Marketing Practices and Nutrition Content of Toddler Milk Across the Americas

Abstract

BACKGROUND: Toddler milk is a breastmilk substitute for young children, yet its marketing and nutritional profile across the Americas has not been systematically synthesized. METHODS: We conducted a content analysis documenting the prevalence of front-of-package claims and imagery on 389 toddler milk products from 14 countries in the Americas. We also compared the nutritional profile of toddler milk with plain cow's milk and chocolate-flavored cow's milk. RESULTS: Nearly all products (99%) displayed at least one front-of-package claim. Claim categories included nutrition-related (97%), health-related (56%), and other marketing (25%). Nutrition-related claims highlighting breastmilk-related components were common; for example, "Contains docosahexaenoic acid" appeared on 52% products. The most common health-related claims referenced brain and cognitive benefits (29%), such as, "Supports brain development." Among other marketing claims, endorsements (eg, "#1 recommended by pediatricians") appeared on 11% of packages. Imagery appeared on 92% of packages. Visual metaphors included shields (32%) and hearts (27%). Nutritionally, toddler milk contained an average total sugar of 6 g/100 mL, higher than plain cow's milk (5 g/100 mL, P < .01) but lower than chocolate-flavored cow's milk (9 g/100 mL, P = .97). Protein averaged 2 g/100 mL, lower than both plain cow's milk (3 g/100 mL, P < .01) and chocolate-flavored cow's milk (3 g/100 mL, P < .01). CONCLUSIONS: Toddler milk products contain more total sugar and less protein than plain cow's milk, yet claims and imagery promoting nutritional and health benefits are nearly universal on their packaging, raising concerns about how these products are being marketed to caregivers. These findings highlight the need for stronger regulations to ensure transparency and support informed food choices.