Sweet Beverage Consumption By Children

Outcome

% of children aged 6 - 23 months who consumed a sweet beverage during the previous day

Sweet beverage consumption among young children is a concern because these drinks can displace more nutritious foods and beverages, and their consumption has been associated with childhood obesity and dental caries. Therefore, this indicator assesses the proportion of children aged 6–23 months who consumed a sweet beverage during the previous day.

There are two main ways to determine the indicator’s value. Both require conducting individual interviews with caregivers of a representative sample of children aged 6-23 months:

 

1) Using Full WHO/UNICEF Liquids Questionnaire - Recommended

WHO/UNICEF’s “liquids questionnaire” (see pages 26 - 27 in the guidance below) also records data on the consumption of sweet drinks (questions 6Cswt, 6Dswt, 6Hswt, 6Jswt, 6E, 6F and 6G). The WHO/UNICEF questionnaire uses separate prompts for different types of liquids and follow-up questions on whether selected drinks were sweetened. This list-based approach is recommended for liquids and should be used whenever feasible.

 

 

2) Asking About Sweet Drinks Only

If you cannot administer the entire “liquids questionnaire”, use the following question only. This single-question approach is shorter and reduces questionnaire length. However, because different types of sweet beverages are not asked about separately, as in the WHO/UNICEF questionnaire, some respondents may forget a drink or may not recognise it as a ‘sweet drink’, which can result in under-reporting. To reduce this risk, adapt the examples to include the main types of sweet beverages commonly consumed by young children in the survey area. When comparability with surveys using the standard WHO/UNICEF questionnaire is important, use the full list-based approach.

Q1: Yesterday, during the day or at night, did [child’s name] drink any sweet drink, whether at home or elsewhere? For example, sweet tea, fruit juice, sweet soda, powdered sweet drink, sweet milk, sweet yoghurt drink, chocolate-flavoured sweet drink or any other sweetened drink?

A1: yes / no / does not know

 

To calculate the indicator’s value, divide the number of children aged 6–23 months who consumed a sweet beverage during the previous day by the total number of surveyed children aged 6–23 months, including those for whom the response was “does not know”. Multiply the result by 100 to convert it to a percentage.

This data can be disaggregated by child sex and age group, and, if relevant and feasible, also by household wealth and geographical area. Where the sample size is adequate, age groups of 6–11, 12–17 and 18–23 months can be used.

1) According to the WHO/UNICEF guidance (see below), sweet beverages include:

   ‑ commercially produced and packaged, sweetened beverages such as soda pop, fruit-flavoured drinks, sports drinks, chocolate and other flavoured milk drinks, malt drinks, etc.

   - 100% fruit juice as well as fruit-flavoured drinks, whether made at home, by informal vendors or packaged in cans, bottles, boxes, sachets, etc.

   - home-made drinks of any kind to which sweeteners (e.g. sugar, honey, syrup, flavoured powders) have been added.

For the purposes of this indicator, beverages sweetened with non-caloric sweeteners are also included, as survey respondents may not reliably distinguish them from beverages sweetened with sugar or other caloric sweeteners.

During questionnaire adaptation and enumerator training, identify locally common drinks that belong in each category and use a manageable set of locally understood examples. The examples should cover important local drinks but should not try to be exhaustive.

 

2) WHO/UNICEF includes 100% fruit juice in this indicator, partly because respondents may not reliably distinguish it from sugar-sweetened juice drinks. Although 100% fruit juice may be perceived as a healthy drink, its consumption should be limited in young children because it contains free sugars and can displace more nutrient-rich foods and beverages. Its inclusion does not mean that 100% fruit juice and sugar-sweetened beverages are considered nutritionally equivalent.

3) Sweet beverage consumption can vary by season and during periods that substantially affect purchasing or feeding practices. For comparisons over time, conduct survey rounds at a similar time of year where feasible and document important contextual differences. Where feasible, spread data collection across different days of the week and use a similar distribution of weekdays and weekends across survey rounds. Do not exclude an individual child’s data simply because their intake on the previous day was unusual. Consider postponing data collection only when there is good reason to expect unusually different feeding practices among a large proportion of the target population.

 

4) If the caregiver is taking care of two children aged 6 - 23 months (from the same household) and household sampling has been used, then data should be collected for both children. If a list method has been used and children have been identified as the primary sampling unit, then data should only be collected for the sampled child.

 

5) This indicator relies on accurate age assessment. Use a reliable record of the child’s date of birth where available. If the date of birth is not known or documented, estimate it using a standardised approach; a locally adapted events calendar can help caregivers recall the child’s approximate date of birth. Read FAO’s Guidelines (see below) for guidance on preparing and using local events calendars.

6) This indicator measures whether any qualifying sweet beverage was consumed during one previous day. It does not measure the amount consumed, frequency of consumption, habitual intake or the adequacy of the child’s overall diet. Use it primarily for population-level monitoring rather than to judge an individual child’s usual feeding practices. 

Also consider using the following indicators:

• Unhealthy Food Consumption by Children (captures other unhealthy food exposure in the same age group)

• Minimum Dietary Diversity - Children (provides a broader measure of dietary variety and micronutrient adequacy)

• Zero Vegetable / Fruit Consumption by Children (adds another complementary measure of poor diet quality)

• Egg and/or Flesh Food Consumption by Children (adds a positive nutrient-dense food indicator using the same recall period)