Research Article
Caregiver's Provision of Non-Recommended Commercially Prepared Milk-Based Drinks to Infants and Toddlers

https://doi.org/10.1016/j.jneb.2021.05.006Get rights and content

Abstract

Objective

Assess milk type provision (commercially prepared infant and toddler formula, cow's milk, and plant milk) to infants and toddlers, accounting for sociodemographic characteristics and marketing claims.

Participants

Caregivers (N = 1,645) of children (aged 6–36 months) recruited through online panels in 2017.

Methods

Cross-sectional survey analysis (system of probit equations) estimated associations between sociodemographics and agreement with marketing claims (independent variables) with milk type provision in the past month (binary dependent variable).

Results

Most caregivers (63%) of infants (aged 6–11 months) provided only breastmilk and/or commercially prepared infant formula. Sixty-five percent of caregivers of 12-month-old infants provided commercially prepared infant formula, and 47% provided cow's milk. Most caregivers (64%) of toddlers (aged 13–36 months) provided cow's milk; some also provided other non-recommended milk types (51%).Associations between milk types suggested milk-based drink provision should be evaluated as a pattern and not as independent behaviors (all Ps < 0.048). Milk type provision was significantly associated with a child's age (months), household income, and race (all Ps < 0.049). Including agreement with marketing claims reduced the significance of associations between milk type provision and some sociodemographic characteristics.

Conclusions and Implications

These findings suggest the need for additional expert guidance to discourage inappropriate and unnecessary milk for young children, provide strategies to transition from breastmilk (or commercially prepared infant formula) to cow's milk, and conduct outreach to communities at risk for health disparities about the dangers of serving milk that is not recommended for their child's age. Research is needed to understand how diverse populations interpret product claims and how marketing may perpetuate health disparities.

Section snippets

INTRODUCTION

In 2018, the American Academy of Pediatrics participated in an expert panel to establish comprehensive guidance on optimal beverage consumption by young children (up to 5 years).1 Healthy Eating Research (HER) convened the panel in recognition of the importance of healthy beverage intake in reducing the risk of diet-related chronic diseases, including obesity, type 2 diabetes, and dental caries. Experts counseled against serving cow's milk or other types of milk (other than breastmilk or

METHODS

This study used a cross-sectional online survey of US primary caregivers of infants (aged 6–11 months), infants in transition (aged 12 months), and toddlers (aged 13–36 months). The large nonprobability sample (n = 1,645) included a diverse sample of participants for meaningful comparisons between demographic groups. This analysis reports the incidence of caregivers’ provision of commercially prepared infant formula, toddler milk, cow's milk, and plant milk in the past month. The survey also

RESULTS

The sample participants (N = 1,645) were mostly female, aged 25–44 years, married, with at least some college education, and approximately half had household incomes < $40,000 (Table 1). Because of sampling procedures, participants were diverse in race/ethnicity. Of the original 2,426 participants, 13% did not meet inclusion criteria, and 14% did not complete the survey for a completion rate of 72%. Data for an additional 107 participants were excluded because of inconsistent responses.

DISCUSSION

Although the majority of caregivers in this sample reported providing recommended milk types to their child, common provision of non-recommended milk types and racial, ethnic, and cultural differences raise concerns.1,2 Furthermore, wide variation in the age that children transitioned from breastmilk and/or commercially prepared infant formula to cow's milk, including frequent transition after 12 months, suggests the need for additional guidance on best practices for this transition.

IMPLICATIONS FOR RESEARCH AND PRACTICE

The results of this study indicate an opportunity for public health education campaigns, community outreach, and additional guidance from health care providers, especially regarding potential nutrient deficiencies, dehydration, and undernutrition when providing cow's milk or plant milk to infants and replacing breastmilk (or commercially prepared infant formula). Furthermore, health care and public health guidance could provide caregivers with strategies for weaning their 12-month-old child

ACKNOWLEDGMENTS

This research was supported by a grant from the Robert Wood Johnson Foundation. The funder did not have any role in study design, collection, analysis, interpretation of data, writing the report, or the decision to submit the report for publication.

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    • Human Milk, Infant Formula, and Other Milks Fed to Infants and Toddlers in the United States, NHANES 2007-2018

      2023, Journal of the Academy of Nutrition and Dietetics
      Citation Excerpt :

      By 6 to <12 months of age, although more than two-thirds of infants were fed infant formula only or human milk only as the primary milk type, the introduction of cow’s milk and flavored cow’s milk was present. These data are consistent with a recent report that 20% to 22% of US infants aged 6 to 11 months were fed any cow’s milk or toddler milk.36 This is of concern, given that the American Academy of Pediatrics,37 the Healthy Eating Research Expert Panel,38 and the most recent DGA1 all discourage the introduction of milks other than human milk or infant formula before a child’s first birthday,1 as cow’s milk and cow’s milk substitutes fail to provide appropriate amounts of key nutrients required for infants aged 0 to <12 months.

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    Conflict of Interest Disclosure: The authors have not stated any conflicts of interest.

    Dr Romo-Palafox was affiliated with the Rudd Center for Food Policy & Obesity, University of Connecticut at the time this study was completed.

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