A cross-sectional analysis of the nutritional quality and prices of commercial infant and toddler food products in the Canadian food supply

Abstract

Background

Adequate nutrition is essential for growth and development during infancy and early childhood; however, the healthfulness and cost of commercial infant and toddler food and beverage products (ITP) have not been documented in Canada.

Objective

This study assessed the nutritional quality and prices of ITP in the Canadian food supply.

Design

Using the Food Label Information and Price 2020 database, ITP intended for children < 4-years-old (n = 423) were examined for their energy and nutrient content (per 100 g or mL), the prevalence of products ‘High in’ nutrient(s)-of-concern (according to Canadian front-of-pack labelling thresholds), and their price (per 100 g or mL).

Results

Median energy level of ITP was 101 kcal [IQR: 67, 400], derived primarily from carbohydrates (21.7 g [14.1, 71.4]). Although total and saturated fat (1.2 g [0, 7.1] and 0 g [0, 0], respectively) and sodium (16 mg [4, 100]) were low, ITP were also low in protein (3.6 g [0.8, 10.0]) and iron (0.9 mg [0.4, 6.0]), and high in sugars (10.9 g [5.5, 17.6]). Based on Canadian front-of-pack labelling thresholds, 59% (n = 248) of products were ‘High in’ one or more nutrients-of-concern, particularly sugars (55%, n = 234). Prices varied significantly, ranging from $1.32 to $6.95, with toddler products costing more than those for infants ($3.14 vs. $1.55).

Conclusions

Overall, the nutritional quality of commercial ITP in Canada is poor, with many products ‘High in’ sugars, highlighting the need for healthier, more affordable options and public health policies that can support healthier food environments for infants and toddlers.

Adequate nutrition during early childhood is critical for supporting children’s health (1). Eating habits in infancy and toddlerhood help establish sociocultural norms and values around food that can have lifelong impacts on diet and health (2–4). Over the past decade, the commercial infant and toddler food product (ITP) market has experienced substantial growth (5). However, evidence suggests the nutritional quality of ITP may not be adequate, with high levels of sugars and low in other key nutrients, such as protein and iron (6–9). In particular, toddler milk products (beverage products marketed as nutrition supplements for children ≥ 1-year-old (10)) are similar to whole cow’s milk in calories and protein but are high in added sugars, similar to soft drinks (11). Canada recently promulgated front-of-pack labelling (FOPL) regulations, requiring a ‘High in’ nutrition symbol on pre-packaged food and beverage products meeting and/or exceeding thresholds for nutrients-of-concern (saturated fat, sugars, and sodium) by January 2026 (12). However, many ITP, including toddler milks, are not subject to FOPL regulations, highlighting a potential gap in regulations and a need to comprehensively examine the nutritional quality of ITP.

Food costs can influence consumers’ purchasing decisions, influencing the quality of dietary patterns, particularly among those in lower socioeconomic positions (13). Some studies suggest healthier products, such as fruits, vegetables, and whole grains, are more expensive than “less healthy,” energy-dense, nutrient-poor options like processed snacks and sugary beverages (14). Price disparity can restrict access to nutritious foods and contribute to poor dietary outcomes, particularly for vulnerable populations. The objective of this study was to assess the nutritional quality and price of ITP in the Canadian food supply.

METHODS

Data collection

The University of Toronto Food Label Information and Price (FLIP) 2020, a branded food composition database, was used in the study (15). Briefly, FLIP 2020 was collected between May 2020 and February 2021 by web-scraping product information of foods sold in seven Canadian grocery retailers (15). The FLIP database collects various product details, including name, brand, Nutrition Facts table (NFt), ingredients list, and price. All products were categorized according to Health Canada’s Table of Reference Amounts for Food (TRA), which serves as the basis for determining the serving size in NFt (16).

Food and beverage products classified under TRA category W (Foods Intended Solely for Children Under Four Years of Age) and toddler milks (beverage products marketed as nutrition supplements for toddlers aged 1 year and older (10)) were identified. Products with incomplete NFt (e.g., missing serving size), implausible NFt (e.g., reported caloric values exceeded the calculated values using the Atwater factors (17) by more than 20%), missing container size, or price were excluded. Duplicate products (i.e., same product with same container size) were identified using universal product codes, store-specific product numbers, and select label information (i.e., container size, energy, and macronutrient information).

