A Profile of Flavourings in Commercial Complementary Foods in South Africa

ABSTRACT

Research into the sugar content of commercial complementary foods (CCFs) for infants and young children (IYC) has been extensive, but little attention has been given to flavourings in these products. This study aimed to create a profile of the prevalence and type of flavourings in CCFs for IYC in South Africa (SA). Data were collected on CCFs indicated as suitable for introduction from ages 6 to 23 months at 26 physical stores in the Western Cape, and the online stores of nine major SA retailers between June 2022 and February 2023. Data were collected by photographing product labels and contacting the manufacturers for further information. The results showed that 36.2% of CCFs contained flavourings, with 75.9% of these containing one and the remainder up to three flavourings. More than half (52.4%) of the flavouring‐containing products were marketed as suitable for introduction from 6+ months, and almost half (48.6%) of the baby drinks, all indicated as suitable for introduction from 6+ months, contained flavourings. Flavourings were present in 84.2% of dry baby foods (cereals/porridges). The flavourings in CCFs were primarily of sweet flavours (> 80%) with vanilla being the most prevalent flavour. Moreover, only 51% of CCFs complied with all SA labelling regulations relating to flavourings and 78.3% violated regulations relating to non‐addition claims. The prevalence of sweet CCFs with added flavourings raises concerns about its potential negative impact on children's taste preferences, dietary habits, and consequent long‐term health outcomes. Re‐evaluating the use of flavourings in CCFs and strengthening the enforcement of labelling regulations in SA is imperative.

Commercial complementary foods (CCFs) in South Africa are largely sweet and flavoured, with most products targeting infants from 6+ months. This raises concerns about early taste preferences and the need for stricter regulation and labelling of flavourings.

Summary

• The baby food market in South Africa (SA) is characterised by predominantly sweet commercial complementary foods (CCFs) high in sugar and with a high prevalence of flavourings.

• The flavourings present in CCFs are mostly sweet across a wide variety of fruit and other sweet flavours in natural and/or nature‐identical forms.

• Baby food manufacturers most intentionally target infants from 6+ months of age already.

• There is a need to re‐evaluate the use of flavourings in CCFs and enforce labelling regulations in SA.

1. Introduction

Optimal nutrition from conception until a child reaches the age of 2 years is crucial as it strengthens the likeliness of survival and supports optimal growth and development (World Health Organization 2023a, 2023b). Maternal nutrition is one of the most important factors affecting nutrient availability for a fetus and an infant during pregnancy and breastfeeding, respectively (Phillips 2006). Furthermore, maternal nutrition during pregnancy and breastfeeding influences an infant's gut microbiome, which is involved in their health and immune system development (Lundgren et al. 2018). However, from the age of 6 months, suitable complementary foods must be introduced to the diet and fed together with breastmilk to supplement the growing nutritional and energy needs of infants and young children (World Health Organization 2002).

Optimal complementary foods and feeding practices are threatened by many inappropriate commercial complementary foods (CCFs) and the inappropriate promotion of these foods (World Health Organization 2017). CCFs are mostly sweet and high in sugar, and many contain added sugar to appeal to the innate preference infants and young children have for sweet tastes (Garcia et al. 2013; Marais et al. 2019). These foods are promoted widely even though research demonstrates that predominantly sweet‐tasting foods reinforce infants' and young children's sweet‐taste preferences and may result in adverse health outcomes such as obesity and an increased risk of non‐communicable diseases during childhood and in later life (Beauchamp and Moran 1982; Foterek et al. 2015; Vaziri et al. 2020; De Cosmi et al. 2017).

Furthermore, some baby food products even contain added flavourings to improve the acceptance of these foods (German Federal Institute for Risk Assessment 2020). Flavourings are substances or mixtures added to foodstuffs in small amounts to give, alter or improve their flavour (Republic of South Africa 2010). Flavourings can be natural, nature‐identical, or artificial (Codex Alimentarius Commission 2004). Natural flavourings are obtained by physical processes from plant or animal material; nature‐identical flavourings are chemically identical to substances naturally present in plant or animal material, but they are chemically isolated from aromatic raw materials or produced through chemical synthesis; and artificial flavourings mimic the flavour of natural foods, but they are chemically different from substances naturally present in foods and are produced through chemical synthesis (Codex Alimentarius Commission 2008; Food and Agricultural Organization of the United Nations and World Health Organization 2004; Food and Drug Administration 2024). Flavouring‐containing commercial foodstuffs for infants and young children may similarly impact taste preferences as sweet‐tasting foods and have the same consequences (First Steps Nutrition Trust 2016; World Health Organization 2019; German Federal Institute for Risk Assessment 2020).

