1. Beal, Judy A. DNSc, RN, FNAP, FAAN

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The World Health Organization (WHO, 2019) recently issued an alert on dangerous levels of sugars in baby food after studying food and drink products marketed for infants and young children in Europe and Israel in 2017 and 2018. They found at least half of products analyzed in three of four cities provided >30% of their calories from sugar and about a third listed sugar, concentrated fruit juice, or other sweeteners as an ingredient. Although concerns about excess sugar consumption by infants and young children have been raised by researchers for many years, this new WHO report calls attention to this issue once again.


Foods, snacks, juices, desserts, and dinners marketed to babies, toddlers, and adolescents often have a higher than recommended percent of calories from sugar and higher than recommended sodium levels (Cogswell, Gunn, Yuan, Park, & Merritt, 2015; Elliott, 2011). In one study, of 100 samples of infant formulas, breakfast cereals, packaged baked goods, and yogurts, 74% contained >20% of total calories per serving from sugars (Walker & Goran, 2015). Nutrition labeling was incorrect and underestimated the total sugar values. Pediatric providers should advise parents to carefully review labels and to limit these foods.


Excess sugar consumption has long been tied to poor health outcomes in children. In the scientific statement from the American Heart Association about added sugars and cardiovascular disease in children, Vos et al. (2017) noted strong associations between increased sugar consumption, increased adiposity, and dyslipidemia. They recommended children consume no more than 6 teaspoons of added sugars per day, avoid any added sugar in children less than 2 years of age, and that parents review food labels specifically for fructose, high-fructose corn syrup, glucose, honey, lactose, and sucrose. The WHO (2019) report warns parents that developing a sweet tooth early could predispose a child to preferring sweeter foods later in life.


Pediatric nurses can play a critical role in education of parents about nutrition and avoidance of excess sugar. Inform parents of the significant health risks both in the short and long term of excess sugar consumption early in their child's life. Teach parents how to read nutrition labels, which have been made more explicit since 2016. However, reading nutrition labels is not easy or intuitive, so providing examples and reviewing directly with parents work well. Other recommendations for parents to reduce their children's sugar intake include: exclusive breastfeeding for 6 months (American Academy of Pediatrics [AAP], 2018); avoiding introduction of fruit juice until 6 to 9 months and then limiting consumption to 4 to 6 oz per day (AAP); avoiding introduction of any sugar-sweetened beverages (AAP); use of single-ingredient baby foods for the first year of life (Krans, 2019); avoiding baby foods that combine fruit with vegetables so that children do not associate only good taste with sweetness (Krans); and choosing fresh foods and produce as often as able (Krans). The WHO (2019) has taken a renewed interest in this serious health issue and pediatric nurses are critical in advancing the recommendations.




American Academy of Pediatrics. (2018). Infant food and feeding. Retrieved from[Context Link]


Cogswell M. E., Gunn J. P., Yuan K., Park S., Merritt R. (2015). Sodium and sugar in complementary infant and toddler foods sold in the United States. Pediatrics, 135(3), 416-423. doi:10.1542/peds.2014-3251 [Context Link]


Elliott C. D. (2011). Sweet and salty: Nutritional content and analysis of baby and toddler foods. Journal of Public Health, 33(1), 63-70.[Context Link]


Krans B. (2019). Read the label: Your child's baby food may have too much sugar. Healthline. Retrieved from Accessed August 22, 2019. [Context Link]


Vos M. B., Kaar J. L., Welsh J. A., Van Horn L. V., Feig D. I., Anderson C. A. M., ..., Johnson R. K. (2017). Added sugars and cardiovascular disease risk in children: A scientific statement from the American Heart Association. Circulation, 135(19), e1017-e1034. doi:10.1161/CIR.0000000000000439 [Context Link]


Walker R. W., Goran M. I. (2015). Laboratory determined sugar content and composition of commercial infant formulas, baby foods and common grocery items targeted to children. Nutrients, 7(7), 5850-5867.[Context Link]


World Health Organization. (2019). Commercial foods for infants and young children in the WHO European Region: A study of the availability, composition and marketing of baby foods in four European countries. Geneva, Switzerland: Author. [Context Link]