Toddlers and young children in the second and third years of life (12-35 months) may be nutritionally vulnerable, especially if they eat a limited range of foods or consume a diet that is energy rich but nutrient poor. We compared dietary intakes among children aged 18-35 months from the National Diet and Nutrition Survey (2008-2011) and children aged 12-18 months from the Diet and Nutrition Survey of Infants and Young Children (2011) with UK Dietary Reference Values (DRVs) to assess potential nutrient excess or inadequacy. Multiple criteria were used [reference nutrient intake (RNI), estimated average requirements (EAR) and lower reference nutrient intake (LRNI)], and where the LRNI or EAR were unavailable they were estimated as 75% of the EAR or RNI, respectively. Compared to current recommendations, there appear to be significant shortfalls in intakes of vitamin D in young children in the UK, and supplementation, although recommended by government, is not addressing the problem because take-up is low (9-11%). Vitamin D intakes (including supplements) averaged only 55% of the RNI among children aged 12-18 months and 33% of the RNI for those aged 18-35 months, while 64% and 87% of the younger and older group, respectively, had intakes below the LRNI (estimated). Endogenous synthesis of vitamin D may be insufficient to fulfil requirements, especially in winter. Iron intakes are also suboptimal among some groups. Based on the EAR cut-point method, the estimated population prevalence of dietary inadequacy for children aged 18-35 months was 91% for vitamin D and 31% for iron. Zinc, vitamin A and iodine had estimated levels of dietary inadequacy ranging from 5% to 19%. Mean energy intakes were below the 1991 DRV for energy but above the most recent DRV issued in 2011, while protein intakes in both surveys were in excess of the RNI. Further work is warranted to identify dietary patterns associated with low micronutrient intakes and status, and to assess the best strategies for ensuring adequacy, especially among vulnerable groups. Parents and healthcare professionals should be informed as to how to minimise the risks of both nutrient deficiency and excessive energy intakes for the young children in their care. Government can facilitate provision of appropriate advice via the healthcare system and encourage provision of appropriate foods and supplements via enabling legislation. The food industry also has a role in the responsible provision of fortified foods and drinks that can address nutrient inadequacy.

Nutrition in the second year is important as this is a period of rapid growth and development. Milk is a major food for young children and this analysis evaluated the impact of the type of milk consumed on nutrient intakes and nutritional status. Data from the Diet and Nutrition Survey of Infants and Young Children were used to investigate the intakes of key nutrients, and Fe and vitamin D status, of children aged 12–18 months, not breastfed, and consuming >400 g/d fortified milk (n 139) or >400 g/d of whole cows’ milk (n 404). Blood samples from eligible children for measurement of Hb (n 113), serum ferritin and plasma 25-hydroxyvitamin D (25(OH)D) concentrations (n 105) were available for approximately 20 % of children. Unpaired Mann–Whitney tests were used to compare nutrient intakes and status between consumers of fortified and cows’ milk. Mean daily total dietary intakes of Fe, Zn, vitamin A and vitamin D were significantly higher in the fortified milk group. Mean daily total dietary intakes of energy, protein, Ca, iodine, Na and saturated fat were significantly higher in the cows’ milk group. Hb was not different between groups. The fortified milk group had significantly higher serum ferritin (P = 0·049) and plasma 25(OH)D (P = 0·014). This analysis demonstrates significantly different nutrient intakes and status between infants consuming >400 g/d fortified milk v. those consuming >400 g/d whole cows’ milk. These results indicate that fortified milks can play a significant role in improving the quality of young children's diets in their second year of life.

Breastfeeding provides the optimum nutrition for young infants and one of the aims of the new UK-World Health Organization growth charts is to encourage healthcare professionals and parents to see breastfed infants' growth rate as the norm. Formula-fed infants gain weight more quickly than breastfed infants in the first year of life, and this may be because of the greater quantity of protein in infant formula. Childhood obesity rates are increasing and obesity is probably the result of a multitude of factors. Observational studies have indicated that rapid growth in infancy may contribute to a later risk of obesity. New randomised controlled studies have shown that lower protein levels in infant formula can slow infants' weight gain, and this may offer short-and long-term health benefits. New innovations in protein quality now allow reductions in the total protein content of infant formula.

Infants are growing rapidly from 6-24 months and have high nutrient needs in proportion to their body size. This sub-group of the population are prone to dietary imbalances and inadequacies. It is of vital importance to get nutrition right during this time period to support appropriate growth and development.Overweight and obesity rates are increasing in pre-school children, and maternal nutritional status and early life feeding have been identified as 'critical windows' for obesity risk. After the recommended period of exclusive breastfeeding, an increasingly diversified selection of foods are offered to infants and young children, and milk becomes less dominant in the diet.Rapid weight gain during infancy is the strongest risk factor for childhood overweight and obesity, and this may be modifiable with early intervention. During the complementary feeding period, there is an increase in protein intake, which is in excess of requirements, and may be associated with adverse outcomes regarding later body mass index and body fatness. Guidelines for healthcare professionals have been developed to raise the issue of overfeeding during infancy, and to manage overweight if it arises.Dietary intake measures show a deteriorating quality of diet as infants move from the first 12 months of life into the second year, with potential excesses of protein, energy, saturated fatty acids, salt and non-milk extrinsic sugars. Formula manufacturers can reduce the protein content of formulas for infants and young children in order to support appropriate growth, whilst supplements, fortified foods and milks can supply 'at risk' micronutrients.