Rachael Zimlich, RN, BSN

Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.

Americans eat a lot of sugar—much of it hidden in the foods we eat. Not even children are immune.

 has shown that children consume far more added sugar than they should, and now a report reveals that nearly all children in the United States consume added sugars before age 2 years.

Journal of the Academy of Nutrition and Dietetics

, found that almost 85% of infants and toddlers were fed foods with added sugars or artificial sweeteners regularly—even daily. The study used data collected by the Centers for Disease Control and Prevention (CDC) between 2011 and 2016.

The CDC researchers found that in a nationally sample of more than 1200 children from birth to age two years, 98.3% of toddlers aged one to two years and 60.6% of infants up to age one year were fed added sugars. These sugars were mainly found in snacks, bakery and sweets, baby foods, yogurts, and fruit drinks.

Kirsten Herrick, PhD, MSc, now works at the National Cancer Institute but led the study while employed at the CDC’s National Center for Health Statistics. She says although the fact that added sugars are finding their way into the diets of infants and toddlers wasn’t surprising, just how much they are consuming should serve as a wake-up call for parents and pediatricians.

“Added sugars are everywhere in the US diet. So, it’s not surprising that US toddlers and infants are exposed to added sugars,” Herrick says. “What is surprising is how much they are consuming and how quickly consumption amounts reach amounts similar to those of older children.”

Generally, children under age two years should avoid added sugars altogether. The American Heart Association recommends no more than 6 teaspoons—or less than 25 grams—of added sugar daily for children aged 2 to 18 years. The CDC report, however, revealed that toddlers in the study consumed an average of 5.8 teaspoons each day whereas infants averaged just under a teaspoon.

Not only can these added sugars lead to obesity and other health problems later in life, but they also fill the children up, leaving less appetite and less room in their diets for nutritionally dense foods. Consuming a lot of added sugars also trains their tastes for foods with a lot of sugar, the report cautions, setting poor dietary habits.

There were few demographic differences in the study group’s results by gender, parental income or education, or race for infants. For toddlers, there were some racial and ethnic patterns, with non-Hispanic white and non-Hispanic black children consuming the highest amounts of added sugars.

It’s easier than ever to spot added sugars, thanks to new regulations that require added sugars to be included on every Nutrition Facts panel as of January 2020, Herrick notes. Still, sometimes these labels can still be deceiving.

“Pediatricians can also help parents identify added or hidden sugars by reading the ingredients list and looking for different words used to refer to added sugars in products,” Herrick says.

The American Heart Association also offers a 

 to highlight some of these terms, she adds.

“To tell if a processed food contains added sugars, you need to look at the list of ingredients,” Herrick explains. “Sugar as many other names. Besides those ending in ‘-ose,’ such as maltose or sucrose, other names for sugar include high fructose corn syrup, molasses, cane sugar, corn sweetener, raw sugar, syrup, honey, or fruit juice concentrates.”

The study authors note that a 2020 revision of the Dietary Guidelines for Americans will update with new advice for children under age 2 years. Herrick is hopeful the report will shine new light on the prevalence of added sugars the diets of infants and toddlers.

“My hope is that this work will raise awareness for both clinicians and parents about how much added sugars young children consume and what the common sources are,” she says. “For infants and toddlers especially, a healthy diet that meets the recommended intake of key nutrients leaves little room for the extra calories from added sugars. Plus, we are still learning about how early eating patterns may influence both later eating patterns and potentially later health.”

1. Drewnowski A, Rehm C. Consumption of added sugars among US children and adults by food purchase location and food source. 

. 2014;100(3):901-907. doi:10.3945/ajcn.114.089458

2. Herrick K, Fryar C, Hamner H, Park S, Ogden C. Added sugars intake among US infants and toddlers. 

. 2020;120(1):23-32. doi:10.1016/j.jand.2019.09.007

3. American Heart Association. Sugar recommendation healthy kids and teens infographic. Accessed September 25, 2020. 

https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/sugar-recommendation-healthy-kids-and-teens-infographic#:~:text=Kids%20are%202%2D18%20should,Cardiovascular%20Disease%20Risk%20in%20Children

4. American Heart Association. Added sugars. Updated April 17, 2018. Accessed September 25, 2020. 

https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars

Articles

A recent report reveals just how much sugar infants and toddlers are eating—and it’s not pretty.

