Advancements in Non-Thermal Processing Technologies for Enhancing Safety and Quality of Infant and Baby Food Products: A Review

Citation: Pasdar, N.; Mostashari, P.; Greiner, R.; Khelfa, A.; Rashidinejad, A.; Eshpari, H.; Vale, J.M.; Gharibzahedi, S.M.T.; Roohinejad, S. Advancements in Non-Thermal Processing Technologies for Enhancing Safety and Quality of Infant and Baby Food Products: A Review. Foods 2024,13, 2659. https://doi.org/10.3390/ foods13172659 Academic Editors: Diego A. Moreno and Nieves Baenas Received: 19 July 2024 Revised: 20 August 2024 Accepted: 21 August 2024 Published: 23 August 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). foods Review Advancements in Non-Thermal Processing Technologies for Enhancing Safety and Quality of Infant and Baby Food Products: A Review Nasim Pasdar 1, Parisa Mostashari 2, Ralf Greiner 3, Anissa Khelfa 4, Ali Rashidinejad 5, Hadi Eshpari 6, Jim M. Vale 7, Seyed Mohammad Taghi Gharibzahedi 8,* and Shahin Roohinejad 7,* 1Department of Agricultural Engineering and Technology, Payame Noor University (PNU), Tehran 19395-4697, Iran; [email protected] 2Department of Food Science and Technology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran 19419-33111, Iran; [email protected] 3Max Rubner-Institut, Federal Research Institute of Nutrition and Food, 76131 Karlsruhe, Germany; [email protected] 4École Supérieure de Chimie Organique et Minérale (ESCOM), Universitéde Technologie de Compiègne (UTC), EA 4297 TIMR, 1 Allée du Réseau Jean-Marie Buckmaster, 60200 Compiègne, France; [email protected] 5Riddet Institute, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand; [email protected] 6Department of Food Science and Technology, Oregon State University, Corvallis, OR 97331, USA; [email protected] 7Department of Food, Nutrition and Packaging Sciences, Clemson University, Clemson, SC 29634, USA; [email protected] 8Institute of Materials Science, Faculty of Engineering, Kiel University, 24143 Kiel, Germany *Correspondence: [email protected] (S.M.T.G.); [email protected] (S.R.) Abstract: Breast milk is the main source of nutrition during early life, but both infant formulas (Ifs; up to 12 months) and baby foods (BFs; up to 3 years) are also important for providing essential nutrients. The infant food industry rigorously controls for potential physical, biological, and chemical hazards. Although thermal treatments are commonly used to ensure food safety in IFs and BFs, they can negatively affect sensory qualities, reduce thermosensitive nutrients, and lead to chemical contaminant formation. To address these challenges, non-thermal processing technologies such as high-pressure processing, pulsed electric fields, radio frequency, and ultrasound offer efficient pathogen destruction similar to traditional thermal methods, while reducing the production of key process-induced toxicants such as furan and 5-hydroxymethyl-2-furfural (HMF). These alternative thermal processes aim to overcome the drawbacks of traditional methods while retaining their advantages. This review paper highlights the growing global demand for healthy, sustainable foods, driving food manufacturers to adopt innovative and efficient processing techniques for both IFs and BFs. Based on various studies reviewed for this work, the application of these novel technologies appears to reduce thermal processing intensity, resulting in products with enhanced sensory properties, comparable shelf life, and improved visual appeal compared to conventionally processed products. Keywords: infant formulas; baby foods; food safety; quality control; functional foods; nutrition; probiotics; non-thermal processing 1. Introduction The first days of life, from before birth to a child’s second birthday, are a pivotal period for human development [ 1 , 2 ]. Infancy is a period of rapid growth, second only to fetal life, and maintaining optimal nutrition is necessary during this time [ 3 ]. This critical period of growth is marked by numerous psychological, physical, and mental changes, including Foods 2024,13, 2659. https://doi.org/10.3390/foods13172659 https://www.mdpi.com/journal/foods Foods 2024,13, 2659 2 of 29 the development of digestive and immune functions, as well as the composition of the gut microbiota [4,5]. Nutrition during infancy plays a vital role in preventing non-communicable diseases [ 6 , 7 ]. Insufficient nutrient intake is a primary cause of postnatal growth restriction in neonates and the post-neonatal period [ 5 ]. Several studies have reported that undernutrition is responsible for 45% of all deaths among children under 5 years of age [ 8 ]. Breastfeeding is widely recognized as the nutritional gold standard for infants. The World Health Organization (WHO) recommends breastfeeding for at least six months following birth. Several studies have shown that breast milk protects against numerous diseases and enhances the intellectual development of children [ 8 , 9 ]. However, in situations where breastfeeding is unavailable, inappropriate, or inadequate, milk-based infant formulas (IFs) are used as a substitute for breast milk [1]. IFs, formulated to mimic mature human milk, are designed to provide infants with optimal nutrition for their development and growth [ 10 ]. Baby foods (BFs) are a type of soft, easily digestible food specially formulated for infants up to 12 months and young children from 1 to 3 years old. They are designed to provide essential nutrients required for growth and development during the critical period when infants transition from breast milk or formula to solid foods [ 11 ]. The global market value for BF and IF products exceeded USD 88 billion in 2022 and is expected to reach USD 150 billion by 2032, with a CAGR of over 5.3% [ 12 ]. However, despite the increasing demand for commercial IFs and BFs worldwide, concerns remain regarding their safety and efficacy. Commercial IFs and BFs may become contaminated with various microbes at different stages of processing. In many instances, IFs are intrinsically contaminated due to the addition of thermally sensitive micronutrients without prior heat treatment, which is necessary to meet regulatory standards. Consequently, these raw ingredients serve as potential pathways for bacterial transmission [ 8 ]. Furthermore, with regard to liquid infant products, the drying zone as well as the containers used for filling act as vectors for biological transmission. Generally, heat sterilization ensures microbiological safety and product stability [ 13 ]. However, excessive heating can adversely affect the sensory, biophysical, and nutritional characteristics of infant products. The main irreversible changes that occur during conventional thermal treatment of macronutrients in infant food include protein denaturation and aggregation, lipid–protein interactions, sugar isomerization, and various chemical reactions [ 14 ]. The Maillard reaction is particularly critical, producing toxicants such as acrylamide, heterocyclic amines, and certain polycyclic aromatic hydrocarbons, which are associated with the degradation of nutritional values and ratios [ 15 , 16 ]. Balancing food safety with minimizing heat treatment losses remains a significant challenge for IF and BF manufacturers. The limitations of traditional food processing technologies have led the food industry to seek alternative processing methods. Non-thermal food processing technologies offer promising approaches to balancing microbiological and chemical safety, as well as sensory and nutritional properties in IF and BF production. Pioneering technologies such as high-pressure processing (HPP), ultrasound (US), pulsed electric field (PEF), and radio frequency (RF) are leading research in food processing for newborns and children. This review aims to assess the risk associated with critical chemical and microbial contaminants in food intended for infants and young children. It also highlights the application of non-thermal technologies as alternatives to conventional heat processing, ensuring the safety, quality, and nutritional content of infant and baby products at both pilotand industrial-scale production levels (Figure 1). Foods 2024,13, 2659 3 of 29 Foods 2024, 13, x FOR PEER REVIEW 3 of 30 Figure 1. Comparison of conventional and emerging processing technologies in influencing sensory attributes, nutrient content, and freshness of infant and young child foods. 2. Infant and Young Children’s Food Categories The consumer population of infants and young children under 36 months of age is typically divided into three stages: stage one (0–6 months, infants), stage two (7–12 months, follow-up infants), and stage three (13–36 months, young children) [17]. Infant products are specifically formulated to meet the distinct developmental stages of infants, each stage having unique nutritional requirements as defined by the recommended dietary allowance (RDA). Figure 2 illustrates various stages of IFs and BFs in accordance with child growth. The main foods consumed by infants and young children under 36 months of age include infant formula, complementary foods, and water are discussed as follows: Figure 2. Examples of food products for different stages of infant and baby growth. Figure 1. Comparison of conventional and emerging processing technologies in influencing sensory attributes, nutrient content, and freshness of infant and young child foods. 2. Infant and Young Children’s Food Categories The consumer population of infants and young children under 36 months of age is typically divided into three stages: stage one (0–6 months, infants), stage two (7–12 months, follow-up infants), and stage three (13–36 months, young children) [ 17 ]. Infant products are specifically formulated to meet the distinct developmental stages of infants, each stage having unique nutritional requirements as defined by the recommended dietary allowance (RDA). Figure 2illustrates various stages of IFs and BFs in accordance with child growth. The main foods consumed by infants and young children under 36 months of age include infant formula, complementary foods, and water are discussed as follows: Foods 2024, 13, x FOR PEER REVIEW 3 of 30 Figure 1. Comparison of conventional and emerging processing technologies in influencing sensory attributes, nutrient content, and freshness of infant and young child foods. 