The introduction of solids at around 6-months of age, is an important step in an infant’s journey. However, the myriad of possible food options can be daunting for new mums, dads, and carers.1

Among the vast number of commercial infant food products available, food pouches remain a popular option for caregivers, with one in five parents currently feeding their infants these types of prepackaged food.2 Whilst food pouches may offer convenience, it is essential for health professionals to critically assess their impact on infant nutrition and development, and weigh any benefits against a number of drawbacks.

Concerns about infant food pouches

Lack of vegetables

Whilst pouches may claim to contain vegetables, the reality is that these are usually more sweet varieties of vegetables along with fruit. Typically made up of apple or pear purees, and in the rare circumstances where more bitter vegetables are used, they are often sweetened with fruit puree .1 A recent study found that among the 276 vegetable pouches studied, only one of them did not contain any sweetening.1 Regular consumption of fruit sweetened pouches may prevent infants from learning to enjoy the taste of vegetables.

Lack of texture

The uniform taste, texture, and smell of these pouches, as well as the use of a spout, limits infants experience of the new world of foods. This may prevent them from overcoming their inherent fear of new foods and lead to sweet taste preferences. This may prevent the development of healthier preferences influencing food habits later in life as well as potentially creating developmental issues with learning to chew. 3,4

The need for infants to learn to like the taste and texture of unfamiliar foods, and to have repeated exposure to foods and tastes, does not occur with high use of pouches as they all taste sweet.

Low iron content

Recommended Dietary Intake (RDI) for iron during infancy ranges from 0.2mg/day between 0-6 months, when the newborn has iron stores from pregnancy to 11mg/day at 7-12 months, after those stores have diminished. 5,6

With the increased iron requirements coinciding with the introduction of solids, it is imperative for first foods to be rich in iron. Examples of high iron foods are meat, eggs, legumes, spinach, or broccoli. However, infant food pouches often fall short in providing sufficient iron, on average containing 0.3mg of iron per 100g, compared to iron fortified cereals with up to 10mg/100g. 6 Providing sufficient iron is crucial for preventing iron deficiency issues in infants.

Emphasis should be placed on alternative iron-rich food options like those above, and the importance of offering infants varied textures and flavours. Frozen or canned vegetables without added salt are also viable alternatives.

High sugar content

In addition to the low iron content, a significant concern with food pouches is that they contain very high amounts of free sugars (sugars that are added to food, or already in natural sweeteners such as fruit juices and purees). Research has found that on average these pouches contain 8.4 g/100 g of sugar, far higher than their non-pouch alternatives. 6 The sugar content of food pouches is particularly concerning due to the recommendation by the Australian Government to restrict free sugar for children under 12 months of age. However, 42% of young infants are introduced to free sugars during this time. 1,7

Dental caries

Excessive sugar consumption, as seen in the use of infant food pouches, is linked to dental caries, a prevalent issue among Australian children. This tooth decay is primarily due to sugar fermentation by cariogenic microbes in the mouth. 7 An Australian study found that sugar was related to 1.5 times increase in caries risk and was attributable to 11% of caries in Australian children. The strong relationship between sugar intake and caries is particularly worrying due to the increasing prevalence in Australia, with 41% of 5–10-year-olds being impacted. 7   This raises serious concerns about the long-term oral health implications of introducing these pouches early in an infant’s diet.

Rapid weight gain and increased risk of unhealthy weight later in life

Another risk is unhealthy weight gain. Recent studies have shown that free sugar content is correlated with rapid weight gain during infancy. 8 Furthermore, consumption via the food pouch spout can lead to quick and excessive consumption of the contents, providing far more energy than is necessary, adding to the already increased risk of rapid weight gain. 1

Infant rapid weight gain is linked to a nearly 4 times higher risk of being overweight or obese throughout life. 9 Obesity at an early age also carries with it, possible associations with lower cognitive abilities in children and adolescents. 10

Alternatives to pouches

In the complex landscape of introducing solids, health and early years professionals play a pivotal role in guiding mums, dads and carers towards informed choices. While infant food pouches offer convenience, their potential drawbacks necessitate a cautious approach. By advocating for nutrient-rich alternatives and emphasising the importance of varied, whole-food experiences, health professionals can contribute significantly to the long-term health and well-being of infants.

As such, it is important for parents to be aware of affordable, accessible and nutritious alternative foods that are suitable for infants and the family as a whole. Tofu, legumes and iron fortified cereals are good examples of affordable foods that are good sources of iron and protein and low in sugar and saturated fat. 11 Frozen or canned vegetables (no added salt), contain similar micronutrients to fresh, and if snap frozen the vegetables will retain the same texture, although younger infants should consume softer food. 11  Ultimately, it is best to encourage mums, dads and carers to think of pouches in a similar way to takeaway foods, e.g. acceptable for occasional but not everyday use.

For further information on introducing solids, you can refer to the INFANT group sessions and the My Baby Now app.

References  

1. Brunacci KA, et al., The big squeeze: a product content and labelling analysis of ready-to-use complementary infant food pouches in Australia, BMC Public Health. 2023. Available from:
2. RCH National Child Health Poll [internet]. https://rchpoll.org.au. 2022. Available from: https://rchpoll.org.au/polls/ready-made-baby-foods-do-parents-know-the-facts/#:~:text=The%20latest%20results%20from%20the,make%20sure%20children%20grow%20and
3. Spill S, et al., Repeated exposure to food and food acceptability in infants and toddlers: a systematic review, The American Journal of Clinical Nutrition. 2019. Available from: https://www.sciencedirect.com/science/article/pii/S0002916522032439
4. Schwartz, C, et al. Development of healthy eating habits early in life. Review of recent evidence and selected guidelines. 2011. Available from: https://www.sciencedirect.com/science/article/pii/S0195666311004739
5. Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes | NHMRC [Internet]. www.nhmrc.gov.au. 2006. Available from: https://www.nhmrc.gov.au/about-us/publications/nutrient-reference-values-australia-and-new-zealand-including-recommended-dietary-intakes
6. Katiforis I, et al., Energy, Sugars, Iron, and Vitamin B12 Content of Commercial Infant Food Pouches and Other Commercial Infant Foods on the New Zealand Market. 2021. Available from: https://www-ncbi-nlm-nih-gov.ezproxy-b.deakin.edu.au/pmc/articles/PMC7922386/
7. Echeverria MS, et al., Trajectories of Sugar Consumption and Dental Caries in Early Childhood, Journal of Dental Research. 2022. Available from: https://journals-sagepub-com.ezproxy-b.deakin.edu.au/doi/abs/10.1177/00220345211068743
8. Burgess B, et al., Added sugars mediate the relation between pre-pregnancy BMI and infant rapid weight gain: a preliminary study. 2021. Available from: https://www-nature-com.ezproxy-b.deakin.edu.au/articles/s41366-021-00936-w.pdf
9. Zheng M, et al., Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. 2018. Available from: https://www-ncbi-nlm-nih-gov.ezproxy-b.deakin.edu.au/pmc/articles/PMC6203317/
10. Li N, et al., Impact of Early-Life Weight Status on Cognitive Abilities in Children. 2018. Available from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5975980/
11. Introducing solids: why, when, what and how [internet]. www.raisingchildren.net.au. 2023. Available from: https://raisingchildren.net.au/babies/breastfeeding-bottle-feeding-solids/solids-drinks/introducing-solids#types-of-food-to-offer-when-introducing-solids-nav-title