LOS ANGELES >> Every week, Caitlin Scuttio stops by Target and piles her cart with pureed food pouches for her 4-year-old and twin 18-month-olds sons.

In goes a 24-pack of unsweetened applesauce. Then a 24-pack of the fruit and veggie blend. And finally, the yogurt pouches for her oldest son’s breakfast. “He’d eat six apple sauce pouches a day if I let him,” Scuttio said.

Total monthly pouch budget: $200.

“They have such a chokehold on my family. I can’t imagine our grocery list without it at this point,” she said. “We are definitely a pouch family.”

And they aren’t alone. Sales of food pouches — soft bags with plastic spouts for easy consumption — have increased 900% since 2010, overtaking jarred purees as the predominant baby food on the market. Parents generally spoon-feed jars of pureed foods for a few months in the first year of life when introducing solids, but pouches marketed to parents of toddlers and older children have prolonged pureed food eating by years.

While the occasional pouch can be part of a healthy diet, doctors and nutritionists are raising concerns that an overreliance on pouches can interfere with nutrition, long-term food preferences, dental hygiene and even speech and language development. And marketing practices can leave parents confused about what’s actually inside the packages.

“Pouches are highly processed foods,” said Dr. Steven Abrams, a professor of pediatrics at the University of Texas at Austin Dell Medical School. “They certainly serve as a quick snack, but we need to make sure that pouches don’t make up too much of a toddler’s diet. We want kids to learn to chew and eat foods like meat, and fruits and vegetables that are not processed.”

What’s inside varies greatly — some contain only fruit, while others have a mix of vegetables, grains, yogurt and even meat. Whereas many jarred foods contain a single ingredient like pureed peas or carrots, pouches are more often a blend that features a sweet fruit such as apple or pear as the primary ingredient.

A 2019 study found that infant and toddler food in pouches contained significantly more sugar per serving than foods available in other forms of packaging.

To be sure, there is not an epidemic of children who don’t know how to chew. But Dr. Mark Corkins, a pediatric gastroenterologist at the University of Tennessee Health Science Center who chairs the American Academy of Pediatrics committee on nutrition, said he sometimes sees children who are so reliant on the smooth, sweet taste of pouches that they have developed food and texture aversions and refuse to eat regular fruits or vegetables.

“In the long run we’re going to pay for it,” he said.

Popularity

Pouches are convenient: Unlike glass jars, they don’t shatter when dropped and toddlers can suck down the slurry without help.

“It is so dang hard to be a parent of young children in the U.S. Having [pouches] on an airplane, having them in the car — it is so convenient that I would never take that away from parents. I used pouches with my children,” said Bridget Young, an associate professor of pediatrics at the University of Rochester School of Medicine.

“The industry has gone from jars to pouches because it’s more cost-effective and convenient,” said Dr. Tanya Altmann, a pediatrician in Calabasas and author of the book What to Feed Your Baby. But it’s what’s inside that’s important, and “not all pouches are created equal.”

As a tool, she said, pouches “can be a contributor to a family’s nutrition,” but not a prime source. Those without added sugars or salt may even have advantages over other processed snacks.

Heidi Martinez, a mother of three in Pittsburg, said she always buys the pouches with at least one vegetable. As her oldest son goes through “picky stages, I like that he is still getting some kale and beets,” she said. “I don’t know that they’re actually healthier but I feel better about it.”

Slippery slope

The early years of a child’s life are crucial for developing lifelong healthy eating habits. Babies are born with a preference for sweet foods, said Jill Castle, a pediatric dietitian in Massachusetts. Typically, a child must be repeatedly introduced to various foods to get them used to different textures and flavors, such as the taste of vegetables.

Fruit puree can disguise the taste of vegetables, reinforcing sweetness, Castle said.

If a child’s diet consists mostly of pouches, “when you actually give them chopped-up carrot and peas that roll around the plate, they’re not used to that at all,” and may refuse it, said Daisy Coyle, who researches pouches.

Ideally, lumpy textures should be introduced as early as possible so the child can learn to use their tongue and jaw to manipulate and swallow food, a process that requires 30 different muscles to work together, said Susan Greenberg, a speech pathologist at Children’s Hospital Los Angeles. “We think it’s a natural process, but it’s like learning to walk,” she said.

A variety of textures is also crucial to developing a child’s long-term food preferences.

The full sensory experience of eating food is also important, she added — getting messy, using spoons, fingers and tiny fists to squish food and smear on a highchair and face.

Dentists also have concerns about what pouches mean for oral hygiene. Dr. Francisco Ramos-Gomez, director of the UCLA Center for Children’s Oral Health, said the way purees such as apple sauce stick to the teeth is different from eating an actual apple, and prolonged exposure erodes the teeth and causes cavities.

But it’s all a matter of moderation, Greenberg said. “Pouches are easy, and we live in a world that’s really busy these days. I think we can all agree that it’s not a bad thing. It just can’t replace the other things.”