As infants and toddlers have unique nutritional and texture requirements (18), images of product package were examined to categorize ITP based on age group: (i) products for infants (<1-year-old); and (ii) products for toddlers (1–<4-years-old). Products with minimum age requirements under one year (e.g., 6+ months) were categorized as infant products, while all others were classified as toddler products.

Energy and nutrient level assessment

Energy and nutrient content were assessed per 100 g (or mL) and serving size (according to TRA). Core nutrients required to be reported in the NFt were examined, including: energy; total fat; saturated fat; total carbohydrates; sugars; fibre; protein; calcium; and iron (19). Percent daily value (%DV) per serving size for nutrients was calculated using Canada’s daily values for nutrition labelling (20).

‘High in’ nutrients-of-concern assessment

Using thresholds for Canadian FOPL regulations, products ‘High in’ nutrients-of-concern were identified (12). Products were assessed against thresholds for nutrients-of-concern (sodium, sugars, and saturated fats) for children 1 to<4 years (Supplementary Table 1). Although products for infants and toddler milks are not subject to Canadian FOPL regulations (12), high levels of added sugars have been reported in these products in other countries (6,8,9,21); thus, FOPL thresholds were applied to examine potential gaps in the regulations.

Ingredient assessment

The main ingredient of ITP was assessed to further examine their composition. In the absence of quantitative ingredient lists in Canada, main ingredient was defined as the first listed non-water ingredient (i.e., top contributor by weight) reported in the ingredients list. If water was listed as the first ingredient, the second ingredient was considered the main ingredient. Main ingredients were categorized based on their characteristics: (i) grains; (ii) fruits or vegetables; (iii) protein; and (iv) sugars-based ingredients. As per Health Canada (22), sugars-based ingredients were defined as monosaccharides (e.g., fructose, galactose), disaccharides (e.g., sucrose, maltose), combinations of mono- and di-saccharides (e.g., high fructose corn syrup), sweetening agents (e.g., maple syrup, honey), and functional substitutes for sweetening agents (e.g., fruit juice, fruit purée).

Price assessment

Undiscounted price was assessed per 100 g (or mL) and serving size. To measure a market-representative price of ITP available across different retailers, duplicate products were included in the analysis.

Statistical analysis

Energy and nutrient content and price were reported as medians [interquartile range (IQR)] overall, by ITP categories (based on TRA), and by age category. The number and proportion of ITP meeting and/or exceeding the Canadian FOPL nutrient thresholds (i.e., would display a ‘High in’ nutrition symbol) were examined overall, by ITP category, and by age group. All analyses were conducted using R (RStudio 2022.02.3, PBC).

RESULTS

Out of 1098 ITP identified, 389 did not have a complete or plausible NFt, 1 was missing price, and 285 were duplicates, resulting in 423 ITP for energy and nutrient assessment. Twenty products were missing ingredient information, resulting in 403 ITP included in the ingredient analyses. Supplementary Table 2 shows ITP categorized by ITP category and age group.

Energy and nutrient levels

Overall, median energy level was 101 kcal/100 g or mL [IQR: 67, 400]. Median total fat level was 1.2 g [0, 7.1] (1%DV/serving) with almost no saturated fat content, while median protein level was 3.6 g [0.8, 10.0] (Table 1). Most calories came from total carbohydrates with a median of 21.7 g [14.1, 71.4], of which 10.9 g [5.5, 17.6] (13%DV/serving) were sugars. Micronutrient levels were generally low with a median sodium level of 16 mg [4, 100] (1%DV/serving) and iron level of 0.9 mg [0.4, 6.0] (6%DV/serving). Supplementary Table 3 shows the energy and nutrient levels per serving overall, by ITP category, and by age group.

Table 1.

Energy and nutrient levels of commercial infant and toddler food and beverage products (ITP) per 100 g or mL.