While extensive research has been done on the sugar content of CCFs and the impact thereof, little is known about flavourings in these products. Therefore, the magnitude of the potentially negative effect of flavourings in CCFs is unknown. In an attempt to map the CCF landscape, this study aimed to create a profile of flavourings, with a specific focus on prevalence and type (taste, flavour, and nature), added to CCFs for infants and young children in South Africa (SA).

2. Methods

2.1. Study Design

A quantitative cross‐sectional descriptive study with an analytical component was conducted to create a profile of flavourings in CCFs for infants and young children available on the SA retail market.

2.2. Study Sample

The study sample consisted of CCFs aimed at infants and young children 6 to 23 months of age (i.e., CCFs that can be introduced between 6 months and 2 years of age), available on the South African retail market (in‐store and online).

2.2.1. Inclusion and Exclusion Criteria

The study sample included products that indicated the age of introduction, or a milestone (e.g., sitting or crawling) occurring within the 6 to 23‐month age range. Different sizes of the same product (meaning products with the same brand name, sub‐brand name, descriptive name and flavour variant) were only represented once in the study sample. Products under the same brand name and sub‐brand name but with different descriptive names and/or flavour variants were all included as unique products. Where a new and improved formulation of an existing product was also available, the original formulation, as well as the updated formulation, were included as separate products.

Products that were out of stock and remained so during the entire data collection period were excluded from the study. Products for which the necessary information could not be obtained were also excluded from the study. Commercial Milk Formulas (CMFs) and any other milk or milk‐like products marketed as suitable for feeding infants and young children younger than 36 months of age were excluded.

2.3. Data Sources

In the pursuit of obtaining a cross‐sectional view of CCFs on the SA retail market, the retail stores at which data were collected included supermarkets, hypermarkets, pharmacies, and baby chain stores that were selected if they: (1) sold a variety of complementary foods; (2) were among the main contenders in the SA retail market; and (3) their target market included a large portion of the Living Standard Measure (LSM). Based on these criteria, data were collected from all the physical chain stores (26 in total) of Shoprite Holdings Ltd, Pick'n Pay Retailers Ltd, Spar Group Ltd, Massmart Holdings Ltd, Woolworths Holdings Ltd, Clicks Group Ltd, Dis‐Chem Pharmacies Ltd, Baby Boom, and Toys R Us in George, one of the largest cities in the Western Cape province of SA. To ensure the results were representative of all of SA, data were also collected from the online stores, nationally, of all the chain stores of these major SA retailers.

2.4. Data Collection

The first part of the data collection period was from June to September 2022. During this time all the CCFs available in the selected chain stores were recorded. Products were found in‐store by checking the baby food aisles, as well as all fridges and freezers. The principal researcher collected the data in‐store and online by photographing each product included in the study sample and all the relevant information on its label with a smartphone. Consent was given by each store manager before products were photographed in‐store. Therefore, the products did not have to be purchased. The variables that were recorded for each product included: (1) manufacturer; (2) manufacturing location; (3) product name (brand name, sub‐brand name, descriptive name, and variant); (4) packaging type; (5) food type; (6) food subtype; (7) intended use; (8) age of introduction (from x months); (9) age category; (10) non‐addition claims relating to flavourings; (11) ingredients; (12) product taste indicators (fruits, honey, and added sugar); (13) product taste; (14) whether the product contains flavourings; (15) number of flavourings; (16) type of flavourings (taste, flavour, and nature); and (17) compliance of flavouring labelling with three sets of SA labelling regulations relating to flavourings [Regulations Relating to the Labelling and Advertising of Foodstuffs (R146) under section 15 (1) of the Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act 54 of 1972)].

Non‐addition claims are statements asserting that an ingredient, which is allowed to be added and is typically present in a food product, has not been added to the food product (Codex Alimentarius Commission 2013).

CCFs were classified as sweet or savoury based on previous studies (Garcia et al. 2013; Marais et al. 2019) with some modifications of the criteria set out in these studies. Sweet CCFs included almost all foods sweetened with fruits, honey, or added sugar, with some exceptions, and also teas. Savoury was all other foods, including pureed vegetables only, pureed fruits and vegetables if the product contained more vegetables than fruits, composite meals, including ones containing some fruit or added sugar in small amounts, and unsweetened cereals and grains.

