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The first 1000 days is a critical window to optimize nutrition. Young children, particularly 12–24 month-olds, are an understudied population. Young children have unique nutrient needs and reach important developmental milestones when those needs are met. Intriguingly, there are differences in the dietary patterns and recommendations for young children in the US vs. globally, notably for breastfeeding practices, nutrient and food guidelines, and young child formulas (YCFs)/toddler drinks. This perspective paper compares these differences in young child nutrition and identifies both knowledge gaps and surveillance gaps to be filled. Parental perceptions, feeding challenges, and nutrition challenges are also discussed. Ultimately, collaboration among academia and clinicians, the private sector, and the government will help close young child nutrition gaps in both the US and globally.

Docosahexaenoic acid (DHA) is essential for brain and cognitive development in toddlers; however, global intakes often fall below recommended levels. This study evaluated the bioavailability of DHA from commercial toddler formulas fortified with either microencapsulated high‐DHA fish oil powder or high‐DHA fish oil. A double‐blind, randomized controlled trial was conducted in 120 healthy Indonesian toddlers aged 2–3 years. Participants were assigned to one of three groups: (A) dry‐blended formula with microencapsulated high‐DHA fish oil powder, (B) unfortified control formula, or (C) wet‐mixed high‐DHA fish oil formula. Bioavailability was assessed using both blood and fecal fatty acid levels. Both DHA‐fortified formulas increased blood DHA levels, total omega‐3 fatty acids, and the Omega‐3 Index. However, only the microencapsulated DHA formula led to statistically significant improvements compared with the control. Apparent DHA digestibility and the incremental area under the curve (iAUC) for blood DHA were significantly higher in the microencapsulated DHA formula group compared with the high‐DHA fish oil formula group. Adherence and intake were also highest in the microencapsulated group, possibly due to improved palatability, although sensory characteristics were not directly assessed. While improvements in DHA status were statistically significant, the overall magnitude of change was modest, and its clinical significance remains uncertain. Nonetheless, microencapsulation may offer advantages for enhancing DHA bioavailability in young children. Higher DHA dosages or longer intake durations may be needed to achieve Omega‐3 Index levels exceeding 8% in populations with low baseline status. This double‐blinded randomized trial assessed the effect of different DHA fortification methods in toddler formula on blood DHA levels, digestibility, and adherence. Among 120 toddlers, microencapsulated high‐DHA tuna oil powder added via dry‐blending (Group A) significantly improved blood DHA levels compared to the unfortified control. DHA digestibility remained high in both fortified groups, with Group A also achieving the best adherence.

Background Hispanic children face disproportionately higher risks for early life obesity and resultant comorbidities such as Type 2 diabetes and fatty liver disease. Sleep habits are modifiable behaviors that impact early childhood obesity; Hispanic infants have been shown to have less nighttime sleep compared to their white counterparts. Pediatricians often coach families on parents’ nighttime responsive feeding and longer child sleep duration as protective factors against early life obesity, but must understand the family context and potential barriers. This study aimed to discover the sleeping habits and routines of Hispanic toddlers at risk for obesity through the perspective of their mothers. Methods This qualitative study used a phenomenological approach. 14 Hispanic mothers were recruited from a Federally Qualified Health Center in Central Texas for qualitative interviews regarding their experience raising a small child. Children aged 6 to 18 months with child weight-for-length ratio ≥ 85% for age were approached for study involvement and consented during well child visits. Interviews occurred over several months during 2018–2019; NVivo software was used for analysis of qualitative themes. Two reviewers coded and used constant comparative methods to identify common themes. Results Mothers diverged from AAP recommended guidelines for infant and toddler feeding and sleep habits. Mothers shared their intentions and the real-life barriers to implementing recommended habits. Mothers discussed wanting to have their child sleep in a separate bed or room but not having the resources (i.e., financial, space) to do so. Additionally, mothers discussed knowing not to feed to soothe at night but couldn’t bring themselves to let their child cry if they knew feeding would soothe them. Co-sleeping, feeding to sleep, middle of the night feeding, and lack of structured sleep habits were common interview themes and potentially modifiable factors. Conclusions Pediatricians need to be sensitive to culture and the real-world needs of families to determine if best practices are “practical.” Themes from these parent interviews can inform tailored interventions for children at high risk of obesity. Interventions should promote responsive nighttime feeding and structured sleep, working with individual family logistics, to coach families towards optimal healthy environments and healthy child weight.

