Food pouches for infants — how to advise parents

Although birth rates have declined globally over the past 50 years, increasing prosperity has made several convenience products for babies and infants particularly popular. Baby food and formula markets were estimated at $35bn, and the diaper market is worth $27bn (2015 figures)^[1]
. Parents choose baby food to ensure the health and growth of their baby, and they are ready to spend on feeding methods that save them time. A large range of pouches containing food have been developed to match their demands.

British pharmacies are a major point of sales of baby food and a popular source of parental advice, too. But how does a pharmacist find out about the new foods provided in pouches? There are no trial data or large epidemiological studies to assist. An independent review by the First Steps Nutrition Trust^[2]
published this year is a particularly useful resource. It found that pouches of baby food pose an array of challenges: economic, nutritional and neurodevelopmental.

Its 2016 analysis of 343 products from the 4 main producers of food pouches reveals concerns that might be worth passing on to an inquisitive parent. Food pouches are, firstly, more expensive than jars and considerably more pricey than home-made equivalents. Secondly, food pouches are often marketed for children under six months of age, although this is not recommended by any national or international authority. Thirdly, these foods are not high in micronutrients and so, when used, must be part of a broader and more nutritious diet. For instance, the meat component of a meal in a pouch may comprise only 8–11% of its contents, making it relatively low in iron and zinc.

Pouches of food are not recommended to be sucked directly by an infant. Pouch caps are a choking hazard, the contents may be ingested rapidly and so infants cannot see or identify what they are eating. The textures of these products are smoother than home-prepared meals. Therefore, such foods have been associated with subsequent fussy eating. Involving children with the touch, texture and taste of solid foods is a crucial part of their development that is bypassed by the semi-liquid contents of a pouch. Processing of vegetables and fruits for pouches, by breaking down their cell walls, delivers higher levels of free sugars that are likely to habituate the infant to sweet tastes and compromise their oral microbiome, as well as future oral and dental health. Pouches themselves cannot be recycled and therefore increase household waste.

Pre-packaged processed foods may not always result in better nutrition. A careful review of the health claims commonly printed on pouches for infants suggested that these claims are common but are not based on research. Without knowledge of the diet of a specific infant, the health claims are aspirational rather than nutritionally based^[3]
. It is crucial not to undermine parents that are prepared to make infant meals at home. Given the high frequency of obesity and micronutrient deficiencies in British children, pharmacists need to be cautious and well informed when discussing pouches to enquiring parents.

Colin Michie

Paediatrician, London