The regulation sets referred to above were: (1) Regulations 23, 36(1), and 36(2) according to which flavourings must be indicated in the ingredients list, may be indicated by their category name, that is, ‘flavouring(s)’, and must not be qualified further by the word natural, nature‐identical, synthetic, artificial, or any other similar word; (2) Regulation 36(3) according to which a food that contains a flavouring of an ingredient but not the real ingredient itself must contain the word ‘flavouring’ or ‘flavoured’ in the name or descriptor of the product; and (3) Regulation 42 according to which a flavouring or carrier of a flavouring that is derived from or contaminated with a common allergen must have the origin of the common allergen indicated in parenthesis after the name of the flavouring (Republic of South Africa 2010).

The second part of the data collection period was from October 2022 to February 2023. During this time, baby food manufacturers were contacted to obtain further information on the flavourings present in these products. The further information that was requested included information on the type of flavourings (taste, flavour and nature) as well as information that was needed to confirm compliance with the previously mentioned labelling regulations. For this study, flavouring taste refers to either sweet or savoury. It is dependent on the taste of the food the flavouring is derived from or mimicking, for example, banana flavouring will be classified as sweet as bananas are sweet. Flavouring flavour refers to the specific food the flavouring is derived from or mimicking, for example, banana, vanilla, honey, and so forth. Flavouring nature is based on the method of derivation and chemical structure of the flavouring and can be natural, nature‐identical, or artificial (Codex Alimentarius Commission 2008; Food and Agricultural Organization of the United Nations and World Health Organization 2004; Food and Drug Administration 2024; Codex Alimentarius Commission 2004).

2.5. Data Analysis

Microsoft Excel was used to capture and analyse the data. Data was transferred from the pictures taken in‐store and online to Microsoft Excel, cleaned, re‐arranged and organised. Based on a study by Sweet et al. (2012) and Marais et al. (2019), CCFs were categorised according to food type as dry baby foods, prepared baby foods, snacks/finger foods, or baby drinks, and also further classified according to food subtype. While Sweet et al. (2012) categorised baby food as dried, prepared, and other based on Euromonitor International's 2011 article ‘Baby Foods in South Africa’, here the food type ‘other baby food’ was separated into snacks/finger foods and baby drinks. Dry baby foods require liquid, usually water or milk, to be added before consumption, for example, cereal/porridge; prepared baby foods can be consumed as is and are usually sold in jars or pouches e.g. pureed fruits/vegetables/composite meals; and snacks/finger foods and baby drinks include all the other products marketed for babies, for example, teething biscuits, rusks, puffs, chewy/fruity treats, juices, teas, etc. (Sweet et al. 2012). Data analysis was done using descriptive statistics, specifically frequency distribution, in which the data distribution across single and various combinations of multiple variables was investigated. The results were used to create a profile of the prevalence and type of flavourings in these products.

2.6. Ethics Statement

The research proposal was submitted for ethics review to the Research Ethics Committee: Social, Behavioural and Educational Research (REC: SBE) on 22 April 2022. The study was classified as low risk after review by the Department/Faculty Ethics Screening Committee (DESC/FESC): Faculty of Agrisciences and provisional ethics approval was granted on 4 August 2022. Formal ethics approval from the REC: SBE at Stellenbosch University was granted on 22 February 2023 (Project ID: 25005).

3. Results

Out of 446 CCFs indicated as suitable for introduction to infants and young children aged 6 to 23 months from 19 manufacturers (12 South African and seven international), 401 products could be included in the study due to their availability and obtainability of the necessary information about them. The majority (87.5%; n = 351) of the products included in the study were manufactured in South Africa, while the rest (12.5%; n = 50) were imported.

3.1. Prevalence of Flavourings in CCFS

Of all the available CCFs included in the study, 36.2% (n = 145) contained flavourings. Most (75.9%; n = 110) of the products that contained flavourings contained only one flavouring, whereas the rest contained up to three flavourings (Table 1).

Table 1.

Prevalence and number of flavourings in the available CCFs.

Contains flavouring(s)
Number of flavourings	n (%)	As % of n yes
No	256 (63.8)	—
Zero	256 (63.8)	—
Yes	145 (36.2)	100
One	110 (27.4)	75.9
Two	19 (4.7)	13.1
Three	4 (1.0)	2.8
Unknown	12 (3.0)	8.3
Total	401 (100)	—

3.1.1. Age Category and Age of Introduction

The majority (94.5%; n = 379) of CCFs were indicated as suitable for introduction from an age within the older infant category (6–11 months) and included all CCFs with an age of introduction within this age range, that is, 6+, 7+, 8+, 9+ or 10+ months. Only 5.5% (n = 22) were indicated as suitable for introduction from an age within the young child category (specifically 12–23 months) and included all CCFs with an age of introduction within this age range, that is, 12+, 13+ or 18+ months. Of the CCFs indicated as suitable for introduction to older infants and young children, 34.3% (n = 130) and 68.2% (n = 15) contained flavourings, respectively.

