Growing-Up Milks Can Contribute to Balanced Nutrition in Young Children

The infant and young child nutrition industry believes that in addressing the causes of malnutrition, it is not just a matter of having not enough to eat, but instead, having the right food with the right amount and type of nutrients. In fact, many children in families that have escaped poverty continue to suffer from inappropriate infant and young child feeding and a lack of nutritious complementary foods.

A review of global data on nutrient intakes of young children aged 12-36 months and on dietary intake performed by the Nutrition Association of Thailand (NAT) and the Early Nutrition Academy in 2015 found that the nutrients, vitamin A, D, B12, C and folate and calcium, iodine, iron, zinc and DHA, are often limited in the diets of young children globally, not meeting FAO/The World Health Organization (WHO) daily recommendations[1]. The results of this review were in agreement with the European Food Safety Authority (EFSA) review of dietary intakes of young children in Europe[2].

We recognise the challenge of providing optimal infant and young child nutrition is complex and multifaceted. We support WHO’s recommendation to exclusive breastfeeding for the first six months of life as the best nutrition option. After six months of age, when breast milk alone is not able to meet the nutritional needs of infants, WHO recommends introducing complementary foods when the child is around the age of 6 months – starting with 2-3 meals per day when the child is 6-8 months of age, and increasing to 3-4 meals per day when the child is 9-23 months of age. Given the relatively small amounts of complementary foods that are consumed at 6-23 months, the complementary foods introduced need to be very nutrient-dense. For example, at 12-23 months of age, complementary foods need to provide 97% of iron, 42% of zinc, 50-83% of riboflavin, 90-100% of vitamin D and 26-86% of calcium to ensure that the child meets its nutritional requirements.

In addition, UNICEF data also shows that significant proportions of children aged 6-23 months across Asia do not achieve a minimum acceptable diet, defined as the combination of two indicators: minimum dietary diversity[3a] and minimum meal frequency[4]. Several factors that influence this can be cultural and socioeconomic factors.

Across Asia, dietary patterns mainly consist of cereals or starchy roots and tubers, commonly used during early infancy as a basis for gruels, which have a low-energy-density and micronutrient content. Once Asian toddlers switch to table foods and eventually share family meals, they are then exposed to complementary foods, essentially typical Asian diets which are low in iron- and zinc-rich foods such as meat or fortified foods. This could perpetuate micronutrient deficiencies that leave these children short of what they need for growth, development and immunity.

In order to feed young children a balanced dietary intake, it will be necessary to educate and change the lifestyles of many families. Furthermore, adaptations of the diet, in order to correct some of the observed deficits, might result in imbalances. For instance, by giving extra meat to increase the iron intake, or extra fish to increase the omega 3 fatty acid DHA intake, the protein intake could become excessive. Several studies show that high/excessive intake during the early years is a risk factor for later overweight. At the other end of the spectrum, each nutrient deficiency can be addressed in the form of food supplements through drops or liquid form for a child’s daily intake. However, in reality, such external nutrient intakes will be low and will be relatively expensive.

Growing up milks can help mothers and caregivers mitigate these challenges.

As science-based drinks fortified with additional nutrients, vitamin and minerals such as protein, calcium, iron, vitamins D, E and C, zinc and the omega 3 fatty acid DHA, growing up milks help mothers and caregivers create varied diets that provide toddlers with optimal intakes in nutrition. Growing-up milk can be an effective way to support balanced nutrition in children and their long-term physical and mental development. Also, when compared to other complementary diets, growing up milks are more cost-effective and reliable.

Studies have shown that the benefits of growing up milk – in this case improving nutrient deficiency in children – do not come at the expense of breastfeeding rates. This is due to the complementary nature of growing up milks. Other studies have also found little correlation between the use of growing up milk and earlier discontinuation of exclusive breastfeeding, or the duration of any breastfeeding. For instance, the Lancet series reported that nearly 90% of mothers from low-to-middle income countries and about 95% of mothers from low-income countries practiced continued breastfeeding through 12 months. The Ministry of Health of Malaysia also found no robust evidence that the use of formula milks for toddlers, pregnant and breastfeeding mothers negatively affected breastfeeding practices [5].

While growing-up milks provide nutrient-dense diets, the industry’s marketing policies and practices make clear that growing-up milks are specially formulated for toddlers as part of a mixed diet and cannot be considered as a breastmilk substitute. This is because the composition and function of growing up milks do not support this classification. Instead, they should be used to supplement continued breastfeeding, similar to other complementary foods.

The infant and young child nutrition industry remain committed to improving the nutrition levels in young children to enable them to realise their full potential. This will have long-term benefits for stronger, healthier communities and nations. The industry will continue to work with regulators, policymakers and other stakeholders to develop information- and science-based policies that benefit young children in Asia.

[1] Composition of Follow-Up Formula for Young Children Aged 12-36 Months: Recommendations of an International Expert Group Coordinated by the Nutrition Association of Thailand and the Early Nutrition Academy, Annals of Nutrition & Metabolism 2015; 67: 119-132

[2] European Food Safety Authority (EFSA): Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. EFSA Journal 2013; 11: 3408.

[3] Minimum dietary diversity is defined as a child consuming at least 4 of 7 food categories in a day (WHO, 2008).

[4] Minimum meal frequency is defined as a child consuming food at least 2 times for breastfed children 6-8 months, at least 3 times for breastfed children 9-23 months, and at least 4 times for non-breastfed children 6-23 months (WHO, 2008).

[5] MOH Malaysia, Effect of promoting Formula Milk for Toddler and Pregnant as well as Breastfeeding Mothers on the Breastfeeding Practice (2014).