{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:15:44Z","timestamp":1788221744014,"version":"build-2803163510"},"reference-count":56,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Toddler milk is a breastmilk substitute for young children, yet its marketing and nutritional profile across the Americas has not been systematically synthesized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We conducted a content analysis documenting the prevalence of front-of-package claims and imagery on 389 toddler milk products from 14 countries in the Americas. We also compared the nutritional profile of toddler milk with plain cow\u2019s milk and chocolate-flavored cow\u2019s milk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Nearly all products (99%) displayed at least one front-of-package claim. Claim categories included nutrition-related (97%), health-related (56%), and other marketing (25%). Nutrition-related claims highlighting breastmilk-related components were common; for example, \u201cContains docosahexaenoic acid\u201d appeared on 52% products. The most common health-related claims referenced brain and cognitive benefits (29%), such as, \u201cSupports brain development.\u201d Among other marketing claims, endorsements (eg, \u201c#1 recommended by pediatricians\u201d) appeared on 11% of packages. Imagery appeared on 92% of packages. Visual metaphors included shields (32%) and hearts (27%). Nutritionally, toddler milk contained an average total sugar of 6\u00a0g\/100 mL, higher than plain cow\u2019s milk (5\u00a0g\/100 mL, P\u2009&amp;lt;\u2009.01) but lower than chocolate-flavored cow\u2019s milk (9\u00a0g\/100 mL, P\u2009=\u2009.97). Protein averaged 2\u00a0g\/100 mL, lower than both plain cow\u2019s milk (3\u00a0g\/100 mL, P\u2009&amp;lt;\u2009.01) and chocolate-flavored cow\u2019s milk (3\u00a0g\/100 mL, P\u2009&amp;lt;\u2009.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Toddler milk products contain more total sugar and less protein than plain cow\u2019s milk, yet claims and imagery promoting nutritional and health benefits are nearly universal on their packaging, raising concerns about how these products are being marketed to caregivers. These findings highlight the need for stronger regulations to ensure transparency and support informed food choices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2026-076449","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:02:57Z","timestamp":1787529777000},"source":"Crossref","is-referenced-by-count":0,"title":["Marketing Practices and Nutrition Content of Toddler Milk Across the Americas"],"prefix":"10.1542","volume":"158","author":[{"given":"Ana Paula C.","family":"Richter","sequence":"first","affiliation":[{"name":"1Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"2Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"3Current affiliation: Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison J.","family":"Lazard","sequence":"additional","affiliation":[{"name":"4Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"5Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily W.","family":"Duffy","sequence":"additional","affiliation":[{"name":"2Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"6Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina"},{"name":"7Current affiliation: University of North Carolina Greensboro, Greensboro, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deshira D.","family":"Wallace","sequence":"additional","affiliation":[{"name":"1Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"2Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley D.","family":"Golden","sequence":"additional","affiliation":[{"name":"1Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"5Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey Smith","family":"Taillie","sequence":"additional","affiliation":[{"name":"2Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"6Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa G.","family":"Hall","sequence":"additional","affiliation":[{"name":"1Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"2Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"},{"name":"5Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"issue":"14","key":"2026083119565661000_r1","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.1017\/S1368980016001117","article-title":"Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and 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in Australia","volume":"24","author":"McCann","year":"2021","journal-title":"Public Health Nutr."},{"issue":"2","key":"2026083119565661000_r6","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1159\/000507840","article-title":"Ultra-Processed Food Consumption among the Paediatric Population: An Overview and Call to Action from the European Childhood Obesity Group","volume":"76","author":"Khandpur","year":"2020","journal-title":"Ann Nutr Metab."},{"key":"2026083119565661000_r7","volume-title":"Baby Food FACTS Nutrition and Marketing of Baby and Toddler Food and Drinks","author":"Harris","year":"2017"},{"issue":"10","key":"2026083119565661000_r8","doi-asserted-by":"crossref","first-page":"2338","DOI":"10.3390\/nu11102338","article-title":"The Association between Early Childhood and Later Childhood Sugar-Containing Beverage Intake: A Prospective Cohort 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practices","volume":"82","author":"Richter","year":"2024","journal-title":"Nutr Rev."