The specific age of introduction that was most intentionally targeted by baby food manufacturers was 6+ months (Figure 1). More than half (52.6%; n = 211) of all the available CCFs indicated on the packaging that they were suitable for introduction from 6 months onward, and of these 36% (n = 76) contained flavourings. This means that 52.4% (n = 76) of all the flavouring‐containing products (n = 145) were branded as suitable for introduction from as early as 6 months. CCFs for introduction from 6+ months were also one of only two ages of introduction, the other being 8+ months, for which the products contained up to three flavourings.

Figure 1.

Distribution of CCFs across the different ages of introduction in the two age categories.

3.1.2. Intended Use, Food‐Type and Food Subtype

The majority (91.3%; n = 366) of CCFs were foods, while only 8.7% (n = 35) were beverages. Foods included the food types dry baby foods, prepared baby foods, and snacks/finger foods, while beverages included baby drinks. Just over a third (35%; n = 128) of the foods contained flavourings, while almost half (48.6%; n = 17) of the beverages contained flavourings.

The most prevalent food type was prepared baby foods, while the most prevalent food subtype was cereals/porridges (Table 2). Flavourings were found to be most commonly present in dry baby foods, consisting of only cereals/porridges, with 84.2% (n = 80) of the products containing flavourings.

Table 2.

Distribution of CCFs and prevalence of flavourings across intended uses, food types, and food sub‐types.

Intended use
Food type	Total		Contains flavouring(s)
Food subtype	n 1	%	n 2	As % of n 1	As % of n 2 total
Foods	366	91.3	128	35	88.3
Dry baby foods	95	23.7	80	84.2	55.2
Cereals/Porridges	95	23.7	80	84.2	55.2
Prepared baby foods	237	59.1	34	14.3	23.4
Pureed fruits	61	15.2	7	11.5	4.8
Pureed fruits and vegetables	18	4.5	0	0	0
Pureed vegetables	18	4.5	0	0	0
Pureed composite meals	74	18.5	11	14.9	7.6
Pureed desserts	18	4.5	8	44.4	5.5
Dairy/Yoghurt only	1	0.2	1	100	0.7
Dairy/Yoghurt and Pureed fruits	43	10.7	7	16.3	4.8
Dairy/Yoghurt and Pureed fruits and vegetables	3	0.7	0	0	0
Dairy/Yoghurt and Pureed vegetables	1	0.2	0	0	0
Snacks/Finger foods	34	8.5	14	41.2	9.7
Biscuits/Cookies/Wafers/Crackers	11	2.7	5	45.5	3.4
Rusks	1	0.2	0	0	0
Puffs/Veggie straws/Baked rolls	12	3	3	25	2.1
Chewy treats/Fruit snacks/Bars	10	2.5	6	60	4.1
Beverages	35	8.7	17	48.6	11.7
Baby drinks	35	8.7	17	48.6	11.7
Teas	6	1.5	4	66.7	2.8
100% Fruit juices	4	1	1	25	0.7
100% Fruit juice blends	13	3.2	4	30.8	2.8
100% Fruit and Vegetable juice blends	2	0.5	0	0	0
Fruit juices/nectars w/tea/tea extract	6	1.5	6	100	4.1
Fruit juices/nectars w/water	3	0.7	1	33.3	0.7
Fruit juices/nectars w/tea/tea extract and water	1	0.2	1	100	0.7
Total	401	100	145	—	100

Almost half (49.5%; n = 47) of dry baby foods, and by default cereals/porridges, specified their suitability for introduction from 6+ months. Most (76.6%; n = 36) of these cereals/porridges, however, contained up to three flavourings. All baby drinks (100%; n = 35) were specified as suitable for introduction from 6+ months and almost half (48.6%; n = 17) of these contained flavourings. Baby drinks (specifically fruit juices/nectars with tea/tea extract) which specified their suitability for introduction from 6+ months contained up to three flavourings. The available teas included flavoured and unflavoured rooibos tea (rooibos, meaning red bush, is an indigenous South African fynbos species that is used to produce the herbal tea called rooibos tea which is referred to as a health drink due to it being caffeine‐free, its low tannin content, and its many proposed health‐promoting properties such as its high antioxidant activity [Joubert and de Beer 2011]) and blends of rooibos and chamomile tea while the juices included various 100% fruit juices, as well as 100% juice blends (fruits only or fruits and vegetables), and juice blends with tea and/or water (Table 2).

