Catharine Anne Kerle Fleming

The first 1000 days of life are widely recognised as an important period for growth, development and the establishment of dietary preferences and eating behaviours that may persist across the life course. In Australia, the food regulator (Food Standards Australia New Zealand, FSANZ) recently abandoned Proposal P1058—Nutrition labelling about added sugars , which considered an amendment to the Australia New Zealand Food Standards Code to include ‘added sugars’ information in the Nutrition Information Panel (NIP). This decision provides an opportunity to examine implications for products manufactured and marketed for infants and toddlers. At present, the NIP requires declaration of total sugars, but this does not distinguish between intrinsic sugars naturally present in foods and sugars contributed through ingredients such as fruit juice concentrates, fruit purees, syrups, or other sweetening ingredients. This distinction is relevant in the context of the rapidly expanding market for commercial infant and toddler foods, including squeeze pouches, fruit‐based snacks, toddler yoghurts and sweetened snack‐style products that often utilise extruded fruit juice products as an ingredient to create a sweeter taste profile. In addition, parents often assume that commercial infant and toddler foods are healthy and low in sugar. While the broader evidence base for the general population did not support mandatory reform across all packaged foods, the implications for infant and toddler products remain relevant to ongoing policy discussions. The recent FSANZ decision provides an opportunity to consider whether foods marketed to infants and young children represent a distinct regulatory context in which greater labelling clarity, alongside other policy approaches, may contribute to early‐life nutrition objectives.

Introduction: Community‐based food cooperatives have shown potential in addressing food insecurity, but longitudinal evidence assessing their impact is limited. This study evaluated the effects of participating in a community‐based food cooperative on food insecurity, dietary behaviours, and physical health outcomes among Australian adults. Methods: A pre‐post survey of new cooperative members measured demographics, household food insecurity status (United States Department of Agriculture 6‐item Household Food Security Survey Module (HFSSM)), dietary behaviours (servings/day of core food groups), and objective physical health indicators (weight, waist circumference, and blood pressure). Participants were classified as secure (HFSSM score = 0) or insecure (HFSSM score ≥ 1). A McNemar's test assessed the change in proportion of participants classified as food insecure from baseline to follow‐up, and paired t ‐tests or non‐parametric equivalents compared other outcomes. Results: At baseline, 58 participants completed surveys, and 25 completed physical data collection. Participants were primarily female (93.1%), 18–33 or 35–44 years old (37.9% each), and of European background (81.0%). The proportion of participants reporting food security improved from baseline (54.2%) to follow‐up (66.7%) ( p = 0.041). Importantly, participants who were food secure remained so at follow‐up. Those who were food insecure also reported more favourable improvements in dietary behaviours and meal preparation habits, though many of these did not reach statistical significance. Conclusion: Participation in a community‐based food cooperative was associated with improved food security among Australian adults. So What?: These findings highlight the potential of community‐based food cooperatives to reduce food insecurity and support their integration into broader health promotion and food security strategies.

During 2021–2022, families with infants and young children were among the > 450,000 people who spent 2 weeks in Australia's institutional COVID‐19 quarantine. Given pre‐existing lack of emergency planning for children, there were concerns about whether parents would be adequately supported in this temporary accommodation. This paper reports on research considering the breastfeeding, breastmilk feeding and formula feeding of infants and young children in Australia's COVID‐19 quarantine. Two‐hundred and sixteen parents who quarantined with children aged 0–36 months completed an online survey with closed‐ and open‐ended questions. One hundred and twenty‐seven children were being fed breastmilk (103) and/or infant formula (40) when entering quarantine. Breastfeeding, formula feeding and breastmilk feeding challenges were reported. Breastfeeding mothers were concerned about frequent feeding and stress reducing milk supply. Parents who were formula feeding commonly lacked appropriate resources with half having to wash feeding bottles in bathrooms that also contained a toilet. Mothers who were breastmilk feeding experienced the challenges associated with both breastfeeding and formula feeding. On‐site staff and health providers did not always respond to requests for help with appropriate assistance, and parents were rarely referred to health or parenting helplines. Parental capacity to follow the national infant feeding guidelines was commonly compromised by the quarantine environment, and child health was placed at risk. This study has implications for infant feeding resourcing and support in other types of temporary accommodation, including those related to natural disasters, family violence, or homelessness or any closed environment, such as prisons or immigration detention. Infant feeding support requirements should be included in emergency planning and standards developed for temporary accommodation for families.

