New guidance on toddler formula reinforces doctors' advice

MUSC Children’s Health pediatrician Sara Ritchie, M.D., was pleased to hear that the American Academy of Pediatrics published new guidance on toddler formulas. Its conclusion: most toddlers don’t need the pricey products. 

“I think it just kind of validated everything that we already thought we knew,” Ritchie said.

The American Academy of Pediatrics reviewed the context, evidence and rationale for what it called older infant-young child formulas. It determined that:

• For babies under a year old, the liquid part of the child’s diet should come from breastmilk or standard infant formula that has been reviewed by the Food and Drug Administration.
• For children 12 months and older (toddlers), the diet should include a variety of fortified foods. Older infant-young child formulas can be part of that diet but aren’t more nutritious than human and/or cow milk, the academy’s report states.

That’s worth considering, because toddler formula isn’t cheap. At a downtown Charleston grocery store, one brand cost for $35.99 for a 12.7 ounce can in Oct. 2023. Another cost $32.99 for 32 ounces. For comparison, a gallon of store-brand whole milk cost $3.39.

Those prices could really add up for Ritchie’s patients at the MUSC Children’s Health R. Keith Summey Medical Pavilion. “We have a lot of families who are state insured, so Medicaid families, and they use WIC to help pay for their formula and their milk.”

WIC stands for the Women, Infants and Children Nutrition Program. “WIC is certainly not going to cover a toddler formula unless the child has extra calorie needs due to a medical condition.”

That comment about kids with medical conditions gets at an important caveat in the discussion about formulas for toddlers. “Some kids have dysphasia and so they can't swallow properly or there are certain textures of liquids that they can't swallow properly because of their developmental delay or their underlying disease or whatever the case may be. And those kids actually need those calories.”

So aside from calories, what’s in toddler formulas, also known as toddler milks and growing-up milks? Unlike infant formulas, there are no criteria for toddler formulas. So their contents vary.

 

But the American Academy of Pediatrics report said that some contain ingredients that are unnecessary for children or even problematic. That includes high or low protein, higher sodium levels than cow’s milk and added sweeteners.

Ritchie, a mother herself, also had concerns about how toddler formulas have been marketed. “They say they support brain development and immune health and all of these things. And so as a parent, you may feel a little guilty. If you see that on the shelf, then it's like, ‘Oh, well if I don't offer my kids this, then I'm not encouraging their brain development.’ But the truth is that you could give them some carrots and corn and it would be the same.”

The same – or better, she said. Ritchie emphasized the importance of toddlers getting nutrition from food as well as milk. “We want to stay below 20 to 24 ounces in a day for whole milk or 2% or whatever it is that you're choosing,” Ritchie said.

“Your other nutrients, we really want the child to get from regular foods. And then the risk is that let's say a parent offered four ounces of toddler milk, that's probably not that big a deal. But if we're replacing meals with it or offering it with every meal, then the toddler is just not getting the solid foods the child needs.”

Ritchie, physician lead of the pediatric primary care site at the Summey Pavilion, said formulas can also be a factor in excess weight gain.

“Sometimes, what I'll see is that a child might be eating normal amounts of food, but instead of drinking water with their meal or a limited amount of milk, they're drinking a large volume of this toddler formula or getting offered it in between meals when they wouldn't normally get offered calories. And then, we're seeing obese children. Potentially, just taking out that toddler formula is all they need to do.”

An industry group called the Infant Nutrition Council of America takes issue with criticism of toddler formulas. It told the Washington Post they fill in nutrition gaps. The American Academy of Pediatrics disagreed, as did Ritchie.

“I think that there's a real problem with toddler formula, because most toddlers just don't need it. We really want families to focus on water, regular milk if they're able to drink regular milk, and then just a variety of foods across all categories - fruits, vegetables, proteins, so they can become happy, healthy eaters.”