3.1.3. Product Taste

The majority (77.6%; n = 311) of CCFs were sweet‐tasting, while 22.4% (n = 90) were savoury‐tasting. Of the sweet‐tasting products, 45.0% (n = 140) contained flavourings. This means that 96.6% (n = 140) of all the flavouring‐containing products were sweet‐tasting. The majority (80.1%; n = 169) of the products specified for introduction from 6+ months were sweet‐tasting, while only 19.9% (n = 42) were savoury‐tasting. Flavourings were present in 45.0% (n = 76) of these sweet‐, but not in any of these savoury‐tasting products. Sweet‐tasting products with a known number of flavourings contained up to three flavourings while savoury‐tasting products with a known number of flavourings contained only one flavouring.

Sweet‐tasting products contained sweet flavourings, for example, banana and honey, as far as could be determined. The taste of flavourings in savoury products could not be determined.

3.2. Type of Flavourings in CCFs

Baby food manufacturers were generally reluctant to participate in this study by disclosing information about the flavourings present in their products. Some flavourings remained unidentified as they were only listed in the ingredient list by the category name ‘flavouring(s)’ and manufacturers were either unwilling to share more information about the flavourings in the product or could not be reached at all. Therefore, not all information about every flavouring present could be obtained and for this reason, the data set was incomplete.

3.2.1. Flavouring Tastes

The majority (80.4%; n = 148) of flavourings resided in the sweet taste category, while the rest (19.6%; n = 36) remained unidentified. However, by deduction, it is possible to say that flavourings in the savoury taste category could not have exceeded 3.3% (n = 6).

3.2.2. Flavouring Flavours

Eighteen different flavours could be identified from among the flavourings present in the available products, while some flavours remained unidentified. All the flavours that could be identified were sweet and included mostly fruit flavours, but also other sweet flavours like vanilla (in the form of vanilla essence, vanilla extract, and most popularly—vanillin), caramel (in the form of caramel liquid and caramel powder), chocolate (in the form of cocoa powder), honey, and rooibos (Figure 2). Vanilla was the most prevalent identified flavour by far (Figure 2). Banana was the most prevalent fruit flavour, and the second most prevalent identified flavour overall (Figure 2). Rooibos was the third most prevalent identified flavour overall (Figure 2).

Figure 2.

Prevalence of the different flavours of flavourings in CCFs.

Of the CCFs marketed as suitable for introduction from 6+ months, 87.2% (n = 184) were multi‐flavour foods containing multiple ingredients across different food groups, some containing sugar and/or salt, spices, and various flavourings. Some of these products contained multiple flavourings, multi‐flavour flavourings (e.g., tutti frutti), or even a combination of the two (e.g., a berry‐flavoured rooibos tea containing tutti frutti and strawberry flavourings). Of the rest, 0.9% (n = 2) were single‐flavour foods with flavouring, 1.4% (n = 3) were single‐flavour foods with added sugar, salt, and/or spices, and 10.4% (n = 22) were single‐flavour foods consisting of single or minimal ingredients with no added sugar, salt, spices, and/or flavourings.

3.2.3. Flavouring Natures

While the nature of most (44.6%; n = 82) of the flavourings remained unidentified, 37% (n = 68) were identified as natural, 18.5% (n = 34) as nature‐identical, and none as artificial.

The fruit flavourings identified were mostly natural, while the other sweet flavourings including vanilla, caramel, chocolate, honey, and rooibos were almost equally natural and nature‐identical.

3.3. Compliance With Labelling Regulations Relating to Flavourings

3.3.1. Non‐Addition Claims

The majority (78.3%; n = 314) of CCFs had a flavouring‐related non‐addition claim such as ‘Flavouring Free’, ‘No Artificial Flavours’, or ‘No Artificial Flavourings’ present on their packaging. Just over a third (35.4%; n = 111) of these products contained one or more flavourings of a different nature (i.e., natural or nature‐identical), despite the presence of these claims. This means 76.6% (n = 111) of all the flavouring‐containing products had a flavouring‐related non‐addition claim present on their packaging.

3.3.2. Labelling of Flavourings

While the labelling of all the CCFs that contained flavourings complied with Regulation Set 1, 91.7% (n = 133) with Regulation Set 2, and 59.3% (n = 86) with Regulation Set 3, only 51% (n = 74) complied with all three regulation sets (Table 3). Furthermore, 8.3% (n = 12) of flavouring‐containing CCFs were noncompliant with Regulation Set 2 and compliance of 40.7% (n = 59) with Regulation Set 3 could not be determined.

Table 3.

Compliance with three sets of South African labelling regulations relating to flavourings.