	Overall	By ITP categorya						By age groupb
		Dry, instant cereals	Ready-to-eat cereal and cereal bars	Cookies and teething biscuits	Strained dishes	Combination dishes	Toddler milk	Infants (<1 y)	Toddlers (1–3 y)
n (%)	423	72 (17.0%)	21 (5.0%)	104 (24.6%)	207 (48.9%)	10 (2.4%)	8 (1.9%)	323 (76.4%)	100 (23.6%)
Energy (kcal)	101 [67, 400]	393 [367, 429]	389 [350, 391]	400 [375, 450]	67 [57, 78]	87 [78, 92]	83 [79, 100]	78 [63, 196]	391 [107, 429]
Total fat (g)	1.2 [0, 7.1]	8.9 [5.0, 10.7]	8.3 [7.5, 10.9]	3.1 [0, 14.6]	0.1 [0, 0.8]	2.7 [2.6, 4.0]	3.3 [3.2, 3.5]	0.4 [0, 4.3]	7.5 [1.7, 14.3]
Saturated fat (g)	0 [0, 0]	0 [0, 0]	0 [0, 0]	0 [0, 0]	0 [0, 0]	0 [0, 0]	0.6 [0.5, 1.0]	0 [0, 0]	0 [0, 0]
Protein (g)	3.6 [0.8, 10.0]	14.3 [12.1, 14.3]	5.0 [5.0, 5.6]	7.1 [5.0, 10.0]	0.8 [0.7, 1.7]	3.3 [3.2, 3.9]	3.3 [3.0, 3.8]	1.7 [0.8, 10.0]	5.6 [3.8, 10.0]
Total carbohydrates (g)	21.7 [14.1, 71.4]	67.9 [64.3, 71.4]	70.0 [69.6, 72.2]	80.0 [70.6, 90.0]	14.8 [12.5, 17.2]	10.0 [9.4, 11.3]	10.0 [9.1, 14.0]	18.0 [14.1, 67.9]	70.0 [18.3, 72.2]
Sugars (g)	10.9 [5.5, 17.6]	20.7 [10.0, 28.6]	30.4 [30, 33.3]	14.3 [0, 21.4]	10 [7.0, 12.5]	2.1 [2.0, 3.9]	7.5 [0, 8.6]	10.9 [6.7, 14.8]	13.8 [2.0, 30.0]
Fibre (g)	1.7 [1.6, 3.6]	6.7 [3.3, 7.1]	5.6 [5.0, 8.7]	0 [0, 10]	1.6 [1.6, 2.3]	1.3 [1.3, 1.3]	0 [0, 0]	1.7 [1.6, 3.3]	5 [1.3, 8.0]
Sodium (mg)	16 [4, 100]	107 [33, 161]	39 [15, 175]	50 [6, 214]	8 [2, 16]	153 [127, 194]	39 [38, 40]	12 [3, 39]	71 [22, 200]
Calcium (mg)	37 [0, 191]	589 [367, 982]	122 [110, 191]	0 [0, 641]	34 [0, 52]	46 [38, 73]	106 [106, 117]	37 [0, 157]	106 [0, 220]
Iron (mg)	0.9 [0.4, 6.0]	50.0 [46.7, 50.0]	4.2 [3.7, 4.7]	0 [0, 6.3]	0.6 [0.4, 1.1]	0.8 [0.6, 0.9]	1.2 [1.1, 1.2]	0.9 [0.4, 8.6]	2.2 [0.1, 4.7]

Values are median [IQR] per 100 g or mL. n = 423. ^aInfant and toddler food and beverage product (ITP) categories were based on Health Canada’s Table of Reference Amounts for Food Categories (16). Categories with ≤5 products were not reported due to their poor representation of the category; these include Juices (n = 1) and Yogurt (n = 0). ^bProducts with a minimum age requirement of under 1 year on their packages were categorized as products for infants (<1-year-old), while all other products were considered to be for toddlers (1–<4-years-old). Abbreviations: ITP, Infant and toddler food and beverage product.