2. Infant and Young Children’s Food Categories The consumer population of infants and young children under 36 months of age is typically divided into three stages: stage one (0–6 months, infants), stage two (7–12 months, follow-up infants), and stage three (13–36 months, young children) [17]. Infant products are specifically formulated to meet the distinct developmental stages of infants, each stage having unique nutritional requirements as defined by the recommended dietary allowance (RDA). Figure 2 illustrates various stages of IFs and BFs in accordance with child growth. The main foods consumed by infants and young children under 36 months of age include infant formula, complementary foods, and water are discussed as follows: Figure 2. Examples of food products for different stages of infant and baby growth. Figure 2. Examples of food products for different stages of infant and baby growth. 2.1. Infant Formula The European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition, along with the Scientific Committee on Food of the Foods 2024,13, 2659 4 of 29 European Commission, provides recommendations and regulations governing the nutrient composition of infant formula products. According to their guidelines, “infant formula” is designed as a suitable substitute for breastfeeding during the first 4–6 months (stage one). “Follow-on formula” (FOF) is intended for infants aged 6–12 months (stage two), while “toddler formula” or “follow-up formula” (FUF) is appropriate for children between 12 and 36 months (stage three) [ 18 , 19 ]. To meet the nutritional needs of infants aged 3 to 36 months as an alternative to breastfeeding, IFs must adhere to the nutritional requirements outlined by the WHO and the United Nations International Children’s Emergency Fund (UNICEF). Infant formulas are formulated using bovine milk, milk from other sources, or a combination thereof, with or without additional ingredients, to fulfill the nutritional needs of infants. These formulas are available in various formulations, including skimmed versions; those diluted with vegetable oils; fortified with vitamins, minerals, and iron; and those containing rice, carob, or soy for specific medical requirements [ 9 , 20 ]. Generally, IFs are available in three forms: powder, liquid concentrate, and ready-to-feed. While ready-tofeed bottles contain pre-diluted liquid formula, concentrated liquids and powder forms need to be mixed with water, which can include mineral water, bottled water, or tap water [ 21 ]. While a wide range of formula brands and types are available on the market (Table 1, [ 22 – 41 ]), there is no universally appropriate formula for all babies. The type of powdered milk recommended by pediatricians depends on a child’s nutritional needs or specific infant risks. Several leading manufacturers in the global infant nutrition market include Abbott (Chicago, IL, USA), Baby Gourmet (Calgary, AB, Canada), Danone (White Plains, NY, USA), Reckitt Benckiser Group PLC (Slough, UK), Nestlé(Vevey, Switzerland) [ 11 ], SMA ® Nutrition (Gatwick, UK), Friesl (Amersfoort, The Netherlands), Kraft Heinz (Sharpsburgh, PA, USA), HiPP GmbH & Co. (Pfaffenhofen an der Ilm, Germany), Vertrieb KG (Pfaffenhofen, Germany), and Arla Food (Viby, Denmark). Table 1. A selection of different commercial infant formula and baby foods currently available on the market. Type of Infant/Baby Foods Infants’ Foods Available Features Stage Ref. First infant formula milk (IFM) powder/liquid Foods 2024, 13, x FOR PEER REVIEW 4 of 30 2.1. Infant Formula The European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition, along with the Scientific Committee on Food of the European Commission, provides recommendations and regulations governing the nutrient composition of infant formula products. According to their guidelines, “infant formula” is designed as a suitable substitute for breastfeeding during the first 4–6 months (stage one). “Follow-on formula” (FOF) is intended for infants aged 6–12 months (stage two), while “toddler formula” or “follow-up formula” (FUF) is appropriate for children between 12 and 36 months (stage three) [18,19]. To meet the nutritional needs of infants aged 3 to 36 months as an alternative to breastfeeding, IFs must adhere to the nutritional requirements outlined by the WHO and the United Nations International Children’s Emergency Fund (UNICEF). Infant formulas are formulated using bovine milk, milk from other sources, or a combination thereof, with or without additional ingredients, to fulfill the nutritional needs of infants. These formulas are available in various formulations, including skimmed versions; those diluted with vegetable oils; fortified with vitamins, minerals, and iron; and those containing rice, carob, or soy for specific medical requirements [9,20]. Generally, IFs are available in three forms: powder, liquid concentrate, and ready-to-feed. While readyto-feed bottles contain pre-diluted liquid formula, concentrated liquids and powder forms need to be mixed with water, which can include mineral water, bottled water, or tap water [21]. While a wide range of formula brands and types are available on the market (Table 1, [22–41]), there is no universally appropriate formula for all babies. The type of powdered milk recommended by pediatricians depends on a child’s nutritional needs or specific infant risks. Several leading manufacturers in the global infant nutrition market include Abbott (Chicago, IL, USA), Baby Gourmet (Calgary, AB, Canada), Danone (White Plains, NY, USA), Reckitt Benckiser Group PLC (Slough, UK), Nestlé (Vevey, Switzerland) [11], SMA® Nutrition (Gatwick, UK), Friesl (Amersfoort, The Netherlands), Kraft Heinz (Sharpsburgh, PA, USA), HiPP GmbH & Co. (Pfaffenhofen an der Ilm, Germany), Vertrieb KG (Pfaffenhofen, Germany), and Arla Food (Viby, Denmark). Table 1. A selection of different commercial infant formula and baby foods currently available on the market. Type of Infant/Baby Foods Infants’ Foods Available Features Stage Ref. First infant formula milk (IFM) powder/liquid - Suitable from birth - Based on whey protein for easier digestion - Whey/casein ratio of 60:40 - Carbohydrate: lactose is the main source - Fat: polyunsaturated fatty acids and phospholipid contributes to cognitive functions, memory and concentration, cellular membrane composition, and general well-being Stage 1 [22] - Suitable from birth - Based on whey protein for easier digestion - Whey/casein ratio of 60:40 - Carbohydrate: lactose is the main source - Fat: polyunsaturated fatty acids and phospholipid contributes to cognitive functions, memory and concentration, cellular membrane composition, and general well-being Stage 1 [22] Follow-on formula (stage 2) Foods 2024, 13, x FOR PEER REVIEW 5 of 30 Follow-on formula (stage 2) - Only suitable for babies over 6 months old as a complementary to weaning - Casein-based, they are more like cow’s milk than breast milk - In comparison to unmodified cow’s milk, these products should contain less protein, a higher fat content similar to human milk fat, and more carbohydrates. - Higher iron, calcium, zinc, and vitamin A and C levels than standard formulas, although these are less bioavailable - A major difference between IF and FOF (follow-on formula) is the higher minimum and maximum iron content of IF - Contain omega 3 and 6 and iodine for growth as well as prebiotics (GOS/FOS) and probiotics Stage 2 [23,24] Growing up milk GUM (toddler milk)/follow-up formula (FUF) - Suitable for children between 1 and 3 years - An alternative to whole cow’s milk that compensates for nutritional deficiencies during a child’s transition to family nutrition - A GUM made from cow’s milk should preserve calcium, B 2 , and A while having a lower protein and fat content and energy value - It contains ARA and DH since the central nervous system continues to depose these compounds in high concentrations until the second year of life Stage 3 [25] Hungry baby formulas - Suitable for “hungrier babies” - Infant milk for hungrier babies is a nutritionally complete breastmilk substitute with a different balance of milk protein - Based on casein content for slow digestion and being less hungry soon after feeding - Casein based, whey/casein ratio 20:80 - Contains DHA (omega 3) as required by the legislation for all infant formula Stage 1, 2 [26] - Only suitable for babies over 6 months old as a complementary to weaning - Casein-based, they are more like cow’s milk than breast milk - In comparison to unmodified cow’s milk, these products should contain less protein, a higher fat content similar to human milk fat, and more carbohydrates. - Higher iron, calcium, zinc, and vitamin A and C levels than standard formulas, although these are less bioavailable - A major difference between IF and FOF (follow-on formula) is the higher minimum and maximum iron content of IF - Contain omega 3 and 6 and iodine for growth as well as prebiotics (GOS/FOS) and probiotics Stage 2 [23,24] Foods 2024,13, 2659 5 of 29 Table 1. Cont. Type of Infant/Baby Foods Infants’ Foods Available Features Stage Ref. Growing up milk GUM (toddler milk)/follow-up formula (FUF) Foods 2024, 13, x FOR PEER REVIEW 5 of 30 Follow-on formula (stage 2) - Only suitable for babies over 6 months old as a complementary to weaning - Casein-based, they are more like cow’s milk than breast milk - In comparison to unmodified cow’s milk, these products should contain less protein, a higher fat content similar to human milk fat, and more carbohydrates. - Higher iron, calcium, zinc, and vitamin A and C levels than standard formulas, although these are less bioavailable - A major difference between IF and FOF (follow-on formula) is the higher minimum and maximum iron content of IF - Contain omega 3 and 6 and iodine for growth as well as prebiotics (GOS/FOS) and probiotics Stage 2 [23,24] Growing up milk GUM (toddler milk)/follow-up formula (FUF) - Suitable for children between 1 and 3 years - An alternative to whole cow’s milk that compensates for nutritional deficiencies during a child’s transition to family nutrition - A GUM made from cow’s milk should preserve calcium, B 2 , and A while having a lower protein and fat content and energy value - It contains ARA and DH since the central nervous system continues to depose these compounds in high concentrations until the second year of life Stage 3 [25] Hungry baby formulas - Suitable for “hungrier babies” - Infant milk for hungrier babies is a nutritionally complete breastmilk substitute with a different balance of milk protein - Based on casein content for slow digestion and being less hungry soon after feeding - Casein based, whey/casein ratio 20:80 - Contains DHA (omega 3) as required by the legislation for all infant