	Regulation set 1	Regulation set 2	Regulation set 3	All three regulation sets
Compliance status	n 1 (%)	n 2 (%)	n 3 (%)	n 1,2&3 (%)
Compliant	145 (100.0)	133 (91.7)	86 (59.3)	74 (51.0)
Noncompliant	0 (0.0)	12 (8.3)	0 (0.0)	12 (8.3)
Unknown	0 (0.0)	0 (0.0)	59 (40.7)	59 (40.7)
Total	145 (100)	145 (100)	145 (100)	145 (100)

4. Discussion

4.1. Prevalence of Flavourings in CCFs

According to international guidance, optimal complementary foods should consist of ‘suitable, nutrient‐rich, home‐prepared, and locally available foods' (World Health Organization 2017). CCFs are, however, widely available, and frequently purchased as ready‐to‐eat and ready‐made products, which serve the demand of parents and caregivers who lack sufficient resources, for example, time, to prepare complementary foods at home (World Health Organization 2019; Srivastava and Chaturvedi 2020). Therefore, CCFs can displace home‐prepared complementary foods (World Health Organization 2017). However, the new WHO Guideline for complementary feeding of infants and young children 6–23 months of age does demonstrate that when fortified, suitably formulated and appropriately labelled CCFs have their place, such as Cereal grain‐based complementary foods (World Health Organization 2023a, 2023b).

The results of this study indicate that there is an intentional focus on infants, especially from 6 months old already, by baby food manufacturers. This is an important finding as while complementary foods should be introduced at 6 months due to the increased nutrient and energy needs at this age (World Health Organization 2002; Srivastava and Chaturvedi 2020), it should be appropriate, safe, and adequate as this is also an exceptionally vulnerable stage of an infant's health, growth and development (World Health Organization and United Nations Children's Fund 2003; World Health Organization 2017; World Health Organization 2024). While guidance exists for the formulation, labelling and promotion of CCFs including various Codex guidelines and standards, and the WHO Guidance on ending the inappropriate promotion of foods for infants and young children: implementation manual (Codex Alimentarius Commission 2017a; Codex Alimentrarius Commission 2017b; Codex Alimentarius Commission 2019; World Health Organization 2017), it seems that manufacturers are not heeding this guidance. Furthermore, guidance exists on what appropriate, safe, and adequate complementary foods and feeding practices are, including the Guiding principles for complementary feeding of the breastfed child, Guiding principles for feeding non‐breastfed children 6–24 months of age, and now also the WHO Guideline for complementary feeding of infants and young children 6–23 months of age. However, there is often a lack of proper knowledge about this among parents and caregivers (Aggarwal et al. 2008; Bimpong et al. 2020; Mekonen et al. 2024), leading to baby food manufacturers getting away with not heeding the aforementioned guidance.

The World Health Organization has expressed concern about the number of unsuitable products being marketed as suitable for infants and young children (World Health Organization 2017). The results of this study correspond with the results of other global studies, including another South African study, in that sweet‐tasting CCFs predominate (Elliott 2010; Garcia et al. 2013; Maalouf et al. 2017; Padarath et al. 2020; Marais et al. 2019). The results of these studies also indicate that many of the CCFs that are classified as savoury have sweet tastes due to the presence of sweet ingredients such as pureed fruits, fruit juice, honey, and even added sugar. According to Garcia et al. (2013), CCFs contain sweet ingredients to make them more palatable by appealing to infants' innate preference for sweet tastes. This means infants and young children who regularly consume CCFs are repeatedly exposed to sweet tastes, which could reinforce their innate preference for sweet tastes (Padarath et al. 2020).

Furthermore, against the recommendation of the WHO and Centres for Disease Control and Prevention (CDC), all the available teas and juices were marketed as suitable for introduction from 6+ months (World Health Organization 2002; Centers for Disease Control and Prevention 2023a). Both the WHO and CDC advise against giving infants and young children from 6 to 23 months of age nutrient‐poor drinks like tea and high‐sugar drinks like juice during the complementary feeding process as these might displace breastmilk and other nutrient‐rich foods (World Health Organization 2002; Centers for Disease Control and Prevention 2023a). Teas are not recommended since polyphenol‐rich teas like rooibos tea interfere with iron absorption in infants and young children (Dewey 2003; Dewey 2005; Ndiaye et al. 2020). Fruit and vegetable juices are not recommended as they offer no nutritional benefits before the age of 12 months and might displace breastmilk or CMF if introduced before solid foods (Heyman et al. 2017; World Health Organization 2017). The CDC encourages the consumption of only breastmilk or CMF and small amounts of water between 6 and 12 months of age (Centers for Disease Control and Prevention 2023b). According to the WHO, breastmilk remains the most appropriate liquid throughout the complementary feeding process (Dewey 2003).