},{"issue":"3","key":"2026083119565661000_r12","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.jand.2021.08.101","article-title":"The Impact of Toddler Milk Claims on Beliefs and Misperceptions: A Randomized Experiment with Parents of Young Children","volume":"122","author":"Richter","year":"2022","journal-title":"J Acad Nutr Diet."},{"issue":"2","key":"2026083119565661000_r13","doi-asserted-by":"crossref","first-page":"528","DOI":"10.3390\/ijerph18020528","article-title":"Parental Perceptions and Exposure to Advertising of Toddler Milk: A Pilot Study with Latino Parents","volume":"18","author":"Duffy","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"2026083119565661000_r14","volume-title":"Marketing Claims on Infant Formula and Toddler Milk Packages: What Do Caregivers Think They Mean?","author":"Romo-Palafox","year":"2019"},{"issue":"2","key":"2026083119565661000_r15","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1007\/s11747-014-0378-5","article-title":"Broken Halos and Shattered Horns: Overcoming the Biasing Effects of Prior Expectations Through Objective Information Disclosure","volume":"43","author":"Burton","year":"2015","journal-title":"J Acad Mark Sci."},{"issue":"7","key":"2026083119565661000_r16","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1108\/10610420110410531","article-title":"Packaging communication: attentional effects of product imagery","volume":"10","author":"Underwood","year":"2001","journal-title":"J Prod Brand Manage."},{"key":"2026083119565661000_r17","volume-title":"International Code of Marketing of Breast-Milk Substitutes.","author":"World Health Organization","year":"1981"},{"key":"2026083119565661000_r18","article-title":"Ending inappropriate promotion of foods for infants and young children","author":"World Health Organization"},{"issue":"4","key":"2026083119565661000_r19","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1177\/0890334413487256","article-title":"The association of prenatal media marketing exposure recall with breastfeeding intentions, initiation, and duration","volume":"29","author":"Zhang","year":"2013","journal-title":"J Hum Lact."},{"issue":"1","key":"2026083119565661000_r20","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1746-4358-1-10","article-title":"Infant feeding and the media: the relationship between Parents\u2019 Magazine content and breastfeeding, 1972\u20132000","volume":"1","author":"Foss","year":"2006","journal-title":"Int Breastfeed J."},{"issue":"3","key":"2026083119565661000_r21","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1177\/0890334415576513","article-title":"A Content Analysis of Infant and Toddler Food Advertisements in Taiwanese Popular Pregnancy and Early Parenting 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Librariansh."},{"key":"2026083119565661000_r29","volume-title":"Marketing of Breast-Milk Substitutes: National Implementation of the International Code, Status Report 2024","author":"World Health Organization","year":"2024"},{"key":"2026083119565661000_r30","article-title":"Euromonitor","author":"Euromonitor International","year":"2025"},{"issue":"10","key":"2026083119565661000_r31","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1111\/josh.12087","article-title":"The nutritional role of flavored and white milk in the diets of children","volume":"83","author":"Nicklas","year":"2013","journal-title":"J Sch Health."},{"key":"2026083119565661000_r32","volume-title":"A Nutritional and Marketing Analysis of Milk-Based, Toddler Drinks on the Market in the United States","author":"Jones","year":"2019"},{"issue":"1","key":"2026083119565661000_r33","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jand.2020.08.009","article-title":"Nutrition Claims on Fruit Drinks Are Inconsistent Indicators of Nutritional Profile: A Content Analysis of Fruit Drinks Purchased by Households With Young Children","volume":"121","author":"Duffy","year":"2021","journal-title":"J Acad Nutr Diet."},{"issue":"2","key":"2026083119565661000_r34","doi-asserted-by":"crossref","first-page":"e13332","DOI":"10.1111\/mcn.13332","article-title":"Content analysis of breast milk substitutes marketing on Chinese e-commerce platforms","volume":"18","author":"Han","year":"2022","journal-title":"Matern Child Nutr."},{"issue":"8","key":"2026083119565661000_r35","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1017\/S1368980023000216","article-title":"Content analysis of on-package formula labelling in Great Britain: use of marketing messages on infant, follow-on, growing-up and specialist formula","volume":"26","author":"Conway","year":"2023","journal-title":"Public Health Nutr."