Determination of nutritional status is closely related to the determination of dietary patterns should be given to infants. Nutrition is very important role in mental, physical development, and human productivity. In this study, the system based on android is developed to determine the nutritional status of infants by using Fuzzy Sugeno. Indicator variables are age, height, circle head, and body weight according to the male or female. In this study, the results of measurements of nutritional status of children with Fuzzy Sugenoare tested by comparing the nutritional quality of the data Posyandu toddler by using anthropometric tables. The results of the evaluation measurement accuracy in this application are compared with the results of manual calculation based infant growth charts according to WHO standards. Therefore, these applications can be used to help the community in monitoring the nutritional status of children so that the growth of children is more appropriate in line with expectations.

One of the problems in community health center or health clinic is documenting the toddlers’ data. The numbers of malnutrition cases in developing country are quite high. If the problem of malnutrition is not resolved, it can disrupt the country’s economic development. This study identifies malnutrition status of toddlers based on the context data from community health center (PUSKESMAS) in Jogjakarta, Indonesia. Currently, the patients’ data cannot directly map into appropriate groups of toddlers’ malnutrition status. Therefore, data mining concept with k-means clustering is used to map the data into several malnutrition status categories. The aim of this study is building software that can be used to assist the Indonesian government in making decisions to take preventive action against malnutrition.

Purpose Modern food technology allows designing products aiming to simulate and replace traditional food. In affluent societies there is a rising tendency to consume foods derived from plants including milk imitations or plant drinks based on cereals, nuts, legumes, oil seeds or other plant families. Herein we review production and composition of such drinks, summarize consumers’ motivations to change from milk to plant drinks and highlight nutritional and health implications of consuming plant drinks instead of milk, in particular if non-fortified and if consumed by infants, children, adolescents and the elderly. Results Whereas the macronutrient concentrations of some plant drinks (soy) may approach in some cases (protein) that of cow’s milk, the nutritional quality of most plant drinks, e.g., the biological value of protein and the presence and amount of vitamins and essential minerals with high bioavailability does not. If cow’s milk is exchanged for non-fortified and non-supplemented plant drinks consumers may risk deficiencies of calcium, zinc, iodine, vitamins B2, B12, D, A, and indispensable amino acids, particularly in infants and toddlers who traditionally consume significant portions of milk. The vegetable nature, appearance and taste of such plant drinks may be appealing to adult consumers and be chosen for adding variety to the menu. However, in young children fed exclusively such plant drinks severe metabolic disturbances may occur. Conclusion Parents, dietitians, physicians and consumers should be aware of such potential risks, if non-fortified plant drinks are consumed instead of milk.

The inappropriate marketing and aggressive promotion of breastmilk substitutes (BMS) undermines breastfeeding and harms child and maternal health in all country contexts. Although a global milk formula ‘sales boom’ is reportedly underway, few studies have investigated its dynamics and determinants. This study takes two steps. First, it describes trends and patterns in global formula sales volumes (apparent consumption), by country income and region. Data are reported for 77 countries, for the years 2005–19, and for the standard (0–6 months), follow‐up (7‐12 m), toddler (13‐36 m), and special (0‐6 m) categories. Second, it draws from the literature to understand how transformations underway in first‐food systems – those that provision foods for children aged 0–36 months – explain the global transition to higher formula diets. Total world formula sales grew by 115% between 2005 and 2019, from 3.5 to 7.4 kg/child, led by highly‐populated middle‐income countries. Growth was rapid in South East and East Asia, especially in China, which now accounts for one third of world sales. This transition is linked with factors that generate demand for BMS, including rising incomes, urbanisation, the changing nature of woman's work, social norms, media influences and medicalisation. It also reflects the globalization of the baby food industry and its supply chains, including the increasing intensity and sophistication of its marketing practices. Policy and regulatory frameworks designed to protect, promote and support breastfeeding are partially or completely inadequate in the majority of countries, hence supporting industry expansion over child nutrition. The results raise serious concern for global child and maternal health.