The results of the current study indicate that many CCFs also contained up to three flavourings, especially sweet‐tasting CCFs marketed for introduction from 6+ months. Of these, cereals/porridges and all the beverages stood out. These are important and concerning findings as cereals/porridges are the CCFs most commonly given as first foods to infants in South Africa, and liquids other than breastmilk are commonly introduced before 6 months (Sayed and Schönfeldt 2018; Marais et al. 2019). This means it is very likely that infants will be exposed to flavourings through the very first complementary foods they consume. Repeated consumption of CCFs containing flavourings may lead to a preference for such foods over unprocessed or minimally processed foods (First Steps Nutrition Trust 2016).

Furthermore, it is important to introduce infants to single‐flavour foods with no unnecessary ingredients (e.g., added sugar and salt) and additives (e.g., flavourings), specifically at the beginning of the complementary feeding process (Codex Alimentarius Commission 2019; Paroche et al. 2017; World Health Organization 2017; Fewtrell et al. 2017; German Federal Institute for Risk Assessment 2020; Padarath et al. 2020). Unfortunately, the results of this study indicate that only a very small percentage of CCFs marketed for introduction from 6+ months were single‐flavour foods without any added sugar, salt, and/or flavourings. Therefore, the majority of CCFs specified as suitable for introduction from 6+ months were unsuitable as they do not meet infants' need for exposure to single‐flavour foods at the onset of the complementary feeding process.

Added sugar, other sweetening agents, salt, and flavourings increase the acceptability of CCFs at the beginning of the complementary feeding process, even though it is perfectly normal for infants to only accept certain foods after repeated exposure (Paroche et al. 2017; Anzman‐Frasca et al. 2018). Although these ingredients and additives probably aid in establishing brand loyalty, they may, unfortunately, influence taste preferences and contribute to the increased risk of obesity and non‐communicable diseases during childhood and in later life (Beauchamp and Moran 1982; Foterek et al. 2015; Vaziri et al. 2020; De Cosmi et al. 2017). Neumann et al. (2022) believe that flavourings in foodstuffs may lead to overeating and weight gain resulting in overweight and obesity through one of two potential mechanisms, namely the promotion of hedonic eating or the disruption of flavour‐nutrient learning. The current lack of enforceable legislation or regulations around the composition of CCFs, however, makes it difficult to address this problem.

4.2. Type of Flavourings Present

The predominance of flavourings in the sweet taste category in CCFs, especially in those specified as suitable for introduction from 6+ months, is worrying as existing literature suggests that they, just like sweet‐tasting ingredients, could reinforce sweet taste preferences (First Steps Nutrition Trust 2016; World Health Organization 2019). This means that flavourings in the sweet taste category could enhance the effect of sweet ingredients on taste preferences and could, consequently, cause CCFs, like teas, that do not contain any added sugar or other sweetening agents (e.g., honey, fruit juice or puree) to also lead to a preference for sweet tastes.

While natural fruit extracts, vanilla extract, ethyl vanillin, and vanillin are deemed suitable for use in complementary foods for infants and young children by the Codex Alimentarius Commission, if added in quantities that do not exceed the defined maximum limits (Codex Alimentarius Commission 2017a; Codex Alimentarius Commission 2019; Codex Alimentarius Commission 2017b), the WHO has expressed concerns about flavours that are not generally present in home‐prepared foods, for example, vanilla and chocolate, and not recommended in guidelines for infant and young child feeding, for example, honey (World Health Organization 2019). These flavours may modify or mask the natural flavour of foods, preventing the exposure of infants and young children to a variety of naturally occurring flavours that are important for the development of healthy food preferences, and result in the development of a preference for sweet, high‐sugar, unhealthy foods (World Health Organization 2019; Antignani et al. 2022). The results indicate that flavours of concern occur in many CCFs through the addition of vanilla, caramel, chocolate, honey, and rooibos flavourings.

The results of this study indicate that the majority of the flavourings of which the nature could be identified were natural and the rest nature‐identical, while it remains undetermined if any of the available CCFs contained artificial flavourings. Although baby food manufacturers frequently use natural flavourings and make sure to make claims such as ‘no artificial flavourings’ to appeal to the general perception that ‘natural flavourings are good while artificial ones are bad’, natural flavourings may be highly processed (Codex Alimentarius Commission 2004; Spritzler 2023), contain many other non‐flavour chemicals that can be natural and/or synthetic/artificial (Helmenstine 2019; Spritzler 2023), and ultimately be very similar to artificial flavourings in terms of chemical composition (U.S. Food and Drug Administration 2023).

