Kozeta Miliku, MD, PhD, discusses ways to reduce pediatric UPF intake

In a recent interview with Contemporary Pediatrics, Kozeta Miliku, MD, PhD, an assistant professor at the University of Toronto, discussed the link between ultra-processed food (UPF) consumption and early childhood behavioral development.^1,2

Miliku emphasized that the preschool years represent a sensitive developmental window where even modest dietary improvements can yield long-term benefits for a child's emotional and behavioral health. She also noted that pediatricians do not need exhaustive assessments to begin addressing nutrition. Instead, a brief screening approach should be integrated into routine wellness visits, particularly when parents raise concerns regarding sleep, hyperactivity, or emotional regulation. Practical screening questions include the following:

• How often does the child consume sugary or packaged beverages?
• How frequently are snacks derived from convenient, prepackaged foods?
• What is the frequency of “ready-to-heat” meals vs minimally processed foods such as fruits, vegetables, eggs, and beans?

This screening is intended to complement, not replace, validated behavioral tools by identifying diet as a modifiable factor in the “whole child” care model.

The research highlighted specific UPF categories with the strongest adverse associations. Artificial and sugar-sweetened beverages stood out most clearly, showing a direct link to higher internalizing and total behavior scores.

Miliku recommended starting here, as beverages are easy to identify and often simpler for families to change than entire meal patterns. While ready-to-heat mixed dishes and certain breads also showed associations, the broader clinical goal is shifting the overall dietary pattern toward minimally processed foods (MPFs).

Crucially, Miliku argued that the burden of dietary change should not rest solely on individual families, as they often operate within food environments beyond their control. Pediatricians are encouraged to advocate for systemic changes, including:

• Strengthening nutrition standards in child care and early childhood programs.
• Restricting the marketing of UPFs to young children.
• Implementing “front-of-package” labeling to help parents identify highly processed products.
• Supporting subsidies for healthy staples and improving neighborhood access to affordable fresh or frozen foods.

By combining clinical counseling with policy advocacy, pediatricians can help ensure that the healthier choice becomes the easier choice for families.

This video is part 2 of a 2-part series. Click here for part 1.

No relevant disclosures.

References

1. Ultra-processed foods in preschool years associated with behavioural difficulties in childhood. News release. University of Toronto. March 3, 2026. Accessed March 11, 2026. https://www.eurekalert.org/news-releases/1118583
2. Kavanagh ME, Chen ZH, Tamana SK, et al. Ultraprocessed food consumption and behavioral outcomes in Canadian children. JAMA Netw Open. 2026;9(3):e260434. doi:10.1001/jamanetworkopen.2026.0434