Background The retail market for toddler-specific packaged foods is growing. Many of these products are ultra-processed and high in nutrients of concern for health, yet marketed in ways that may make them appear wholesome. This study aims to assess parents’ responses to claims on unhealthy, ultra-processed toddler food products and test whether removing such claims promotes more accurate product perceptions and healthier product preferences. Methods Parents of toddlers aged 12 to < 36 months ( N  = 838) were recruited for an online experiment testing four on-pack claim conditions: control (no claim); 'contains \"good\" ingredient'; 'free from \"bad\" ingredient'; and unregulated 'child-related' claim. Participants were randomly assigned to one condition, then viewed images of toddler food products that varied in nutrition content and the claims displayed. Participants completed tasks assessing product preferences (unhealthy product displaying claim vs. a healthier option with no claim, across four food categories (banana bars, strawberry snacks, blueberry yogurt snacks and veggie snacks)), purchase intentions and product perceptions. Poisson regression (count variable) and linear regression (continuous outcomes) analyses were employed to test for mean differences by marketing claim conditions. Results For the overall sample, brief exposure to ‘free from \"bad\" ingredient’ claims increased participant’s intentions to purchase unhealthy food products for their toddlers, but there was no clear evidence that ‘contains \"good\" ingredient’ claims and ‘child-related’ claims significantly impacted parent’s preferences, purchase intentions and perceptions of toddler foods. However, certain claims influenced particular parent subgroups. Notably, parents with three or more children chose more unhealthy products when these products displayed ‘contains \"good\" ingredient’ or ‘free from \"bad\" ingredient’ claims; the latter claims also promoted stronger purchase intentions and enhanced product perceptions among this subgroup. Conclusions Findings indicate that ‘free from \"bad\" ingredient’ claims on unhealthy toddler foods are of most concern, as they boost the appeal of these products to parents. ‘Contains \"good\" ingredient’ claims and ‘child-related’ claims showed limited effects in this study. Considering available evidence, we recommend claims should not be permitted on child-oriented foods, as they may promote inaccurate product perceptions and unhealthy product choices by parents, that can detract from their children’s diets and health.

The study objective was to determine the relative validity and reproducibility of a modified FFQ for ranking the nutrient intakes of New Zealand toddlers aged 12-24 months. Cross-sectional study. Dunedin, New Zealand. One hundred and fifty-two participants completed a ninety-five-item FFQ twice, and five days of weighed diet recording (WDR), over one month. Validity and reproducibility were assessed for crude data and for data that were weighted for total fruit and vegetable intake (FV-adjusted). De-attenuated correlations between FV-adjusted FFQ data and WDR data ranged from 0.45 (Zn) to 0.77 (Ca). The percentage classified to the correct WDR quartile by the FV-adjusted FFQ data ranged from 34.6% (total fat, Zn) to 50.3% (Fe). Average gross misclassification was 3%. Bland-Altman statistics showed crude data had a range of 128-178% agreement with the WDR and mean FV-adjusted intakes had 112-160% agreement. FV-adjusted intra-class correlations, assessing reproducibility, ranged from 0.65 (vitamin C) to 0.75 (Ca). The Eating Assessment in Toddlers (EAT) FFQ showed acceptable to good relative validity, and good reproducibility, for ranking participants' nutrient intake and is able to identify toddlers at extremes of the nutrient intake distribution. It will be a useful tool for investigating toddlers' nutrient intakes in studies that require a method of dietary assessment with low respondent burden.

Early life is characterized by developmental milestones such as holding up the head, turning over, sitting up and walking that are typically achieved sequentially in specific time windows. Similarly, the early gut microbiome maturation can be characterized by specific temporal microorganism acquisition, colonization and selection with differential functional features over time. This orchestrated microbial sequence occurs from birth during the first years of age before the microbiome reaches an adult-like composition and function between 3 and 5 years of age. Increasingly, these different steps of microbiome development are recognized as crucial windows of opportunity for long term health, primarily linked to appropriate immune and metabolic development. For instance, microbiome disruptors such as preterm and Cesarean-section birth, malnutrition and antibiotic use are associated with increased risk to negatively affect long-term immune and metabolic health. Different age discriminant microbiome taxa and functionalities are used to describe age-appropriate microbiome development, and advanced modelling techniques enable an understanding and visualization of an optimal microbiome maturation trajectory. Specific microbiome features can be related to later health conditions, however, whether such features have a causal relationship is the topic of intense research. Early life nutrition is an important microbiome modulator, and ‘Mother Nature’ provides the model with breast milk as the sole source of nutrition for the early postnatal period, while dietary choices during the prenatal and weaning period are to a large extent guided by tradition and culture. Increasing evidence suggests prenatal maternal diet and infant and child nutrition impact the infant microbiome trajectory and immune competence development. The lack of a universal feeding reference for such phases represents a knowledge gap, but also a great opportunity to provide adequate nutritional guidance to maintain an age-appropriate microbiome for long term health. Here, we provide a narrative review and perspective on our current understanding of age-appropriate microbiome maturation, its relation to long term health and how nutrition shapes and influences this relationship.