The top 3 ITP categories with the highest energy were Cookies & teething biscuits (median [IQR]: 400 kcal/100 g or mL [375, 450]), Dry, instant cereals (393 kcal [367, 429]), and Ready-to-eat cereal & cereal bars (389 kcal [350, 391]), which also had the highest carbohydrate (80.0 g [70.6, 90.0], 67.9 g [64.3, 71.4], and 70.0 g [69.6, 72.2], respectively), and sugar levels (14.3 g [0, 21.4], 20.7 g [10.0, 28.6], and 30.4 g [30, 33.3], respectively). The highest fat levels were seen in Dry, instant cereals (8.9 g [5.0, 10.7]) and Ready-to-eat cereal & cereal bars (8.3 g [7.5, 10.9]). Combination dishes had the highest sodium levels of 153 mg [127, 194] (22%DV/serving), while Dry, instant cereals had the highest calcium (589 mg [367, 982]; 54%DV/serving) and iron (50 mg [46.7, 50]; 136%/serving) levels.

Infant ITP were less energy-dense and lower in macro- and micro-nutrients than toddler ITP.

‘High in’ nutrients-of-concern

Overall, 58.6% (n = 248) of ITP met or exceeded FOPL thresholds for at least one nutrient-of-concern, mainly for sugars (55.3%, n = 234; Table 2). Only 2.4% (n = 10) of ITP were ‘High in’ saturated fat and 2.1% (n = 9) for sodium.

Table 2.

Proportion of commercial infant and toddler food and beverage products (ITP) that meet and/or exceed thresholds of Canadian front-of-pack labelling regulations

	n	‘High in’ ≥ 1 nutrient-of-concern	‘High in’ nutrient-of-concern type
			‘High in’ saturated fat	‘High in’ sugars	‘High in’ sodium
		n (%)	n (%)	n (%)	n (%)
Overall	423	248 (58.6%)	10 (2.4%)	234 (55.3%)	9 (2.1%)
By ITP category a
Dry, instant cereals	72	35 (48.6%)	0	35 (48.6%)	0
Ready-to-eat cereal and cereal bars	21	16 (76.2%)	0	16 (76.2%)	0
Cookies and teething biscuits	104	5 (4.8%)	2 (1.9%)	3 (2.9%)	0
Strained dishes	207	177 (85.5%)	6 (2.9%)	171 (82.6%)	1 (0.5%)
Combination dishes	10	8 (80%)	0	3 (30%)	8 (80%)
Toddler milks	8	6 (75%)	2 (25%)	5 (62.5%)	0
By age group b
Infants (<1-year-old)	323	204 (63.2%)	7 (2.2%)	197 (61.0%)	1 (0.3%)
Toddlers (1–<4-years-old)	100	44 (44%)	3 (3%)	37 (37.0%)	8 (8%)

Values are n (%). ^aInfant and toddler food and beverage product (ITP) categories were based on Health Canada’s Table of Reference Amounts for Food Categories (16). Categories with ≤5 products were not reported due to their poor representation of the category; these include juices (n = 1) and yogurt (n = 0). ^bProducts with a minimum age requirement of <1 year on their packages were categorized as products for infants (<1-year-old), while all other products were considered to be for toddlers (1–<4-years-old). Thresholds for Canadian FOPL regulations were used to identify products ‘High in’ nutrients-of-concern (12). Abbreviations: ITP, Infant and toddler food and beverage products.

Strained dishes (85.5%; n = 177/207) had the highest proportion of ITP ‘High in’ nutrient(s)-of-concern, primarily for sugars (82.6%, n = 171/207). Although most ITP were not ‘High in’ sodium, 80% of Combination dishes were (n = 8/10).

Compared with toddler ITP, a higher proportion of infant ITP were classified as ‘High in’ nutrient(s)-of-concern (61.0% vs. 37.0%).

Ingredients

Grains were the most common main ingredient (37.5%, n = 151/403), with the majority being non-whole grains (e.g., white flour, rice; Figure 1). The second most common main ingredient was fruits or vegetables (32.5%, n = 131/403), followed by sugars-based (21.8%, n = 88/403) and protein ingredients (8.2%, n = 33/403).

Figure 1.

The frequency of main ingredients in commercial infant and toddler food and beverage products (ITP). Products with missing ingredient information were excluded from the analysis (final n = 403). The main ingredient for each ITP was determined as the first ingredient in the ingredients list, except for products where water was listed as the first ingredient, in which case, the second ingredient was considered the main ingredient. Ingredients were categorized into four major groups (grains, fruits and/or vegetables, protein, sugars-based ingredients) and further separated into minor categories based on their characteristics. Sugars-based ingredients were determined according to Health Canada’s definition and examples (22).

