Why Sugar and Salt Should Not Be Added to Complementary Feeds in the First Year
No sugar or salt should be added to complementary foods for infants in their first year of life. 1, 2
Primary Rationale
Developmental and Physiological Concerns
Infants' immature kidneys cannot efficiently process excess sodium, making them vulnerable to the harmful effects of high salt intake on developing renal systems and potentially elevating blood pressure risk in later life. 3
The maximum recommended sodium intake for infants up to 12 months is 400 mg per day, yet studies show that 70% of infants consuming added salt exceed this threshold, with some reaching 1060 mg per day in the highest consumption quartile. 3
Excessive salt intake during infancy may program higher blood pressure trajectories throughout life, representing a long-term cardiovascular risk that extends well beyond the first year. 3
Taste Preference Programming
Adding sugar and salt to infant foods establishes unhealthy taste preferences that persist into childhood and beyond. 1, 2
Infants have an innate preference for sweet tastes, and children naturally prefer high levels of sweetness; exposing them to added sugars during complementary feeding amplifies this preference and increases motivation to consume sugary foods and beverages later. 1
Early exposure to salty foods creates a preference for higher sodium foods, leading infants to consume three times more bread and use salty flavorings like yeast extract and gravy compared to those not exposed to added salt. 3
The American Heart Association specifically recommends that children under 2 years should avoid added sugars entirely. 4
Nutritional and Health Consequences
Immediate Health Risks
Added sugars contribute to malnutrition, diarrhea, abdominal pain, and dental problems even in the first year of life. 1
- Fruit juices and sugar-sweetened beverages offer no nutritional benefits compared to whole fruits and should be completely avoided during infancy. 1, 2
Long-term Metabolic Impact
High sugar intake during infancy may increase the risk of obesity and metabolic dysfunction through multiple mechanisms:
- Sugar consumption can alter energy balance by increasing preference for calorie-dense foods. 1
- The temporal correlation between increased childhood obesity rates and increased consumption of sugar-containing products suggests a relationship, though causality requires further study. 1
Evidence from Commercial Food Analysis
The majority of commercial toddler foods contain problematically high levels of sodium or added sugars, demonstrating the widespread nature of this problem:
- 84% of toddler meals contain >210 mg sodium per serving, and 69% of infant-toddler savory snacks have >200 mg sodium per 100g. 4
- Over 70% of toddler meals, cereal bars, breakfast pastries, and infant-toddler desserts contain one or more sources of added sugar. 4
- Toddler meals average 2233 mg sodium per 1000 kcal, far exceeding recommendations. 4
Practical Implementation
What Parents Should Do Instead
Focus on offering naturally flavored foods with variety in taste and texture, including bitter-tasting green vegetables, to promote acceptance of diverse flavors without added seasonings. 2
Iron-rich foods (meats, iron-fortified cereals) and vegetables should form the foundation of complementary feeding without any added salt or sugar. 5, 6, 2
Fruits provide natural sweetness without requiring added sugar. 2
Common Pitfalls to Avoid
Parents who breastfeed are paradoxically more prone to adding sugar, salt, and fat to complementary foods, possibly due to concerns about flavor or nutrition. 7
Introduction of complementary foods before 4 months is positively associated with adding sugar and salt. 7
Using homemade foods (rather than commercial baby foods) is associated with higher use of added salt and fat, requiring specific education about avoiding these additions. 7
Austrian mothers use added salt more frequently than Polish mothers (75% vs 53% at 2 years), while Polish mothers more often use added sugar (35% vs 28% at 2 years), demonstrating that cultural practices vary but both require intervention. 8
Critical Window for Intervention
The complementary feeding period (approximately 6-12 months) represents a critical developmental window for establishing lifelong taste preferences and dietary patterns. 1, 2
Clear, practical education on what foods to introduce and when is essential, as most parents introduce solids around 3-4 months with cereals and rusks that may contain added sodium. 3
Manufacturers bear responsibility for reducing sodium content in infant food products, but parents must also be educated to read labels and avoid products with added salt or sugar. 3