerbated the problem.

“Infant formula and toddler formula are often next to each other in the supermarket,” Harris said. "They look similar, but formula is cheaper than formula. So people mix them up and pick the wrong one. Or they think, 'Oh, that's cheaper. I'll use that instead.' “

According to an email from FDA spokeswoman Lindsay Haake, infant drinks do not meet the definition of infant formula and therefore are not subject to the same requirements. That means they don't have to undergo the clinical trials and pathogen safety testing that the infant versions do. “Unlike infant formula, infant formula is not necessary to meet the nutritional needs of its intended consumers,” Haake said.

In a statement to KHN, the Infant Nutrition Council of America said, "Infant beverages have a different use and nutritional composition than infant formula; the two are not interchangeable. Children ages 12 months and older are noted on the front package label."

Some expensive infant formula brands made by smaller companies - often advertised as being made from goat's milk, A2 whole milk (which lacks a common milk protein) or vegan, non-soy ingredients – meet the nutritional requirements for infants, and some advertise this.

Harris argued that this also confuses parents and should not be allowed. Just because an infant formula contains the nutrients required by the FDA for infant formula does not mean it has passed the other tests required for infant formula, she said.

Federal regulators have not forced either company to withdraw these products. In an email, FDA spokeswoman Marianna Naum said: “The FDA does not comment on potential compliance measures.”

A company, Nature’s One, whose infant formula is called “Baby’s Only,” received Warning letter a decade ago by the FDA about marketing it to infants. This case was closed in 2016. The company's website states that Baby's Only formula " meets the nutritional needs of infants " and that " Baby’s Only Organic® can be served up to 3 years of age.” Critics say the language implies the formula is OK for babies under 1. The company's website and Instagram account feature customer testimonials from parents who report feeding their infants formula, as well as pictures of infants drinking it.

Jay Highman, CEO and president of Nature's One, said that Baby's Only is clearly labeled as infant formula and that the back of the can states: "Baby's Only is intended for an infant 1 year of age or older OR as directed by a health professional." He also said that since the company's founding in 1999, the formulas have met all the nutritional, manufacturing and safety standards required for infant formula, although they are not required to. “We acted like we were infant formula, but we sold it as infant formula,” Highman said.

He said the clinical trials required by the FDA are a major obstacle to bringing a new infant formula to market and that many other countries do not require clinical trials. Baby's Only recently completed a clinical trial, he said, and the company expects to soon sell it as infant formula.

However, pediatricians and nutrition experts continue to warn parents against using toddler drinks. “There's no question that formula is very important in the first year of life,” Daniels said. But he doesn't recommend the toddler version "because it's not as useful, because it's confusing, because it's expensive."

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