Price

Overall, median price of ITP was $1.76/100 g or mL [IQR: 1.32, 2.89] (Table 3). Supplementary Table 4 shows median price per serving overall, by ITP category, and by age group. Strained dishes had the lowest price of $1.32/100 g or mL [1.09, 1.55] and Cookies and teething biscuits had the highest price of $6.95 [5.60, 7.85]. Although prices of infant products were lower than toddler products ($1.56 [1.25, 2.12] vs. $3.00 [1.76, 6.64]) per 100 g or mL, the opposite trend was seen when prices were compared by serving size (infants: $1.19/serving [0.58, 1.45] vs. toddlers: $0.51/serving [0.44, 1.21]), likely due to the small serving sizes of the majority of toddler products (i.e., 74% with serving sizes ≤ 30 g).

Table 3.

Price of commercial infant and toddler food and beverage products (ITP) per 100 g or mL

	n	Price ($CAD), median [IQR]
Overall	708	1.76 [1.32, 2.89]
By ITP category a
Dry, instant cereals	132	1.76 [1.76, 1.98]
Ready-to-eat cereal and cereal bars	30	2.89 [2.56, 3.65]
Cookies and teething biscuits	170	6.95 [5.60, 7.85]
Strained dishes	349	1.32 [1.09, 1.55]
Combination dishes	15	1.56 [1.55, 1.60]
Toddler milks	11	3.05 [1.41, 3.23]
By age group b
Infants (<1-year-old)	546	1.55 [1.31, 1.98]
Toddlers (1–<4-years-old)	162	3.14 [1.88, 6.64]

Values are median [IQR]. n = 708. Duplicate products were included in the analysis for a better market representation of prices of infant and toddler food and beverage product (ITP). ^aITP categories were based on Health Canada’s Table of Reference Amounts for Food Categories. Categories with ≤ 5 products were not reported due to their poor representation of the category; these include Juices (n = 1) and yogurt (n = 0). ^bProducts with a minimum age requirement of under 1 year on their packages were categorized as products for infants (<1-year-old), while all other products were considered to be for toddlers (1–<4-years-old). Abbreviations: ITP, Infant and toddler food and beverage products.

DISCUSSION

We examined the nutritional quality and price of commercial ITP in Canada. ITP were generally energy-dense, high in carbohydrates and sugars, and low in total and saturated fat. However, there were notable variations in energy and nutrient levels across ITP categories. Cookies and teething biscuits was the most energy-dense category with high carbohydrates but had low micronutrient levels, while Dry, instant cereals was the most nutrient-dense. Although many ITP would not be subject to FOPL regulations, 58% were ‘High in’ at least one nutrient-of-concern, primarily sugars. ITP prices also varied significantly across categories, with Cookies & teething biscuits to be the most expensive, and toddler ITP more expensive than infant ITP.

Energy and nutrient levels of ITP varied widely across categories, but tended to be higher in carbohydrates and lower in essential nutrients, such as protein, calcium, and iron. Similar findings from other countries highlighted the high caloric contribution from carbohydrates, primarily starches (6,9), in commercial ITP. Our ingredient analysis revealed most ITP consist of carbohydrate-rich foods like grains, fruits, and vegetables. We found Dry, instant cereals to be the most energy- and nutrient-rich ITP category (likely due to voluntary fortification (23)), while other ITP were generally low in calcium and iron. Infants are recommended to consume iron-rich complementary foods (18); yet, our findings suggest such ITP are not readily available in the market. Given complementary foods for infants play an important role in providing essential nutrients for development and can impact lifelong relationships with food, there is a need for various innovative, nutrient-rich ITP designed for infants.

Despite recommendations to limit free and added sugar intakes (24,25), over half of ITP examined were ‘High in’ sugars (total). Further examination of ingredients indicated a common use of sugars-based ingredients, suggesting high total sugar content is primarily attributed to free or added sugars, most commonly using fruit purées and juices. Fruit purées and juices enhance the sweetness of ITP, including vegetables and meats that are not naturally sweet. The widespread use of these fruit-derived sweetening agents may contribute to a preference for sweetened foods among infants and toddlers (3,26), and can create a health halo effect as a fruit-derived ingredient. Chronic exposure to foods with free sugars increases risk of dental caries and metabolic diseases in childhood and later life (24,27,28). Most ITP in this analysis would be exempted from current Canadian FOPL regulations, given they are marketed for infant consumption or regulated as supplemental foods (i.e., toddler milks). Extending Canada’s FOPL regulations to ITP could encourage sugar reduction in food and beverage products, as seen in Chile following the Chilean Law of Food Labelling and Advertising (29).