formula Stage 1, 2 [26] - Suitable for children between 1 and 3 years - An alternative to whole cow’s milk that compensates for nutritional deficiencies during a child’s transition to family nutrition - A GUM made from cow’s milk should preserve calcium, B 2 , and A while having a lower protein and fat content and energy value - It contains ARA and DH since the central nervous system continues to depose these compounds in high concentrations until the second year of life Stage 3 [25] Hungry baby formulas Foods 2024, 13, x FOR PEER REVIEW 5 of 30 Follow-on formula (stage 2) - Only suitable for babies over 6 months old as a complementary to weaning - Casein-based, they are more like cow’s milk than breast milk - In comparison to unmodified cow’s milk, these products should contain less protein, a higher fat content similar to human milk fat, and more carbohydrates. - Higher iron, calcium, zinc, and vitamin A and C levels than standard formulas, although these are less bioavailable - A major difference between IF and FOF (follow-on formula) is the higher minimum and maximum iron content of IF - Contain omega 3 and 6 and iodine for growth as well as prebiotics (GOS/FOS) and probiotics Stage 2 [23,24] Growing up milk GUM (toddler milk)/follow-up formula (FUF) - Suitable for children between 1 and 3 years - An alternative to whole cow’s milk that compensates for nutritional deficiencies during a child’s transition to family nutrition - A GUM made from cow’s milk should preserve calcium, B 2 , and A while having a lower protein and fat content and energy value - It contains ARA and DH since the central nervous system continues to depose these compounds in high concentrations until the second year of life Stage 3 [25] Hungry baby formulas - Suitable for “hungrier babies” - Infant milk for hungrier babies is a nutritionally complete breastmilk substitute with a different balance of milk protein - Based on casein content for slow digestion and being less hungry soon after feeding - Casein based, whey/casein ratio 20:80 - Contains DHA (omega 3) as required by the legislation for all infant formula Stage 1, 2 [26] - Suitable for “hungrier babies” - Infant milk for hungrier babies is a nutritionally complete breastmilk substitute with a different balance of milk protein - Based on casein content for slow digestion and being less hungry soon after feeding - Casein based, whey/casein ratio 20:80 - Contains DHA (omega 3) as required by the legislation for all infant formula Stage 1, 2 [26] Preterm formula Foods 2024, 13, x FOR PEER REVIEW 6 of 30 Preterm formula - Suitable for babies with malnutrition, growth failure - Designed for low-weight premature infants, mainly enriched with elements to continue the proper development of the nervous system - Nutrient-dense formula to support catch-up growth (100% whey protein) Stage 1 [22] Lactose-free formula - Suitable for lactose-intolerant babies: Deficiency of the lactase enzyme prevents lactose digestion - It is not suitable for infants with galactosemia - Reduces symptoms including nausea, abdominal pain, bloating, fussiness, and gas - It contains all the necessary vitamins, minerals, trace elements, fatty acids, and DHA - Lactose-free milk is produced by adding lactase to regular cow’s milk - Lactose enzymes convert lactose into glucose and galactose, two simple sugars that make lactose-free milk sweeter than regular milk Stage 1, 2, 3 [27] Comfort formula - Suitable for babies with delicate tummies - Infant digestive discomfort is the result of gastrointestinal tract immaturity, with minor digestion issues (e.g., colic, and constipation). - Partially hydrolyzed protein, easy to digest - Whey-based (100%) - With 2′-FL-HMO and nucleotides to support the baby’s immune system - A combination of supplements can relieve colic in infants (e.g., oligosaccharides, probiotics, and digestive enzymes) Stage 1, 2, 3 [28,29] Extensively hydrolyzed formula - Suitable for babies with cow’s milk protein allergy (CMPA) - Extensively hydrolyzed - Peptide-based (containing hydrolysates of casein or whey) Stage 1, 2, 3 [30] - Suitable for babies with malnutrition, growth failure - Designed for low-weight premature infants, mainly enriched with elements to continue the proper development of the nervous system - Nutrient-dense formula to support catch-up growth (100% whey protein) Stage 1 [22] Lactose-free formula Foods 2024, 13, x FOR PEER REVIEW 6 of 30 Preterm formula - Suitable for babies with malnutrition, growth failure - Designed for low-weight premature infants, mainly enriched with elements to continue the proper development of the nervous system - Nutrient-dense formula to support catch-up growth (100% whey protein) Stage 1 [22] Lactose-free formula - Suitable for lactose-intolerant babies: Deficiency of the lactase enzyme prevents lactose digestion - It is not suitable for infants with galactosemia - Reduces symptoms including nausea, abdominal pain, bloating, fussiness, and gas - It contains all the necessary vitamins, minerals, trace elements, fatty acids, and DHA - Lactose-free milk is produced by adding lactase to regular cow’s milk - Lactose enzymes convert lactose into glucose and galactose, two simple sugars that make lactose-free milk sweeter than regular milk Stage 1, 2, 3 [27] Comfort formula - Suitable for babies with delicate tummies - Infant digestive discomfort is the result of gastrointestinal tract immaturity, with minor digestion issues (e.g., colic, and constipation). - Partially hydrolyzed protein, easy to digest - Whey-based (100%) - With 2′-FL-HMO and nucleotides to support the baby’s immune system - A combination of supplements can relieve colic in infants (e.g., oligosaccharides, probiotics, and digestive enzymes) Stage 1, 2, 3 [28,29] Extensively hydrolyzed formula - Suitable for babies with cow’s milk protein allergy (CMPA) - Extensively hydrolyzed - Peptide-based (containing hydrolysates of casein or whey) Stage 1, 2, 3 [30] - Suitable for lactose-intolerant babies: Deficiency of the lactase enzyme prevents lactose digestion - It is not suitable for infants with galactosemia - Reduces symptoms including nausea, abdominal pain, bloating, fussiness, and gas - It contains all the necessary vitamins, minerals, trace elements, fatty acids, and DHA - Lactose-free milk is produced by adding lactase to regular cow’s milk - Lactose enzymes convert lactose into glucose and galactose, two simple sugars that make lactose-free milk sweeter than regular milk Stage 1, 2, 3 [27] Foods 2024,13, 2659 6 of 29 Table 1. Cont. Type of Infant/Baby Foods Infants’ Foods Available Features Stage Ref. Comfort formula Foods 2024, 13, x FOR PEER REVIEW 6 of 30 Preterm formula - Suitable for babies with malnutrition, growth failure - Designed for low-weight premature infants, mainly enriched with elements to continue the proper development of the nervous system - Nutrient-dense formula to support catch-up growth (100% whey protein) Stage 1 [22] Lactose-free formula - Suitable for lactose-intolerant babies: Deficiency of the lactase enzyme prevents lactose digestion - It is not suitable for infants with galactosemia - Reduces symptoms including nausea, abdominal pain, bloating, fussiness, and gas - It contains all the necessary vitamins, minerals, trace elements, fatty acids, and DHA - Lactose-free milk is produced by adding lactase to regular cow’s milk - Lactose enzymes convert lactose into glucose and galactose, two simple sugars that make lactose-free milk sweeter than regular milk Stage 1, 2, 3 [27] Comfort formula - Suitable for babies with delicate tummies - Infant digestive discomfort is the result of gastrointestinal tract immaturity, with minor digestion issues (e.g., colic, and constipation). - Partially hydrolyzed protein, easy to digest - Whey-based (100%) - With 2′-FL-HMO and nucleotides to support the baby’s immune system - A combination of supplements can relieve colic in infants (e.g., oligosaccharides, probiotics, and digestive enzymes) Stage 1, 2, 3 [28,29] Extensively hydrolyzed formula - Suitable for babies with cow’s milk protein allergy (CMPA) - Extensively hydrolyzed - Peptide-based (containing hydrolysates of casein or whey) Stage 1, 2, 3 [30] - Suitable for babies with delicate tummies - Infant digestive discomfort is the result of gastrointestinal tract immaturity, with minor digestion issues (e.g., colic, and constipation). - Partially hydrolyzed protein, easy to digest - Whey-based (100%) - With 2′-FL-HMO and nucleotides to support the baby’s immune system - A combination of supplements can relieve colic in infants (e.g., oligosaccharides, probiotics, and digestive enzymes) Stage 1, 2, 3 [28,29] Extensively hydrolyzed formula Foods 2024, 13, x FOR PEER REVIEW 6 of 30 Preterm formula - Suitable for babies with malnutrition, growth failure - Designed for low-weight premature infants, mainly enriched with elements to continue the proper development of the nervous system - Nutrient-dense formula to support catch-up growth (100% whey protein) Stage 1 [22] Lactose-free formula - Suitable for lactose-intolerant babies: Deficiency of the lactase enzyme prevents lactose digestion - It is not suitable for infants with galactosemia - Reduces symptoms including nausea, abdominal pain, bloating, fussiness, and gas - It contains all the necessary vitamins, minerals, trace elements, fatty acids, and DHA - Lactose-free milk is produced by adding lactase to regular cow’s milk - Lactose enzymes convert lactose into glucose and galactose, two simple sugars that make lactose-free milk sweeter than regular milk Stage 1, 2, 3 [27] Comfort formula - Suitable for babies with delicate tummies - Infant digestive discomfort is the result of gastrointestinal tract immaturity, with minor digestion issues (e.g., colic, and constipation). - Partially hydrolyzed protein, easy to digest - Whey-based (100%) - With 2′-FL-HMO and nucleotides to support the baby’s immune system - A combination of supplements can relieve colic in infants (e.g., oligosaccharides, probiotics, and digestive enzymes) Stage 1, 2, 3 [28,29] Extensively hydrolyzed formula - Suitable for babies with cow’s milk protein allergy (CMPA) - Extensively hydrolyzed - Peptide-based (containing hydrolysates of casein or whey) Stage 1, 2, 3 [30] - Suitable for babies with cow’s milk protein allergy (CMPA) - Extensively hydrolyzed - Peptide-based (containing hydrolysates of casein or whey) Stage 1, 2, 3 [30] Hypoallergenic or elemental formula Foods 2024, 13, x FOR PEER REVIEW 7 of 30 Hypoallergenic or elemental formula - Suitable