4.3. Compliance With Labelling Regulations Relating to Flavourings

The Codex Alimentarium Commission and the WHO explicitly advise against making composition‐ or nutrition‐related claims such as non‐addition claims (e.g., ‘no added artificial flavour’) on commercial foodstuffs for infants and young children (Codex Alimentarius Commission 2013; Codex Alimentarius Commission 2019; World Health Organization 1981; World Health Organization 2017). These guidelines aim to prevent such claims as they may be misleading, therefore misinterpreted, and consequently undermine home‐prepared complementary foods and other healthier CCFs without such claims (World Health Organization 2019; Goodman 2017; Skubisz 2017). National regulations, such as those established by SA, are paramount in ensuring that such claims are properly managed and enforced.

In SA, the Regulations Relating to Foodstuffs for Infants and Young Children (No. R. 991) explicitly prohibit any health, medical, or nutrition claims for these products (Republic of South Africa 2012). However, the current study's findings highlight a critical issue: many CCFs in the market carry non‐addition claims regarding flavourings, violating these national regulations. The enforcement of these regulations is essential to protect consumers and ensure that food labels do not mislead parents and caregivers into making improper food choices for their infants and young children.

Since there are no specific national regulations in SA for the labelling of flavourings in CCFs, the relevant national laws, such as the Regulations Relating to the Labelling and Advertising of Foodstuffs (No. R. 146), must be adhered to. The importance of national regulatory frameworks becomes clear when considering that compliance with all the key regulations considered in this study could only be confirmed for about half of the flavouring‐containing CCFs included in the study.

Compliance with Regulation Sets 1 and 2 could be determined by simply studying the labels of the products. While all flavouring‐containing CCFs indicated flavourings correctly in their ingredient lists, a small percentage of CCF names and/or descriptors were misleading to parents and caregivers by implying the products contain certain real ingredients, not just flavourings of these ingredients. This demonstrates the need for stricter regulation and enforcement of these regulations. Such misinterpretations may result in children developing a preference for certain flavours over acceptance of the specific foods, potentially harming their long‐term dietary habits (Anzman‐Frasca et al. 2018; Paroche et al. 2017).

Compliance with allergen‐related regulations, as outlined in Regulation Set 3, is another area where national oversight is crucial. The flavourings in many flavouring‐containing CCFs were found to be free from common allergens, but significant gaps remain in verifying compliance due to challenges in reaching manufacturers. This emphasizes the need for stronger national mechanisms to ensure that food manufacturers fully comply with all aspects of food safety regulations.

The findings of this study emphasize the need to re‐evaluate the use of flavourings in CCFs and strengthen the enforcement of national labelling regulations for these products in SA. National regulations play a critical role in safeguarding public health, ensuring that parents and caregivers receive accurate information about the products they purchase, and maintaining the integrity of infant and child nutrition. Strengthening these regulations and their enforcement would help ensure that infants and young children are provided with safe, nutritious, and appropriately labelled food options.

Furthermore, despite many geographical constraints, SA serves as a trade gateway connecting many of its neighbouring African countries globally for various reasons such as its ample mineral resources, good regional and global transport connections, competitive services, comparatively large size, and superior logistics infrastructure in comparison to other African countries that attract global companies (Draper and Scholvin 2012). From among the manufacturers of the CCFs included in this study, seven global baby food manufacturers were identified. These companies have either set up regional headquarters in SA or their products are being imported to SA. Due to SA's trade gateway status, the results of this study have implications not only for SA but also for its neighbouring African countries.

4.4. Study Limitations

One limitation of this study is that it only considered complementary foods suitable for introduction from ages 6 to 23 months, whereas complementary foods are formulated for young children up to 36 months old, in accordance with Codex Alimentarius guidelines (Codex Alimentarius Commission 2017a). This limitation may restrict the generalisability of the findings to the full range of products available for older infants and young children in South Africa.

The data collection phase of this study also came with some limitations. Online stores were relatively unreliable data sources as many malfunctioned and were not regularly updated, causing uncertainty in the accuracy of the products that were displayed. Furthermore, many baby food manufacturers were reluctant or even unwilling to share further information on the flavourings in their products or could simply not be reached at all. Therefore, the data set was incomplete. From this, the question also arose whether relying on baby food manufacturers to supply accurate information on the flavourings in their products could have introduced bias.

Author Contributions

Wilana Barnard developed the protocol, planned the study, conducted data collection and capturing, analysed and interpreted the data, and drafted the article. Lisanne Monica du Plessis and Gunnar Oliver Sigge provided input at all research planning and development stages and on the article writing.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.