},{"key":"2026083119565661000_r36","volume-title":"Nutrient and Promotion Profile Model: Supporting Appropriate Promotion of Food Products for Infants and Young Children 6\u201336 Months in the WHO European Region","author":"World Health Organization","year":"2022"},{"key":"2026083119565661000_r37","volume-title":"Content Analysis: An Introduction to Its Methodology","author":"Krippendorff","year":"2018"},{"issue":"4","key":"2026083119565661000_r38","doi-asserted-by":"crossref","first-page":"e13186","DOI":"10.1111\/mcn.13186","article-title":"Sugar content and nutrient content claims of growing-up milks in Indonesia","volume":"17","author":"Pries","year":"2021","journal-title":"Matern Child Nutr."},{"key":"2026083119565661000_r39","doi-asserted-by":"crossref","first-page":"e071075","DOI":"10.1136\/bmj-2022-071075","article-title":"Health and nutrition claims for infant formula: international cross sectional survey","volume":"380","author":"Cheung","year":"2023","journal-title":"BMJ."},{"issue":"3","key":"2026083119565661000_r40","doi-asserted-by":"crossref","first-page":"e12962","DOI":"10.1111\/mcn.12962","article-title":"Infant formula and toddler milk marketing and caregiver\u2019s provision to young children","volume":"16","author":"Romo-Palafox","year":"2020","journal-title":"Matern Child Nutr."},{"issue":"5","key":"2026083119565661000_r41","doi-asserted-by":"crossref","first-page":"e2023064050","DOI":"10.1542\/peds.2023-064050","article-title":"Older Infant-Young Child \u201cFormulas\u201d","volume":"152","author":"Fuchs","year":"2023","journal-title":"Pediatrics."},{"issue":"Suppl 2","key":"2026083119565661000_r42","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/mcn.12269","article-title":"Cross-sectional survey shows that follow-up formula and growing-up milks are labelled similarly to infant formula in four low and middle income countries","volume":"12","author":"Pereira","year":"2016","journal-title":"Matern Child Nutr."},{"issue":"1","key":"2026083119565661000_r43","first-page":"9","article-title":"Relax, you\u2019re soaking in it: sources of information about infant formula","volume":"19","author":"Berry","year":"2011","journal-title":"Breastfeed Rev."},{"key":"2026083119565661000_r44","article-title":"WHO\/UNICEF information note: cross-promotion of infant formula and toddler milks","author":"World Health Organization"},{"key":"2026083119565661000_r45","article-title":"Standard for Infant Formula and Formula for Special Medical Purposes Intended for Infants CXS 72\u20131981","author":"FAO"},{"key":"2026083119565661000_r46","article-title":"Standard for Follow-Up Formula for Older Infants and Product for Young Children CXS 156-1987","author":"FAO"},{"issue":"1","key":"2026083119565661000_r47","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1086\/209549","article-title":"Visual Rhetoric in 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persistent violations of the International Code of Marketing of Breast-milk Substitutes: A systematic scoping review","volume":"18","author":"Becker","year":"2022","journal-title":"Matern Child Nutr."},{"issue":"3","key":"2026083119565661000_r51","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1038\/s41415-020-1252-0","article-title":"A cross-country exploratory study to investigate the labelling, energy, carbohydrate and sugar content of formula milk products marketed for infants","volume":"228","author":"Bridge","year":"2020","journal-title":"Br Dent J."},{"key":"2026083119565661000_r52","article-title":"Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months","author":"Health Canada","year":"2014"},{"key":"2026083119565661000_r53","article-title":"Guideline: sugars intake for adults and children","author":"World Health Organization","year":"2015"},{"issue":"2","key":"2026083119565661000_r54","doi-asserted-by":"crossref","first-page":"e1003015","DOI":"10.1371\/journal.pmed.1003015","article-title":"An evaluation of Chile\u2019s Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study","volume":"17","author":"Taillie","year":"2020","journal-title":"PLoS Med."},{"issue":"24","key":"2026083119565661000_r55","doi-asserted-by":"crossref","first-page":"4345","DOI":"10.3390\/nu16244345","article-title":"Defining \u201cHigh-In\u201d Saturated Fat, Sugar, and Sodium to Help Inform Front-of-Pack Labeling Efforts for Packaged Foods and Beverages in the United States","volume":"16","author":"Dunford","year":"2024","journal-title":"Nutrients."},{"key":"2026083119565661000_r56","doi-asserted-by":"crossref","first-page":"1659915","DOI":"10.3389\/fpubh.2025.1659915","article-title":"Prevalence of ultra-processed foods and beverages in newly launched products across the Americas: a comparison between the United States and Latin American countries from 2018 to 2023","volume":"13","author":"Vatavuk-Serrati","year":"2025","journal-title":"Front Public Health."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2026-076449\/1952501\/pediatrics.2026076449.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2026-076449\/1952501\/pediatrics.2026076449.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T23:57:08Z","timestamp":1788220628000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/158\/3\/e2026076449\/208615\/Marketing-Practices-and-Nutrition-Content-of"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":56,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,8,24]]},"published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2026-076449","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"e2026076449"}}