for babies with cow’s milk protein allergy (CMPA) - Fully hydrolyzed protein - Amino acid-based formula - No residual protein Stage 1, 2, 3 [30] SOYA alternative milk formula - Suitable for babies with CMPA - Alternative for extensively hydrolyzedbased formulas - It is not advised for babies under 6 months due to the development of significant osteopenia in preterm infants fed soy formula - It is not generally recommended until 1 year - There are some theoretical concerns over soya milk as it contains phytoestrogens, which adversely affect human development, reproduction, or endocrine function Stage 3 [31] MCT formula - Suitable for babies with fat malabsorption problems - With a high intake of medium chain triglycerides (MCT, 55% of fat) - The addition of functional ingredients, such as omega 3 and 6 fatty acids (docosahexaenoic acid (DHA) and arachidonic acid (ARA)) Stage 1, 2 [32] Anti-reflux or pre-thickened formulas - Suitable for babies with reflux and GERD (gastroesophageal reflux disease) - The main gelling or thickening agent is carobel (e.g., carob bean gum) - Feed thickener reduces GERD by increasing the viscosity or “stickiness” of the liquid content, enabling the feed to be retained in the stomach - Formulas contain starch, vegetable fats, and 100% whey, with partially hydrolyzed protein to reduce reflux symptoms (e.g., regurgitation/spitting up) Stage 1, 2 [33] - Suitable for babies with cow’s milk protein allergy (CMPA) - Fully hydrolyzed protein - Amino acid-based formula - No residual protein Stage 1, 2, 3 [30] SOYA alternative milk formula Foods 2024, 13, x FOR PEER REVIEW 7 of 30 Hypoallergenic or elemental formula - Suitable for babies with cow’s milk protein allergy (CMPA) - Fully hydrolyzed protein - Amino acid-based formula - No residual protein Stage 1, 2, 3 [30] SOYA alternative milk formula - Suitable for babies with CMPA - Alternative for extensively hydrolyzedbased formulas - It is not advised for babies under 6 months due to the development of significant osteopenia in preterm infants fed soy formula - It is not generally recommended until 1 year - There are some theoretical concerns over soya milk as it contains phytoestrogens, which adversely affect human development, reproduction, or endocrine function Stage 3 [31] MCT formula - Suitable for babies with fat malabsorption problems - With a high intake of medium chain triglycerides (MCT, 55% of fat) - The addition of functional ingredients, such as omega 3 and 6 fatty acids (docosahexaenoic acid (DHA) and arachidonic acid (ARA)) Stage 1, 2 [32] Anti-reflux or pre-thickened formulas - Suitable for babies with reflux and GERD (gastroesophageal reflux disease) - The main gelling or thickening agent is carobel (e.g., carob bean gum) - Feed thickener reduces GERD by increasing the viscosity or “stickiness” of the liquid content, enabling the feed to be retained in the stomach - Formulas contain starch, vegetable fats, and 100% whey, with partially hydrolyzed protein to reduce reflux symptoms (e.g., regurgitation/spitting up) Stage 1, 2 [33] - Suitable for babies with CMPA - Alternative for extensively hydrolyzed-based formulas - It is not advised for babies under 6 months due to the development of significant osteopenia in preterm infants fed soy formula - It is not generally recommended until 1 year - There are some theoretical concerns over soya milk as it contains phytoestrogens, which adversely affect human development, reproduction, or endocrine function Stage 3 [31] Foods 2024,13, 2659 7 of 29 Table 1. Cont. Type of Infant/Baby Foods Infants’ Foods Available Features Stage Ref. MCT formula Foods 2024, 13, x FOR PEER REVIEW 7 of 30 Hypoallergenic or elemental formula - Suitable for babies with cow’s milk protein allergy (CMPA) - Fully hydrolyzed protein - Amino acid-based formula - No residual protein Stage 1, 2, 3 [30] SOYA alternative milk formula - Suitable for babies with CMPA - Alternative for extensively hydrolyzedbased formulas - It is not advised for babies under 6 months due to the development of significant osteopenia in preterm infants fed soy formula - It is not generally recommended until 1 year - There are some theoretical concerns over soya milk as it contains phytoestrogens, which adversely affect human development, reproduction, or endocrine function Stage 3 [31] MCT formula - Suitable for babies with fat malabsorption problems - With a high intake of medium chain triglycerides (MCT, 55% of fat) - The addition of functional ingredients, such as omega 3 and 6 fatty acids (docosahexaenoic acid (DHA) and arachidonic acid (ARA)) Stage 1, 2 [32] Anti-reflux or pre-thickened formulas - Suitable for babies with reflux and GERD (gastroesophageal reflux disease) - The main gelling or thickening agent is carobel (e.g., carob bean gum) - Feed thickener reduces GERD by increasing the viscosity or “stickiness” of the liquid content, enabling the feed to be retained in the stomach - Formulas contain starch, vegetable fats, and 100% whey, with partially hydrolyzed protein to reduce reflux symptoms (e.g., regurgitation/spitting up) Stage 1, 2 [33] - Suitable for babies with fat malabsorption problems - With a high intake of medium chain triglycerides (MCT, 55% of fat) - The addition of functional ingredients, such as omega 3 and 6 fatty acids (docosahexaenoic acid (DHA) and arachidonic acid (ARA)) Stage 1, 2 [32] Anti-reflux or pre-thickened formulas Foods 2024, 13, x FOR PEER REVIEW 7 of 30 Hypoallergenic or elemental formula - Suitable for babies with cow’s milk protein allergy (CMPA) - Fully hydrolyzed protein - Amino acid-based formula - No residual protein Stage 1, 2, 3 [30] SOYA alternative milk formula - Suitable for babies with CMPA - Alternative for extensively hydrolyzedbased formulas - It is not advised for babies under 6 months due to the development of significant osteopenia in preterm infants fed soy formula - It is not generally recommended until 1 year - There are some theoretical concerns over soya milk as it contains phytoestrogens, which adversely affect human development, reproduction, or endocrine function Stage 3 [31] MCT formula - Suitable for babies with fat malabsorption problems - With a high intake of medium chain triglycerides (MCT, 55% of fat) - The addition of functional ingredients, such as omega 3 and 6 fatty acids (docosahexaenoic acid (DHA) and arachidonic acid (ARA)) Stage 1, 2 [32] Anti-reflux or pre-thickened formulas - Suitable for babies with reflux and GERD (gastroesophageal reflux disease) - The main gelling or thickening agent is carobel (e.g., carob bean gum) - Feed thickener reduces GERD by increasing the viscosity or “stickiness” of the liquid content, enabling the feed to be retained in the stomach - Formulas contain starch, vegetable fats, and 100% whey, with partially hydrolyzed protein to reduce reflux symptoms (e.g., regurgitation/spitting up) Stage 1, 2 [33] - Suitable for babies with reflux and GERD (gastroesophageal reflux disease) - The main gelling or thickening agent is carobel (e.g., carob bean gum) - Feed thickener reduces GERD by increasing the viscosity or “stickiness” of the liquid content, enabling the feed to be retained in the stomach - Formulas contain starch, vegetable fats, and 100% whey, with partially hydrolyzed protein to reduce reflux symptoms (e.g., regurgitation/spitting up) Stage 1, 2 [33] Probiotic infant formula Foods 2024, 13, x FOR PEER REVIEW 8 of 30 Probiotic infant formula - Newborns’ gut microbiota is dominated by Bifidobacterium and Lactobacillus - Probiotics improve digestion, increase natural resistance to infectious intestinal diseases, enhance immunity, reduce cancer risks, improve nutrient synthesis and bioavailability, prevent allergies, protect the mucosa from pathogen colonization, and balance the intestinal microbiota - PIFM supplemented with probiotics at levels of 102 to 105 CFU/g modulates their immune systems in a similar manner to breast milk Stage 1, 2, 3 [34,35] PKU formula - Suitable for infants with phenylketonuria (PKU) - PKU children must follow a low-protein diet and avoid aspartame - PKU formula should be used along with breast milk or infant formula to provide the infant with phenylalanine, fluid, and general nutrition needs - Free of essential amino acid phenylalanine - Containing other essential and non-essential amino acids, fats, carbohydrates, vitamins, minerals, ARA, and DHA. - Several formulas contain glycomacropeptides - The levels of B vitamins for cofactor production are higher than in routine infant formulas Stage 1, 2, 3 [36] Puree meal (animal foods) - After the first stages of life, toddlersʹ feeding includes cheese and other dairy products, egg yolks, and meat as the main sources of fatty acids - High-quality protein sources should be offered to infants from 6 months, such as fish, yogurt, pureed meat, and eggs Stage 2, 3 [37] - Newborns’ gut microbiota is dominated by Bifidobacterium and Lactobacillus - Probiotics improve digestion, increase natural resistance to infectious intestinal diseases, enhance immunity, reduce cancer risks, improve nutrient synthesis and bioavailability, prevent allergies, protect the mucosa from pathogen colonization, and balance the intestinal microbiota - PIFM supplemented with probiotics at levels of 102to 105CFU/g modulates their immune systems in a similar manner to breast milk Stage 1, 2, 3 [34,35] PKU formula Foods 2024, 13, x FOR PEER REVIEW 8 of 30 Probiotic infant formula - Newborns’ gut microbiota is dominated by Bifidobacterium and Lactobacillus - Probiotics improve digestion, increase natural resistance to infectious intestinal diseases, enhance immunity, reduce cancer risks, improve nutrient synthesis and bioavailability, prevent allergies, protect the mucosa from pathogen colonization, and balance the intestinal microbiota - PIFM supplemented with probiotics at levels of 102 to 105 CFU/g modulates their immune systems in a similar manner to breast milk Stage 1, 2, 3 [34,35] PKU formula - Suitable for infants with phenylketonuria (PKU) - PKU children must follow a low-protein diet and avoid aspartame - PKU formula should be used along with breast milk or infant formula to provide the infant with phenylalanine, fluid, and general nutrition needs - Free of essential amino acid phenylalanine - Containing other essential and non-essential amino acids, fats, carbohydrates, vitamins, minerals, ARA, and DHA. - Several formulas contain glycomacropeptides - The levels of B vitamins for cofactor production are higher than in routine infant formulas Stage 1, 2, 3 [36] Puree meal (animal foods) - After the first stages of life, toddlersʹ feeding includes cheese and other dairy products, egg yolks, and meat as the main sources of fatty acids - High-quality protein sources should be offered to infants from 6 months, such as fish, yogurt, pureed meat, and eggs Stage 2, 3 [37] - Suitable for infants with phenylketonuria (PKU) - PKU children must follow a low-protein diet and avoid aspartame - PKU formula should be used along with breast milk or infant formula to provide the infant with phenylalanine, fluid, and general nutrition needs - Free of essential amino acid phenylalanine - Containing other essential and non-essential amino acids, fats, carbohydrates, vitamins, minerals, ARA, and DHA. - Several formulas contain glycomacropeptides - The levels of B vitamins for cofactor production are higher than in routine infant formulas Stage 1, 2, 3 [36] Foods 2024,13, 2659 8 of 29 Table 1. Cont. Type of Infant/Baby Foods Infants’ Foods Available Features Stage Ref. Puree meal (animal foods) Foods 2024, 13, x FOR PEER REVIEW 8 of 30 Probiotic infant formula - Newborns’ gut microbiota is dominated by Bifidobacterium and Lactobacillus - Probiotics improve digestion, increase natural resistance to infectious intestinal diseases, enhance immunity, reduce cancer risks, improve nutrient synthesis and bioavailability, prevent allergies, protect the mucosa from pathogen colonization, and balance the intestinal microbiota - PIFM supplemented with probiotics at levels of 102 to 105 CFU/g modulates their immune systems in a similar manner to breast milk Stage 1, 2, 3 [34,35] PKU formula - Suitable for infants with phenylketonuria (PKU) - PKU children must follow a low-protein diet and avoid aspartame - PKU formula should be used along with breast milk or infant formula to provide the infant with phenylalanine, fluid, and general nutrition needs - Free of essential amino acid phenylalanine - Containing other essential and non-essential amino acids, fats, carbohydrates, vitamins, minerals, ARA, and DHA. - Several formulas contain glycomacropeptides - The levels of B vitamins for cofactor production are higher than in routine infant formulas Stage 1, 2, 3 [36] Puree meal (animal foods) - After the first stages of life, toddlersʹ feeding includes cheese and other dairy products, egg yolks, and meat as the main sources of fatty acids - High-quality protein sources should be offered to infants from 6 months, such as fish, yogurt, pureed meat, and eggs Stage 2, 3 [37] - After the first stages of life, toddlers’ feeding includes cheese and other dairy products, egg yolks, and meat as the main sources of fatty acids - High-quality protein sources should be offered to infants from 6 months, such as fish, yogurt, pureed meat, and eggs Stage 2, 3 [37] Organic infant formula Foods 2024, 13, x FOR PEER REVIEW 9 of 30 Organic infant formula - Removing certain ingredients (e.g., palm oil, refined sugars, carrageenan, DHA, and ARA extracted using hexane), synthetic preservatives, and artificially synthesized or chemically extracted nutrients (e.g., lycopene, lutein, nucleotides, taurine, L-methionine, and L-carnitine) Stage 1, 2, 3 [38] Complementary foods: cereal/ porridge - The range of products includes rehydration-ready powders, RTS (thermally sterilized) purees formulated with cereals, dates, honey, bananas, and biscuits, as well as organic fruit and cereals. - By enzymatic dextrinization, these products promote better nutrient absorption by adapting cereal composition to infant digestion - The first stage of semisolids begins with digestible cereals, primarily rice - A puree made from whole grains (wheat, rice, barley, oats) is a good source of carbohydrates, fiber, iron, folate, and B vitamins - A porridge contains 5–8 cereals (wheat, millet, sorghum, rice, oats, barley, and rye) to deliver high nutritional value, high in fiber, calcium, and iron, and high in dextrinization (88% to 90%) - High biological value proteins, including a mixture of quinoa, cereals, and fruits rich in vitamins A, K, D, E, C, B 1 , B 2 , B 6 , biotin, folic acid, and B 12 Stage 2, 3 [39] Complementary foods: fruit/vegetable puree - By the age of 6 months, children are introduced to additional carbohydrate sources via pulses, fruits and vegetables, and grains - The most popular vegetable puree includes (e.g., spinach, peas, carrot, tomato sweet potato, corn, pumpkin, broccoli puree) - Fruit purees with or whit out particles (e.g., apple, banana, strawberry, mango, passion fruit, blueberry, peach) - The WHO bans added sugars in these products for children under 36 months of age Stage 2,3 [40] - Removing certain ingredients (e.g., palm oil, refined sugars, carrageenan, DHA, and ARA extracted using hexane), synthetic preservatives, and artificially synthesized or chemically extracted nutrients (e.g., lycopene, lutein, nucleotides, taurine, L-methionine, and L-carnitine) Stage 1, 2, 3 [38] Complementary foods: cereal/ porridge Foods 2024, 13, x FOR PEER REVIEW 9 of 30 Organic infant formula - Removing certain ingredients (e.g., palm oil, refined sugars, carrageenan, DHA, and ARA extracted using hexane), synthetic preservatives, and artificially synthesized or chemically extracted nutrients (e.g., lycopene, lutein, nucleotides, taurine, L-methionine, and L-carnitine) Stage 1, 2, 3 [38] Complementary foods: cereal/ porridge - The range of products includes rehydration-ready powders, RTS (thermally sterilized) purees formulated with cereals, dates, honey, bananas, and biscuits, as well as organic fruit and cereals. - By enzymatic dextrinization, these products promote better nutrient absorption by adapting cereal composition to infant digestion - The first stage of semisolids begins with digestible cereals, primarily rice - A puree made from whole grains (wheat, rice, barley, oats) is a good source of carbohydrates, fiber, iron, folate, and B vitamins - A porridge contains 5–8 cereals (wheat, millet, sorghum, rice, oats, barley, and rye) to deliver high nutritional value, high in fiber, calcium, and iron, and high in dextrinization (88% to 90%) - High biological value proteins, including a mixture of quinoa, cereals, and fruits rich in vitamins A, K, D, E, C, B 1 , B 2 , B 6 , biotin, folic acid, and B 12 Stage 2, 3 [39] Complementary foods: fruit/vegetable puree - By the age of 6 months, children are introduced to additional carbohydrate sources via pulses, fruits and vegetables, and grains - The most popular vegetable puree includes (e.g., spinach, peas, carrot, tomato sweet potato, corn, pumpkin, broccoli puree) - Fruit purees with or whit out particles (e.g., apple, banana, strawberry, mango, passion fruit, blueberry, peach) - The WHO bans added sugars in these products for children under 36 months of age Stage 2,3 [40] - The range of products includes rehydration-ready powders, RTS (thermally sterilized) purees formulated with cereals, dates, honey, bananas, and biscuits, as well as organic fruit and cereals. - By enzymatic dextrinization, these products promote better nutrient absorption by adapting cereal composition to infant digestion - The first stage of semisolids begins with digestible cereals, primarily rice - A puree made from whole grains (wheat, rice, barley, oats) is a good source of carbohydrates, fiber, iron, folate, and B vitamins - A porridge contains 5–8 cereals (wheat, millet, sorghum, rice, oats, barley, and rye) to deliver high nutritional value, high in fiber, calcium, and iron, and high in dextrinization (88% to 90%) - High biological value proteins, including a mixture of quinoa, cereals, and fruits rich in vitamins A, K, D, E, C, B1, B2, B6, biotin, folic acid, and B12 Stage 2, 3 [39] Foods 2024,13, 2659 9 of 29 Table 1. Cont. Type of Infant/Baby Foods Infants’ Foods Available Features Stage Ref. Complementary foods: fruit/vegetable puree Foods 2024, 13, x FOR PEER REVIEW 9 of 30 Organic infant formula - Removing certain ingredients (e.g., palm oil, refined sugars, carrageenan, DHA, and ARA extracted using hexane), synthetic preservatives, and artificially synthesized or chemically extracted nutrients (e.g., lycopene, lutein, nucleotides, taurine, L-methionine, and L-carnitine) Stage 1, 2, 3 [38] Complementary foods: cereal/ porridge - The range of products includes rehydration-ready powders, RTS (thermally sterilized) purees formulated with cereals, dates, honey, bananas, and biscuits, as well as organic fruit and cereals. - By enzymatic dextrinization, these products promote better nutrient absorption by adapting cereal composition to infant digestion - The first stage of semisolids begins with digestible cereals, primarily rice - A puree made from whole grains (wheat, rice, barley, oats) is a good source of carbohydrates, fiber, iron, folate, and B vitamins - A porridge contains 5–8 cereals (wheat, millet, sorghum, rice, oats, barley, and rye) to deliver high nutritional value, high in fiber, calcium, and iron, and high in dextrinization (88% to 90%) - High biological value proteins, including a mixture of quinoa, cereals, and fruits rich in vitamins A, K, D, E, C, B 1 , B 2 , B 6 , biotin, folic acid, and B 12 Stage 2, 3 [39] Complementary foods: fruit/vegetable puree - By the age of 6 months, children are introduced to additional carbohydrate sources via pulses, fruits and vegetables, and grains - The most popular vegetable puree includes (e.g., spinach, peas, carrot, tomato sweet potato, corn, pumpkin, broccoli puree) - Fruit purees with or whit out particles (e.g., apple, banana, strawberry, mango, passion fruit, blueberry, peach) - The WHO bans added sugars in these products for children under 36 months of age Stage 2,3 [40] - By the age of 6 months, children are introduced to additional carbohydrate sources via pulses, fruits and vegetables, and grains - The most popular vegetable puree includes (e.g., spinach, peas, carrot, tomato sweet potato, corn, pumpkin, broccoli puree) - Fruit purees with or whit out particles (e.g., apple, banana, strawberry, mango, passion fruit, blueberry, peach) - The WHO bans added sugars in these products for children under 36 months of age Stage 2,3 [40] Baby water Foods 2024, 13, x FOR PEER REVIEW 10 of 30 Baby water - Purified water: filtered water, with impurities removed - Suitable water for drinking when babies get older - Distilled water: made by boiling purified water and collecting steam - Distilled water is the cleanest and purest water available - This water is completely free of everything, even natural minerals such as calcium and magnesium are also removed during the process - Mineral and spring water: water derived from a spring or underground source contains naturally dissolved minerals (at least 250 ppm), including potassium, calcium, and iron Stage 1, 2, 3 [41] 2.2. Complementary Foods Complementary feeding, as defined by the WHO, is “a process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk” [42]. This process, which includes continued breastfeeding, typically occurs between 6 to 23 months of age [43]. Commercial complementary food products are formulated to provide essential micronutrients and macronutrients needed during this stage. These products can be manufactured using simple techniques such as malting, popping, and fermentation, as well as modern food-processing technologies like roller drying, extrusion cooking, and non-thermal processing. Some of the most common commercially prepared IFs include iron-fortified cereals in varieties such as rice, oats, barley, wheat, mixed-grain, and grain with fruit. Additionally, there are juices, including those specifically for infants, citrus juice, canned juice, vegetable or fruit puree, and specially prepared meats for infant consumption [44]. 