Toddlers consuming nearly as much sugar as older kids

Preschoolers are notoriously difficult to feed. It’s a time when independence and a fear of new things take hold, and children have a hard time meeting their goal of a cup or more of vegetables each day.

 out of the United Kingdom may have the answer. Researchers combined storytelling with sensory play about the same vegetables and found more children were willing to try new or unusual vegetables.

. The research team’s goal was to try and identify methods to increase vegetable uptake among one of the toughest crowds.

To complete the study, researchers tested theories about congruent storytelling and sensory play at 12 preschools in the United Kingdom. Children were taught about a new vegetable that few of the children had tried: celeriac. An illustrated and engaging story along with sensory play promoted celeriac, compared to a story about carrots with or without sensory play that was incongruent with the story line.

The researchers found that children who were in the celeriac group had higher odds of eating the vegetable than those in the carrot group. In the carrot group, 68% of the children were willing to eat a carrot before the activity, and that increased by just 2% to 70% willing to eat a carrot after the story. With the celeriac, 69% of children were initially willing to eat the vegetable, but that number grew to 83% after the intervention. The report concluded that congruency between stories and sensory play could improve both interest in and intake of new vegetables in preschoolers.

Preschoolers are an ideal age group to test this theory because many children experience neophobia, or a fear of new things—especially when it comes to vegetables—around age 2 years. The unfamiliar appearance, texture, and sometimes bitter taste of vegetables don’t help, either.

Researchers used stories and play with focus on the same vegetable, compared to stories alone or stories and play that were about vegetables in general rather than 1 specific vegetable. The research team suggests that learning about the new food, then touching and handling it to take away some of the mystery was helpful in increasing consumption of new vegetables.

For parents, this may be a more difficult tool to use, as it could take several attempts to achieve the best results, the study authors warn.

Nekitsing C, Blundell-Birtill P, Cockroft J, Fildes A, Hetherington M. Increasing intake of an unfamiliar vegetable in preschool children through learning using storybooks and sensory play: a cluster randomized trial. 

. 2019;119(12):2014-2027. doi:10.1016/j.jand.2019.05.017

A recent study investigates how fun stories and engaging playtime can help increase vegetable intake among preschoolers.

Stories and play could help increase vegetable intake

A nutritional assistance program aimed at improving diets of pregnant mothers, infants, and young children, may have benefits for older children in the household, too—even after they age out of the program, according to a new report.

Journal of the American Academy of Dietetics and Nutrition

, studied the unintended benefits of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) on older children in participating households.

Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federal program that offers supplemental foods, education on nutrition and breastfeeding, breastfeeding support, access to health care and social services, and pregnancy and postpartum support to women and their children up to age 5 years. Eligibility for this program is based on nutritional risk and income level. Gross income has to be at or below 185% of the federal poverty level and be deemed by a health professional to be at nutritional risk to participate in WIC. Families and individuals who already participate in the Supplemental Nutrition Assistance Program (SNAP), Medicaid, or Temporary Assistance for Needy Families (TANF) are automatically eligible for WIC enrollment.

 participated in the WIC program in 2019, with California and Texas having the most number of residents enrolled. Annual 

 for the WIC program nationwide were just over $3 billion in 2019, with an 

 of about $40 per person. Although this program is costly, the benefits have been well-demonstrated. Previous research has shown an association between participation in the WIC program and healthier eating habits in children up to age 5 years. What has not been investigated before is how the WIC program could potentially help older children living in WIC households.

The new study focused on examining the dietary behaviors of children who were no longer eligible for the WIC program due to age, but lived in households with other children who were enrolled in WIC. Data were collected from 2 independent household surveys collected in 2010 and 2014 as part of the New Jersey Child Health Study.

More than 600 children who were too old to participate in WIC but who lived in households with incomes below 200% of the federal poverty level were included in the study. Nearly 400 of those children lived in homes that participated in the WIC program because of other children in the household.

The research team asked questions about specific foods, including daily fruit and vegetable intake, consumption of 100% juice or sugar-sweetened beverage, and how often sweet and salty snacks were eaten.