Foods in commercial squeeze pouches are a widely used feeding option for children, yet growing concerns exist about their nutritional quality and impacts on feeding development. There is limited evidence on how and why parents use these products, leaving critical gaps in understanding how to design policy and food environments that support positive nutrition choices. This study aimed to explore Australian parents’ experiences and motivations for providing commercial squeeze pouches to infants and children. An online survey was distributed nationally to parents, containing an open-ended question inviting them to describe the role of squeeze pouches in their child’s diet and their reasons for use. Responses were inductively thematically analysed to understand motivations, perceptions, experiences, and feeding contexts. A total of 179 parents, mainly mothers (78.1%), participated, revealing five intersecting themes: societal and behavioural drivers, feeding supplement strategies, feeding confidence and nutritional perceptions, commercial food environment, and environmental impact considerations that influenced their use of squeeze pouches when feeding their child. Within the themes, parents frequently described how squeeze pouches are a practical solution to managing time pressures, fussy or neurodivergent eating behaviours, and feeding during illness or travel. However, many also expressed concerns about cost, packaging waste, and feeding skill development. Overall, a broader societal paradox emerged where convenience and modern parenting demands often outweighed nutritional or environmental ideals. The complex insights provided by parents demonstrate the need for policy and practice responses that address structural and commercial drivers of food choice, while supporting families with accessible, evidence-based feeding guidance.

Background: Foods in commercial squeeze pouches, primarily designed for infants, are expanding into school‐aged children and adolescent markets. Such products are increasingly scrutinized for misleading health claims and poor nutritional content. This study aimed to explore the use of commercial squeeze pouches among Australian children (0–17 years), identify sociodemographic predictors of frequent consumption, and examine the relationship between perceived barriers to achieving a healthy diet and commercial squeeze pouch consumption. Methods: A cross‐sectional survey of Australian parents explored their children's frequency of commercial squeeze pouch consumption alongside parents’ sociodemographic data and perceived barriers to achieving a healthy diet (e.g., time, cost). Logistic regression was used to identify factors associated with frequent consumption of commercial squeeze pouches (weekly or more). Results: Among our sample ( n = 343), 73.8% of children consumed food from commercial squeeze pouches in the past 12 months, and around half consumed them weekly or more (49%). Frequent usage was highest among children 0–2 years old and 2–5 years old (64% of each group), with fruit and dairy‐based pouches the most frequently consumed. Dairy‐based pouches were consumed by 74% of school‐aged children and 30% of adolescents within the past 12 months. Younger parents (OR = 4.2, p < 0.001) and middle‐income families (OR = 2.5, p = 0.019) were more likely to report their children were frequent consumption of commercial squeeze pouches. Perceived time constraints significantly increased the likelihood of using commercial squeeze pouches (OR = 2.6, p < 0.001). Conclusion: Commercial squeeze pouches are frequently consumed by Australian children, driven in part by demographic factors and parenting challenges like time constraints. In addition to supporting parents to make informed choices, public health strategies could extend beyond individual‐level education to include regulatory reforms that limit inappropriate marketing and improve the nutritional quality of foods in commercial squeeze pouches.

Background: Optimal nutrition during adolescence is critical to growth and development. While several adolescent nutrition frameworks exist, a comprehensive reference framework is needed, which reflects the priorities and views of young people and guides action to improve adolescent nutrition. We believe that partnering with young people is key to enabling agency and empowering change. This collaborative project between the Global Adolescent Nutrition Network (GANN) and youth partners aimed to develop a conceptual and actionable framework for adolescent nutrition. This paper presents the methods used to identify the need for and to prioritise the key components of a new framework.Methods: A literature review was conducted to identify and summarise available frameworks for adolescent nutrition (10–19 years). GANN members (N=7) and youth partners (N=4, 18–26 years) used nominal group technique (NGT) methodology to reach consensus on: (1) key characteristics, strengths and limitations of available frameworks; (2) key characteristics of an ideal framework; (3) the best available framework and (4) the need for a new framework.Results: NGT participants listed 37 strengths and limitations of the 15 frameworks identified in the review. These were classified into three themes: theory, usability and visibility. According to NGT participants, the most important (‘top’) theoretical features of an ideal framework were considering all forms of malnutrition’ and including all levels of influence in adolescent nutrition’. Most top usability and visibility features were applicable at global, regional and country levels, and a clear structure to depict levels of influence, respectively. The Innocenti Framework was deemed the best available framework. Most of the participants (90%) agreed that a new framework was needed. Youth partners advocated for greater representation of youth voices in frameworks and programmes related to adolescents. The salient features of the new framework, reached by consensus, emphasise an action-oriented approach that provides practical guidance to improve adolescent nutrition rather than solely explaining its determinants. It will be designed to be adaptable to different contexts, ensuring its visual design, language and content are accessible and engaging for a broad range of stakeholders.Conclusion: Through a novel youth codesign process, we identified key components to inform the development of a new conceptual framework to improve adolescent nutrition. While no new framework is presented in this article and is part of ongoing work, these findings provide guidance for future efforts to create a framework that can effectively inform actions and investments in global adolescent nutrition.