3. Assessment of Hazards and Safety Measures in Infant and Baby Foods The safety and quality of infant food are major concerns for parents and public health authorities [8]. Children are particularly vulnerable to foodborne illnesses, making the safety of food during processing, preparation, and handling critical to their health. There are three main types of hazards in foods that contribute to outbreaks: biological, physical, and chemical. These hazards are discussed in detail below: 3.1. Microbial Hazards The nutrient content of infant and child foods makes them excellent growth media for bacteria. Therefore, any pathogen that remains after processing or contamination can rapidly multiply under optimal conditions [10]. During 2004–2006, the FAO/WHO consultation group identified the most common microorganisms associated with contamination in infant food. These include Salmonella enteritidis, Cronobacter sp., Enterobacter agglomerans, Enterobacter cloacae, Klebsiella pneumoniae, Klebsiella oxytoca, Citrobacter freundii, Citrobacter koseri, Escherichia coli, Hafnia alvei, Acinetobacter sp., Serratia sp., Bacillus cereus, Clostridium botulinum, Clostridium perfringens, Clostridium difficile, Listeria monocytogenes, and Staphylococcus sp. Among these, Salmonella enterica and Cronobacter sp. were identified as the most concerning pathogens, falling under hazard category A [45,46]. - Purified water: filtered water, with impurities removed - Suitable water for drinking when babies get older - Distilled water: made by boiling purified water and collecting steam - Distilled water is the cleanest and purest water available - This water is completely free of everything, even natural minerals such as calcium and magnesium are also removed during the process - Mineral and spring water: water derived from a spring or underground source contains naturally dissolved minerals (at least 250 ppm), including potassium, calcium, and iron Stage 1, 2, 3 [41] 2.2. Complementary Foods Complementary feeding, as defined by the WHO, is “a process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk” [ 42 ]. This process, which includes continued breastfeeding, typically occurs between 6 to 23 months of age [ 43 ]. Commercial complementary food products are formulated to provide essential micronutrients and macronutrients needed during this stage. These products can be manufactured using simple techniques such as malting, popping, and fermentation, as well as modern food-processing technologies like roller drying, extrusion cooking, and non-thermal processing. Some of the most common commercially prepared IFs include iron-fortified cereals in varieties such as rice, oats, barley, wheat, mixed-grain, and grain with fruit. Additionally, there are juices, including those specifically for infants, citrus juice, canned juice, vegetable or fruit puree, and specially prepared meats for infant consumption [44]. 3. Assessment of Hazards and Safety Measures in Infant and Baby Foods The safety and quality of infant food are major concerns for parents and public health authorities [ 8 ]. Children are particularly vulnerable to foodborne illnesses, making the Foods 2024,13, 2659 16 of 29 static principle. Le Chatelier’s theory states that pressure-induced volume reduction alters structural characteristics, while the isostatic principle maintains that pressure is uniformly distributed and proportional in all fluid foods [ 117 , 118 ]. Industrially, this method is predominantly used for processing liquids and solids but is unsuitable for dried milk powder or cereals due to their low moisture content [119]. An HHP technology system involves injecting water into a high-performance cylinder, where foods to be treated are pre-packaged in a flexible material that transmits the water pressure. Solid food products are vacuum-sealed, while liquid food products use a headspace-free seal [ 116 ]. HHP processing technology allows for simultaneous control of three processing parameters—pressure, temperature, and time—offering significant process design flexibility [ 120 , 121 ]. This typically entails subjecting target food products to pressures of 400–600 MPa at temperature ranges of 45 ◦ C or refrigeration, with holding times of 1.5–6 min [48,122]. Unlike heat treatment, pressure treatment is not influenced by product size or geometry, leading to reduced processing times. Previous reports indicate that one of the key advantages of HHP for the IFs/BBF industry is a decrease in unwanted food processing contaminants and microbial populations [ 115 , 123 ]. A major mechanism for microbial inactivation involves the disruption of non-covalent bonds and damage to cytoplasmic ribosomes and cell membranes. HHP can induce several phenomena simultaneously (e.g., disruption of cell walls and membranes, chemical reactions, enzyme activation or inactivation, and protein modification, such as denaturation and gel formation), thereby influencing the overall microbial load [124,125]. High-pressure pasteurization effectively eliminates spoilage bacteria, yeasts, and molds but is ineffective against spores [ 25 ]. To enhance the sterilization and pasteurization processes, high pressures (600 MPa) combined with high temperatures (90–121 ◦ C) are used to inactivate spores, a method known as “high-pressure thermal sterilization” (HPTS) [ 126 , 127 ]. The combination of high pressure and high temperature produces a synergistic effect that reduces processing time, minimizes undesired food processing contaminants, improves food quality, and eliminates microorganisms [ 128 ]. In 2015, the FDA approved pressure-enhanced sterilization, allowing for sterilization temperatures below 121.1 ◦C at 600 MPa [129]. Numerous studies have demonstrated the effectiveness of HPP, either alone or in combination with other technologies, for processing various BFs. For instance, Kultur et al. [ 90 ] used HHP for the pasteurization of fruit purees for babies, achieving pathogen inactivation without generating chemical contaminants such as furan. HPP treatments were conducted at 25, 35, and 45 ◦ C, and pressures of 200, 300, and 400 MPa, for treatment durations of 5, 10, and 15 min. Significant reductions (around 6 log 10 ) in mesophilic aerophiles and yeasts/molds were achieved at 400 MPa and 45 ◦ C for 15 min without furan formation. Kultur et al. [ 91 ] also investigated the potential of HPP for inactivating total mesophilic aerobic bacteria, total yeasts and molds, and reducing furan formation in vegetable-based IFs. They highlighted the synergistic effects of processing parameters such as time, temperature, and pressure in microbial inactivation. The effectiveness of microbial reduction depended on the specific microorganism and the HPP conditions. For example, treatment at 400 MPa and 45 ◦ C for 15 min led to complete inactivation of all microorganisms, with no furan detected in any sample. The use of low temperatures in processing fruit and vegetable baby products helps preserve their sensory characteristics. Li et al. [92] evaluated the nutritional and functional properties of soy protein isolate for IFs using HHP treatment. They found that various functional attributes, such as solubility, water holding capacity, foaming capacity, and emulsification activity index, were enhanced at lower pressure and time levels but diminished at higher levels. Foaming stability decreased with increasing pressure and time, while the emulsification stability index decreased with higher pressure. Soy protein isolate gels exhibited improvements in springiness, hardness, and adhesive force with longer treatment times and increased Foods 2024,13, 2659 17 of 29 pressure, although these improvements were less pronounced than those observed in the control group. Furthermore, HHP induced conformational changes in the tertiary and/or quaternary structure of soy protein isolate [93]. Bu and Li [ 130 ] reported that the HHP-treated sample exhibited a higher swallowing response and greater in vitro digestibility compared to the control. Gel electrophoresis indicated that glycinin was more stable under pressure than β -conglycinin, and high molecular weight subunits were formed through disulfide interactions at higher treatment levels. In another study, Cetin-Karaca et al. [ 131 ] combined high pressure with transcinnamaldehyde to assess the effectiveness of HPP in deactivating B. cereus spores in reconstituted powdered infant formula milk (RPIFM) under optimal conditions (5 min at 600 MPa). The products were then stored at 23 ◦ C and 7 ◦ C for 4 and 6 weeks, respectively. The combined method demonstrated significant antimicrobial activity by eliminating vegetative cells and B. cereus spores in infant foods stored at room temperature and under refrigeration. HPP at 600 MPa reduced pathogen populations by two logs and combining HPP with 0.1% trans-cinnamaldehyde resulted in a three-log reduction. Long-term storage of RPIFM at room temperature led to decreased pH and increased microbial growth. The combination of HPP and trans-cinnamaldehyde was considered a robust antimicrobial alternative to thermal treatments and artificial preservatives. Cetin-Karaca et al. [ 94 ] found that a combination of HPP at 600 MPa for 5 min, 0.05% trans-cinnamaldehyde, and 1% chitosan, with storage temperatures of 7, 23, and 45 ◦C, led to the complete elimination of Cronobacter sakazakii