Overall, the study team didn’t find a big difference in the diets of children between the ages of 5 and 18 years, regardless of whether anyone else in their household was enrolled in the WIC program. There were some healthy patterns observed for children who were too old for WIC but lived in WIC households. Children in the 12- to 18-year-old age range who were ineligible for WIC due to age but lived in WIC households consumed more vegetables that their peers who lived in non-WIC households. Additionally, girls in WIC households who were ineligible for the program consumed 100% fruit juices more often than those in non-WIC households. The report also found that age ineligible children in Hispanic WIC households consumed less sugar-sweetened beverages that children in the same demographic from non-WIC households.

The study concluded that as children age out of WIC eligibility, they may still benefit from the program through younger siblings or household members. Researchers suggest that future revisions to WIC programming should consider the implications and benefits of extending the program to other children in eligible households, according to the report.

1. Steeves S, Acciai F, Tasevska N, DeWeese R, Yedidia M, Ohri-Vachaspati P. The special supplemental nutrition program for women, infants, and children spillover effect: do siblings reap the benefits?. 

. 2020;120(8):1288-1294. doi:10.1016/j.jand.2020.02.013

2. Benefits.gov. Special supplemental nutrition program for women, infants and children (WIC). Accessed September 21, 2020. 

Even though they may be too old to participate in Special Supplemental Nutrition Program for Women, Infants and Children (WIC), a new study shows that the program can help older kids eat better, too.

WIC can benefit older siblings too

 investigated whether participating in programs aimed to supplement food supplies for low-income families could help improve food security and healthy outcomes. Published in the 

, the goal of the study was to investigate food spending in households that participating in the Supplemental Nutrition Assistance Program (SNAP).

The Supplemental Nutrition Assistance Program is a federally funded program that helps low-income families with food expenses at home. The program is administered by individual states, and about 14 million households received SNAP benefits in 2018, according to the US Census Bureau.


Previous reports have shown a positive relationship between SNAP participation, and at-home food spending. However, what research hasn’t shown is how this is affected by food pricing in difference areas.

The new study investigated more than 2500 SNAP and non-SNAP households whose cash income was at or below 185% of the Federal Poverty Level. According to the US Census Bureau, SNAP participation requires household incomes to be below a certain threshold, and benefits then depend on the size, income, and demographic of the household. The average monthly SNAP benefit in 2018 was $251, the census bureau reports. About half of all SNAP households include at least 1 child aged younger than 18 years and a third of those households included a person aged 60 years or older.

The median household income for SNAP families in 2018 was $61,937 per year, according to the US Census Bureau, with the highest levels of SNAP participation in New Mexico and West Virginia. About 13% of the nation’s SNAP households are below the poverty limit. Additionally, most SNAP households are white rather than minorities—with 76% of households being white; 13.5 being Hispanic or Latino; 12.4 being black alone; and less than 5% Asian. Eligibility for SNAP is a bit more generous when disabilities are involved, according to the report, noting that about a quarter of all SNAP participants have at least one person with disabilities in the household.

Researchers compared spending on food at home to maximum SNAP benefits based on household size alongside consumer price indexes. The result was a positive spending difference between SNAP and non-SNAP spending on average.

Households that had a lower household income and higher SNAP participation had spending relative to maximum SNAP benefits that was 29 to 30 percentage points more than low-income, non-SNAP households. These trends were similar in areas with varying price indexes.

The research team concluded that families enrolled in the SNAP program spent more overall on food at home than non-SNAP, low-income families. More research is needed to understand how SNAP participation can help improve food security and overall health outcomes, the report notes.

1. Ismail M, Ver Ploeg M, Chomitz V, Wilde P. Differences in food-at-home spending for SNAP and non-SNAP households given geographic price variation. 

. 2020;120(7):1142-1150.e12. doi:10.1016/j.jand.2019.12.017

2. Loveless T. Supplemental Nutrition Assistance Program (SNAP) Receipt for Households: 2018. Census.gov. Published June 1, 2020. Accessed September 21, 2020. 

https://www.census.gov/content/dam/Census/library/publications/2020/demo/acsbr20-01.pdf

For low-income families, securing an adequate supply of nutritious foods can be a challenge. There are public programs to help supplement grocery budgets, such as the Supplemental Nutrition Assistance Program (SNAP) but do these help needy families improve their overall nutrition?

Author | Rachael Zimlich, RN, BSN

Articles

Toddlers consuming nearly as much sugar as older kids

Stories and play could help increase vegetable intake

WIC can benefit older siblings too

Impact of SNAP on food spending