Background: In recent years, undernutrition has remained a significant public health issue in Tunisia, increasing the risk of illness and mortality in young children. Therefore, this study aims to analyse the prevalence and factors contributing to undernutrition among Tunisian children aged 0–23 months. Methods: The study included 3265 children aged 0–23 months from the 2011–2023 Tunisia Multiple Indicator Cluster Surveys (MICS). Trends and logistic regression analyses were used to determine the prevalence and predictors of undernutrition. Results: The prevalence of stunting, wasting, and underweight in infants and children aged 0–23 months has increased by 3.3%, 0.5%, and 2.1%, respectively. Stunting and underweight were more common among infants aged 0–5 months (11.8% for stunting, 8.9% for underweight, p < 0.01), and first-time mothers (8.3% for stunting, 4.1% for underweight, p < 0.01). In 2023, compared to 2011, the odds of stunting, wasting, and being underweight had increased by 22%, 16%, and 70%, respectively. Infants aged 0–5 months had higher odds of undernutrition in all three indices. Children of obese or overweight mothers, and those who started breastfeeding late, were more likely to be stunted. Boys had significantly higher odds of wasting and underweight. Children with low birth weight, and duration of breastfeeding > 12 months, had significantly higher odds of being underweight. Conclusions: This study shows that infants aged 0–5 months, first-time mothers, boys, and children from poor households in Tunisia are at a higher risk of undernutrition. To address the growing issue of undernutrition in Tunisian children, enhancing maternal and child health and nutrition services, improving parental education, and implementing community-based programs that provide breastfeeding and nutritional education to infants born to new mothers and mothers with high/low BMI is recommended.

Background: In recent years, undernutrition has remained a significant public health issue in Tu-nisia, increasing the risk of illness and mortality in young children. Therefore, this study aims to analyse the prevalence and factors contributing to undernutrition among Tunisian children aged 0-23 months; Methods: The study included 3265 children aged 0-23 months from the 2011-2023 Tunisia Multiple Indicator Cluster Surveys (MICS). Trends and logistic regression analyses were used to determine the prevalence and predictors of undernutrition; Results: The prevalence of stunting, wasting, and underweight in infants and children aged 0-23 months has increased by 3.3%, 0.5%, and 2.1%, respectively. Stunting and underweight were more common among infants aged 0-5 months (11.8% for stunting, 8.9% for underweight, p < 0.01), and first-time mothers (8.3% for stunting, 4.1% for underweight, p < 0.01). In 2023, compared to 2011, the odds of stunt-ing, wasting, and being underweight have increased by 22%, 16%, and 70% respectively. Infants aged 0-5 months had higher odds of undernutrition in all three indices. Children of obese or overweight mothers, and those who started breastfeeding late, were more likely to be stunted. Boys had significantly higher odds of wasting and underweight. Small birth weight, and dura-tion of breastfeeding > 12months had significantly higher odds of being underweight; Conclu-sions: This study shows that infants aged 0-5 months, first-time mothers, boys, and children from poor households in Tunisia are at a higher odd of undernutrition. To address the growing issue of undernutrition in Tunisian children, enhancing maternal and child health and nutrition ser-vices, improve parental education, and implement community-based programs that provide breastfeeding and nutritional education to infants born to new mothers and mothers with high/low BMI is recommended.