after 4, 6, and 2 weeks, respectively. In all HPP treatments, the colonyforming units per milliliter (CFU/mL) decreased by at least 5.5 logs CFU/mL, compared to maximum reductions of 2.1, 1.1, and 3.7 logs CFU/mL without HPP treatments at 7, 23, and 45 ◦ C. Moreover, sensory testing did not reveal a significant difference between the treatment group and the control group. It has been documented that thermal processing and high-pressure thermal processing (HPTP) of pear purees, with or without citric acid, can inhibit oxidative enzymes such as peroxidase (POD) and polyphenol oxidase (PPO), while also improving their sensory properties [ 95 ]. Following HPTP treatment (600 MPa, 90 ◦ C, 5 min) and thermal processing treatment (90 ◦ C, 7 min) in acidified puree, POD was completely deactivated, whereas PPO was deactivated to a maximum of 60%. Therefore, pear puree treated with HP and HPTP was considered a suitable candidate for use in baby formulas due to its low pH, high antioxidant capacity, and reduced activity of oxidative enzymes. Sevenich et al. [ 97 ] investigated the potential benefits of HPTS in the food industry, emphasizing its capacity to enhance food quality, diminish thermal impact, and lower the presence of undesired food processing contaminants such as furan. The study conducted laboratory-scale trials on specific food items to establish temperature–time combinations for achieving a 12 log 10 inactivation of Bacillus amyloliquefaciens. These combinations were then applied in a scale-up process using a 55 L vessel equipped with a high-pressure, hightemperature system. The results demonstrated a significant decrease in furan levels, ranging from 41 to 98% compared to conventional retorting methods. Pilot-scale experiments confirmed these findings, with only one food product exhibiting instability after treatment. Additionally, storage trials (standardized method NF V 08-408) revealed that only two selected treatment conditions (107.5 ◦ C, 9.8 min and 115 ◦ C, 0.45 min at 600 MPa) resulted in an unstable product, specifically in the case of baby food puree. In conclusion, the study suggested that HPTS holds promise as a viable option for adoption within the food industry. Gratz et al. [ 98 ] evaluated the effects of pressure-enhanced sterilization (PES) and ohmic (OH) technologies as alternatives to thermal retorting. Their goal was to enhance the quality of carrot puree for infant consumption by identifying optimal food safety process parameters. Both methods were found to reduce the thermal load on the product without compromising food safety or quality. This technology was observed to heat puree samples more rapidly and uniformly compared to conventional retorts, leading to lower C values. Additionally, PES treatments, besides their synergistic inactivation effect of temperature Foods 2024,13, 2659 18 of 29 and high pressure, resulted in lower C values by lowering the processing temperature. As a result, color, bioactive compounds like carotenoids, and texture were better preserved, while food processing contaminants, particularly furan and its derivatives, were reduced. Wang et al. [ 99 ] investigated the application of pressure-assisted thermal sterilization (PATS) to sterilize BFs, which offer higher nutritional value compared to products processed using conventional thermal methods. Their study focused on sterilizing BFs inoculated with B. subtilis spores using the PATS technique. The results indicated that the combination of temperature and thermal expansion pressure had a synergistic effect on microbial elimination, leading to significant reductions in B. subtilis levels and improved retention of ascorbic acid. 5.2. Radio Frequency (RF) Technology Radio Frequency (RF) technology utilizes electromagnetic waves in the frequency range of 1 to 300 MHz. In RF heating, electromagnetic waves penetrate the food product, causing polar molecules (such as water) to oscillate and generate heat through molecular friction. The rapid and volumetric heating ensures uniform temperature distribution, which is particularly beneficial for foods with high moisture content. Key operational parameters include frequency (typically 13.56 or 27.12 MHz for food applications), power (adjustable depending on the food’s dielectric properties), and treatment time (from seconds to minutes). RF heating is primarily used for pasteurization, sterilization, drying, and thawing, providing rapid and uniform heating with minimal quality degradation [ 105 , 132 ]. In RF heating units (RF-H), electrodes do not directly contact the food to prevent Joule heating (OH heating). This technology is suitable for both solids and liquids due to its deep penetration capacity and rapid heating speed [ 133 ]. Numerous studies have demonstrated the successful use of RF heating for pasteurizing/sterilizing liquid or semi-liquid IFs. A recent experimental study by Lin et al. [ 103 ] confirmed the effectiveness of RF-enhanced traditional thermal processing (RF-assisted TTP) for pasteurizing PIFM. In this study, RF energy was applied to a tray containing PIFM, resulting in a cold spot observed in the center of the top layer. The RF treatment was used after inoculating the sample with C. sakazakii to heat it until the cold spot reached 65 ◦ C at 27.12 MHz and 6 kW. Subsequently, the samples were held at 65 ◦ C in a hot air oven for varying times. Following RF-assisted TTP at 65 ◦ C for 21 h, C. sakazakii was reduced by approximately 5 logs. Qualitative analysis revealed no significant differences in solubility, wettability, digestibility, and color parameters between RF-assisted TTP and TTP. However, both treatments led to significant changes in moisture content, water activity, TBARS, and peroxide value. Another study aimed to develop radio frequency dielectric heating (RFDH) processes to eliminate Salmonella spp. and C. sakazakii in contaminated nonfat dry milk (NDM) intended for infants [ 104 ]. They used a thermal death time (TDT) disk process to estimate the D-values (time required for a one-log reduction) of Salmonella spp. and C. sakazakii in NDM (low-heat: LH; high-heat: HH) at temperatures of 75, 80, 85, or 90 ◦ C, and calculated the z-values (temperature increase required for a tenfold reduction in D-value). For C. sakazakii, D-values ranged from 5.37 to 24.86 min at different temperatures, while for Salmonella spp., D-values ranged from 4.55 to 24.94 min. The study found that both pathogens were inactivated similarly regardless of the treatment method (RFDH vs. conventional). This suggests that RFDH treatment could be used to achieve target temperatures for post-treatment lethality in NDM before packaging, in a high-speed and uniform manner, thereby reducing the risk of food safety issues. Zhang, Zhu et al. [ 105 ] compared the effects of combined radio frequency and hot air treatment (RF-HA) with hot water treatment (HW) on the quality of PIFM for inactivating C. sakazakii by 5 log. Both heat treatment methods showed no significant differences in solubility or crude protein content. However, the increase in moisture content to 2.70 g/100 g (aw: 0.4) resulted in a significant decrease in the glass transition temperature of amorphous lactose, compromising the quality of PIFM. Lowering the moisture content in PIFM subjected to RF-HA treatment increased protein denaturation temperatures, Foods 2024,13, 2659 19 of 29 leading to more stable protein structures. Additionally, RF-HA treatment induced less non-enzymatic browning compared to HW-treated samples. This was further supported by FTIR spectra, which indicated a lower rate of the Maillard reaction in samples treated with RF-HA. Moreover, RF had a significant effect on particle agglomeration in PIFM compared to conventional HW treatment. In a study by Zhang, Xie et al. [ 106 ] a thermostatic RF system was used to deactivate C. sakazakii in PIFM. A proportional–integral–derivative controller was employed to maintain constant material temperature during holding. Similar to previous studies, dielectric material assistance and hot air were utilized to enhance RF heating uniformity. Results showed that the thermal resistance of C. sakazakii decreased with increasing water activity (0.2–0.4 at 25 ◦ C) and temperature (55–70 ◦ C). Combining RF with hot air pasteurization improved microbial inactivation compared to RF or material assistance alone, attributed to better temperature uniformity. Transmission electron microscopy (TEM) analyses and flow cytometry confirmed that RF treatment did not significantly affect the cell wall. RF processing has been shown to achieve significantly higher heating rates than traditional methods, making it a promising technique for pasteurizing PIFM efficiently. Another study by Wang et al. [ 107 ] evaluated the thermal death kinetics of C. sakazakii in PIFM using RF and hot water treatment. The research demonstrated that RF technology effectively disables C. sakazakii in packaged powdered IFs while maintaining product quality. Lin et al. [ 108 ] studied the dielectric properties of packaging materials for PIFM to improve in-package pasteurization using RF and microwave heating (MWH). They investigated how temperature (20–80 ◦ C), frequency (10 MHz–3 GHz), and main components (moisture, whey protein, fat, and lactose) influenced these properties. Results indicated that the loss factor and dielectric constant decreased with higher frequency, while the dielectric loss factor decreased with increased density, temperature, and fat content. The dielectric constant increased with density and main components. Lactose and whey protein exhibited positive dielectric properties due to ionic conduction, while fat had negative dielectric properties due to weak polar attraction. In another study, Zhong et al. [ 109 ] evaluated the impact of radio frequency heating (RFH; 90 ◦ C, 5 and 10 min) on the microstructure, composition (fat distribution, protein oxidation), rehydration characteristics, and flow properties of PIFM. RFH treatment increased protein dityrosine concentration, free fat on powder surfaces, and powder porosity. Additionally, RFH improved flow ability and compressibility compared to the raw sample, although longer durations decreased rehydration ability, indicating lower solubility and smaller contact angles. The Guggenheim–Anderson–de Boer (GAB) model characterized water vapor sorption isotherms, showing that prolonged RFH duration increased C values (63% at 10 min). Recently, Lin et al. [ 103 ] investigated the dielectric properties of PIFM, focusing on