Interestingly, ITP prices varied widely by category and did not appear to be related to nutritional quality. For instance, median price of Cookies and teething biscuits was almost four times higher than Dry, instant cereals, the most energy- and nutrient-dense category. With generally low levels of essential nutrients in ITP, other product characteristics, such as brand and marketing (30), may significantly impact consumer choices more than nutrient levels. The role of brand and marketing may be particularly pronounced for discretionary products for toddlers (i.e., ready-to-eat cereal and cereal bars, and cookies and teething biscuits), with toddler food products often featuring messages or claims on their packaging (9) that can influence consumer choices (31). Public health and clinical guidelines are needed to encourage healthful and cost-effective consumer food choices concerning ITP.

While toddler milks appeared to be good sources of key nutrients, they were also higher in sugars and price than other categories. Compared to the recommended beverage for toddlers (18,32), whole cow’s milk, toddler milks had similar median calorie (nutrient levels according to the Canadian Nutrient File (33) vs. toddler milk based on the present analysis: 90 vs. 83 kcal/100 mL), protein (3.2 vs. 3.3 g), and calcium (117 vs. 106 mg), but were higher in total sugars (5.2 vs. 7.5 g) from sugars-based ingredients (e.g., sucrose, glucose-fructose), unlike naturally occurring sugars in milk (i.e., lactose). In fact, 62% of toddler milks were considered ‘High in’ sugars according to Canada’s FOPL thresholds. Many toddler milks follow labelling and marketing practices that closely resemble those of infant formula, as an alternative to breastmilk or whole milk for toddlers, potentially misleading consumers about their nutritional quality and intended use (10). Further, toddler milks cost about ten times the price of whole milk (median: $3.14/100 mL [3.00, 6.46] based on the present analysis vs. $0.30/100 mL [IQR: 0.23, 0.34] based on the prices of 54 whole milk products in FLIP 2020), which can impose an unnecessary financial burden on families. Labelling regulations for toddler drinks must be re-examined for clarity, transparency, and consistency to help consumers make informed purchasing decisions.

Although we conducted a comprehensive analysis of the nutritional quality of infant and toddler products, there are a few limitations to note. First, some FLIP products were excluded due to unavailable product information, likely due to the absence of mandatory nutrition labelling regulations for online grocery retail (34,35). Second, the current analysis focussed solely on foods within pre-defined TRA categories, excluding products in other categories commonly consumed by this age group (e.g., animal crackers, yogurt, breakfast cereals). There were no ITP identified as juice or yogurt products specifically for < 4-year-olds, meaning these products display nutrition information for all age groups, using higher %DV based on a 2,000-kcal diet. As FOPL regulations are implemented, pre-packaged products commonly consumed by toddlers will be evaluated against higher thresholds (e.g., sugar thresholds for foods with reference amounts of > 30 g or mL are 8 g for < 4-year-olds vs. 15 g for all others). Future research on products commonly consumed by toddlers is needed to capture potential regulatory gaps that may cause consumer confusion regarding their nutritional quality.

CONCLUSION

Overall, the nutritional quality of ITP in Canada is suboptimal, with many “High in” sugars; and the prices of ITPs varied widely. Current labelling regulations may not be effectively communicating the nutritional quality of ITP to consumers and warrant improvement.

Supplementary Data

Supplementary data are available at Paediatrics & Child Health Online.

Funding/Financial Disclosure

Funding for this research was received from the Canadian Institutes of Health Research (CIHR) Project grants (MRL): PJT-165858 and PJT-152979; and Toronto Metropolitan University Faculty of Community Services Publication Grant (JJL). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Potential Conflict of Interest

All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Data Availability

The corresponding author can be contacted with any questions regarding the data used in analysis; data may be shared subject to relevant policies of the host organization.