Health – Lack of iron, overuse of food pouches concern child medical experts

Iron plays a huge role in a baby’s development from infancy through childhood.

A lack of iron intake among young children is very concerning and there needs to be more education for parents on how to prepare iron-rich foods. This was one of the findings of the 2021 Australian Feed Infants and Toddlers Study (OzFITS), the first nationwide survey of the feeding practices of children under two years of age, as presented at the Infant Nutrition Council’s ‘Feeding the Future’ Conference.

Professor Tim Green and Dr Merryn Netting of the South Australian Health and Medical Research Institute presented the findings, which were roughly in line with some of those that came from the Growing Up in New Zealand Longitudinal Study.

Iron plays a huge role in a baby’s development from infancy through childhood. It is especially important to power a baby’s brain, and neurological development, and is a key component in helping red blood cells deliver oxygen from the lungs to the body. Babies with a deficiency might be less physically active and develop more slowly, leading to problems concentrating, a shorter attention span, and poor academic performance.

Prof Green and Dr Netting said nearly half of the infants in the study were exclusively breastfed to four months, and there was a long duration of breastfeeding, with 68% of infants breastfed to six months and 44% breastfed into their second year. Nearly all infants were introduced to complementary foods at the appropriate time, between four and six months.

“We found a mismatch between the number of recommended servings from each food group in the Australian Dietary Guidelines and the dietary intake of toddlers.

“Toddlers [12-24 months] consumed twice as many fruit servings as recommended and nearly all of them consumed discretionary foods (snacks), despite no allowance for these foods. While most consumed the recommended dairy serves, they consumed half the recommended serves for other food groups. Infants [6-12 months] and toddlers met their requirements for most nutrients.

“But one big exception was iron, where 90% of older infants and 25% of toddlers had inadequate iron intakes. We were surprised by the high prevalence of inadequate iron intake, especially in older infants.

“In our study, infant formula and iron‐fortified infant cereals were top sources of iron for infants, although less than one third consumed these products.” The next top sources were iron-fortified cereals, breakfast cereals, bread, and meat. For toddlers, the top five sources were breakfast cereals, infant formula/toddler milks, bread, meat, and egg.

The study also showed excessive sodium intake was of concern, with 1 in 3 toddlers exceeding the upper limit of 1000mg per day – the equivalent of 2.5g of salt. The top five sources of sodium were bread and rolls, cheese, cow’s milk, cereal-based mixed dishes, and processed meat.

“It’s clear from the iron results that there needs to be more education and information for parents on how to prepare iron-rich foods. That includes base foods as well as vegetarian foods that are higher in iron.

“Iron supplements or more iron-fortified foods might be needed, with an emphasis on meat.”

Prof Green and Dr Netting also expressed concerns about the nutritional value of food pouches and their effect on children’s development.

In a paper comparing nutritional and textural properties of commercial infant and toddler foods available in Australia with established infant feeding guidelines, they found many of the purees in squeeze pouches they looked at were inconsistent with guidelines – being sweet, smooth and low in iron.

Pouches comprised half of the 414 products they looked at, while one-third were discretionary foods.

The guidelines recommend “first foods” be rich in iron with no added sugars and that nutrient-poor discretionary foods are to be avoided.

“By sucking from the pouch, children are using the food more like a drink, rather than moving it around in their mouth, and learning all the chewing and swallowing skills. So, if most of their nutrition is coming from pouches they can miss out on important milestones. Of the half of our cohort using pouches, half of them were sucking food directly from the pouch.

“So, there’s more room to include information about pouches in information that we hand to parents, because we could do better for our infants by offering them more nutritious commercial foods.

“Part of that is a regulatory issue and part of that is the way the foods are packaged. Greater regulatory oversight may be needed to better inform parents and caregivers on this.

“Frequent consumption of commercial baby foods low in iron may increase the risk of iron deficiency. And excessive consumption of purées via squeeze pouches may also have implications for overweight and obesity risk.”

The Chief Executive of the INC, Jan Carey, said the findings showed there is definitely a place for toddler milk in meeting the requirements for iron in those toddlers whose diet is inadequate.

“The prevalence of iron inadequacy is a big concern.

“Experts at the conference agreed that iron for developing children’s brains is vital, and it must be comforting to parents to know these products can do a great job in helping to boost those levels.”