Plant-Based and Dairy-Free Drinks: An Emerging Health Hazard for Young Children

‘Growing up’ or ‘toddler’ milks (GUM), marketed for children aged 1–3 years and older, are widely recognised by health bodies as unnecessary and unhealthy. Public health advice is that breastmilk, water, cows' milk or another animal milk should be the main drink for young children from age 1 onwards. Manufacturers claim that GUM are an effective medium to deliver nutrients to young children, especially vitamin D, calcium and iron, which are commonly used to fortify GUM. But GUM are advised against, mainly due to their high free sugars content. UK data show that GUM are the main source of free sugars among those 12- to 18-month-old children who consume them, accounting for half of their total free sugars intake [1]. In 2011, 36% of children in this age group were GUM consumers. That figure is likely to have risen, because GUM sales are increasing worldwide. Globally, there was a more than twofold increase in GUM sales per child born, from 2005 through 2019 [2]. In the context of increasing overweight and obesity and high levels of dental decay in young children, increasing GUM sales represent a worrying trend. While marketing of infant formula suitable from 0 to 12 months is strictly regulated in many regions, GUM marketing for children over 12 months has very few restrictions. This is despite World Health Organization recommendations that inappropriate marketing of all commercial milk formulas aimed at children < 36 months old should be prohibited. The lack of regulations means that manufacturers are able to market GUM using misleading nutrition and health claims and in ways which cross-promote infant formula.

One GUM product category that has received much attention recently and appears to be growing in popularity is plant-based GUM. The increase in availability of plant-based GUM reflects a shift in consumption patterns in the general population—away from cows' milk, towards plant-based alternatives [3]. The nutrient content of plant-based GUM is a cause for concern. Some of the highest-sugar GUM available are plant-based, and a lack of labelling regulation means that consumers are often not aware of the high free sugars content. Indeed, plant-based GUM marketing may misleadingly suggest these products are low in sugar. For example, most oat milks contain free sugars, which are produced by the processing of the oats, where naturally present starch is broken down into sweet-tasting free sugars. This means that an oat milk can claim to have ‘no added sugars’, while containing even more free sugars than a standard cows' milk–based GUM.

Plant-based GUM have low nutritional value in terms of protein concentration or quality and certain micronutrients, compared with animal milks [3]. Thus, their role in young child feeding is uncertain, but there are clear health hazards associated with many plant-based GUM. In parallel with the shift towards plant-milk consumption, there is widespread and growing milk allergy overdiagnosis among infants internationally [4, 5]. Infants with a milk allergy diagnosis are often prescribed or advised to consume specialised low-allergy formula products with high free sugars content. For these children, continuation of a dairy-free diet and substitution with plant-based or specialised low-allergy GUM beyond age 1 year is likely to further promote early-onset dental decay, overweight and obesity [6] (Table 1).

For most GUM, consumption of just 260 ml takes a 1- to 2-year-old child over their recommended total daily free sugars intake, using the UK Department of Health and Social Care (DHSC) limit of 5% of total energy intake [7]. For plant-based and specialised low-allergy GUM, this figure can be as low as 100 mls (Figure 1).

The regulatory environment in many countries rightly focusses on infant formula. However, increasing GUM consumption worldwide, including high-sugar plant-based and specialised low-allergy GUM, has highlighted a need to regulate GUM. Steps need to be taken to ensure that families have access to clear and accurate information about any health risks associated with GUM, enabling them to make informed choices about what to feed their young children, in line with public health recommendations. Product reformulation to limit free sugars content is also likely to be necessary—here, mandatory standards are likely to be more effective than voluntary standards.

R.M.C. and V.L.S. wrote the original report. R.J.B. wrote the first draft of the editorial. All authors edited and commented on the editorial and approved the final version.

The authors declare no conflicts of interest.