dipole loss (fat, lactose, and whey protein) and ionic loss at temperatures and frequencies ranging from 20–80 ◦ C and 10 to 3000 MHz, respectively. They observed that the dielectric loss factor of PIFM increased with higher lactose and whey protein content but decreased with higher fat content. The ionic loss in PIFM increased with temperature but remained constant with frequency. Moreover, lactose, fat, and whey protein dipole loss followed the Debye equation, showing an increase with frequency up to approximately 1, 1, and 1.2 GHz, respectively, before declining. Increasing the whey protein content in reconstituted PIFM led to higher heating rates in RF fields and reduced lipid oxidation in processed PIFM. PIFM can become sticky under unfavorable processing conditions, leading to negative impacts on its physicochemical and functional properties [ 134 ]. Zhang et al. [ 111 ] investigated the effect of RF dry heat treatment on PIFM stickiness. Spray-dried PIFM with a water activity of 0.28 was treated at 70 ◦ C for 0–5 log inactivation of C. sakazakii for varying durations. The RF treatments significantly reduced water activity compared to untreated samples, with minimal changes in surface-free fat content (0.005–0.006 g/g powder) and lactose crystallinity (2–3%). The particle size of PIFM increased significantly initially and then stabilized after 23.3 min, indicating particle sticking occurred during the first pasteurization step. While a visible adhesion and flow of hot surface fat were observed Foods 2024,13, 2659 20 of 29 during the 23.3 min pasteurization, the fat coverage decreased with longer treatment times. Additionally, the increased surface lactose coverage in treated PIFM reduced their water activity, affecting the glass transition. The study concluded that the enhancement in particle size after RF processing was due to free fat bridges on the particle surface, suggesting that RF technology can improve particle quality post-processing. 5.3. Ultrasound (US) Technology Ultrasound technology (US), a non-invasive and non-destructive technique, has gained significant attention in the food industry for its diverse applications. US processing employs high-frequency sound waves, typically above 20 kHz, to develop cavitation in liquid foods. This process generates localized high temperatures and pressures that disrupt microbial cell walls and enhance mass transfer. Key operational parameters include frequency (20 kHz–1 MHz), intensity (W/L), and duration (ranging from seconds to minutes). Lower frequencies are generally used for microbial control, while higher frequencies are applied for homogenization and emulsification [ 135 , 136 ]. This technology can modify the chemical, physical, and functional properties of food, thereby impacting its overall quality [ 137 ]. This phenomenon is attributed to cavitation in liquids, pressure changes in gases, and movement of liquids in solids [ 138 ]. In food processing, the US finds utility in process control, defect detection, property analysis, extraction efficiency improvement, drying, filtration, preservation, and meat tenderization [136,137]. Several studies have investigated the use of US technology in IFs and BFs. For example, Adekunte et al. [ 112 ] studied the quantitative impact of US as an alternative heating method for monitoring the inactivation kinetics of C. sakazakii in RPIFM. The optimization involved varying the amplitude (24.4, 30.5, 42.7, 54.9, and 61 m) and temperature (25 ◦ C, 35 ◦ C, and 50 ◦ C), and the kinetics were analyzed using a modified Bigelow-type model. The combined use of US and temperature led to a significant reduction in the population of C. sakazakii. In another study, the effectiveness of US and conventional pasteurization methods in inactivating enzymes and microbes in pear juice for use in BFs was compared [ 22 ]. US was most effective at 25, 45, and 65 ◦ C with 750 W power, a 20 kHz frequency, and 70% amplitude for 10 min. In contrast, conventional pasteurization required 95 ◦ C for 2 min and 65 ◦ C for 10 min. US pasteurization resulted in greater inactivation of microbes (yeast, mold, and total plate count) and enzymes at a lower temperature (65 ◦ C for 10 min). Additionally, compared to conventional methods (95 ◦ C for 2 min), the use of US retained more phenolic compounds. Using sonication has been reported to tenderize meat by reducing myofibrillar proteins in muscle tissue and improving cohesion and water-holding capacity [ 139 ]. In a study by Luo et al. [ 113 ], US was investigated as a pretreatment method for raw meat to prepare infant meat puree at different power levels (200 W, 400 W, and 600 W, and 20 kHz) and durations (15, 30, and 45 min). Compared to the control, using US power at 400 W and 600 W resulted in decreased viscosity and hardness, and improved texture (firmer texture and higher water content) of the meat puree. Moreover, no significant difference in the digestibility of the meat puree in the gastric phase was observed, while the digestibility in the intestinal phase increased (80.85%) using US (600 W for 15 min). 5.4. Pulsed Electric Field (PEF) Technology Pulsed electric field (PEF) is a non-thermal food preservation technology that involves applying short, high-voltage pulses to food products placed between two electrodes. These pulses induce an electric field that disrupts cell membranes through electroporation, leading to microbial inactivation. Operational parameters include voltage (typically 1 to 100 kV/cm), pulse duration (from microseconds to milliseconds), and the number of pulses (from hundreds to thousands). These parameters can be adjusted to optimize microbial inactivation while preserving food quality and nutrients [ 140 ]. Reversible permeabilization refers to the temporary opening of cell membranes, allowing for the extraction of intracellular compounds such as pigments, flavors, and nutrients. This process is often Foods 2024,13, 2659 21 of 29 used in the food industry to improve the extraction efficiency of valuable components from plant and microbial cells [ 141 ]. Irreversible permeabilization, on the other hand, involves the permanent disruption of cell membranes, leading to cell death. This aspect of PEF is utilized for microbial inactivation in foods, extending their shelf life while maintaining their nutritional and sensory qualities [ 142 ]. Microbial cells are destroyed by creating irreversible pores in the membrane, inducing permeabilization and structural changes in the membrane, which may enhance the mass transfer process through the membrane and result in the release of intracellular contents and the deactivation of microorganisms [ 143 ]. Several studies have evaluated the possibility of using PEF processing to improve the shelf life stability of IFs and BFs. In a study conducted by Pina-Pérez et al. [ 101 ], the effect of PEF processing at different treatment times (60 to 3895 µ s) and field strengths (10 to 40 kV/cm) on the inactivation of C. sakazakii suspended in buffered peptone water (BPW) and PIFM was investigated. They observed a 2.7 log 10 (CFU/mL) reduction in C. sakazakii inoculated in BPW after PEF treatment for 360 µ s (2.5 µ s pulse width) at 40 kV/cm. In PIFM, PEF processing under the same conditions resulted in a 1.2 log (CFU/mL) reduction of C. sakazakii. Higher bacteria inactivation was observed in both substrates with greater field strength and treatment time. PEF processing was suggested as a promising technique to improve the safety of reconstituted IFs before storage in the refrigerator in hospitals. Another study examined the potential cell damage of PEF processing (15 and 35 kV/cm with minimum, medium, and maximum input energy) to C. sakazakii inoculated in different commercial infant formula milk products [ 101 ]. The growth of survivors and the potential presence, recovery, or death of sublethally damaged cells were assessed during a 24-h refrigerated storage period at 8 ◦ C. The utilization of PEF treatment resulted in significant damage to a large percentage (80–90%) of C. sakazakii cells, making them susceptible to subsequent refrigerated storage in infant formula milk. The most substantial reduction (2.30 log cycles) in C. sakazakii was observed with a 15 kV/cm 3000 µ s PEF treatment followed by storage at 8 ◦ C for 24 h. The reduction in cell count was mainly due to the PEF treatment, along with the formation and subsequent death of damaged cells during the refrigerated storage period. Pina-Pérez et al. [ 102 ] investigated the synergistic effect of polyphenol-rich cocoa powder (CocoanOX 12%: CCX) and PEF processing on the deactivation of C. sakazakii in IFs. The study evaluated different concentrations of cocoa powder (1%, 2.5%, and 5% w/v) and the timing of cocoa powder addition (0, 2, and 4 h) before and after PEF treatment (at 15, 25, and 35 kV/cm). The goal was to assess the impact of these variables on the deactivation of C. sakazakii and the subsequent changes in the treated cells during refrigerated conditions (8 ◦ C, 12 h). The results indicated that the combined application of PEF and CCX, along with the timing of CCX addition, significantly influenced the deactivation of C. sakazakii and the subsequent changes in the treated cells during refrigerated storage. The highest level of deactivation (4.41 log 10 cycles) was achieved when CCX was added 4 h after PEF treatment (15 kV/cm for 3000 µs), followed by storage at 8 ◦C for 12 h. A qualitative study was carried out by Nielsen et al. [ 144 ] to assess consumers’ attitudes towards novel processing technologies like PEF and HPP, and their impact on BFs. The findings indicated that participants generally held favorable views of these technologies. They perceived PEFand HPP-treated products as more natural, nutritionally rich, tastier, and environmentally friendly. However, concerns regarding insufficient information about the technologies, skepticism, health considerations, and higher product costs were identified as the main drawbacks associated with PEFand HPP-treated products. 6. Regulatory Landscape of Non-Thermal Processing Technologies The adoption of non-thermal processing technologies like US, PEF, HPP, and RF in food production is remarkably influenced by regional regulatory frameworks. These regulations assess the approval, implementation, and labeling of foods processed with these emerging technologies. In the United States, the FDA plays a central role in regulating non-thermal technologies. For instance, HPP has gained notable traction and regulatory acceptance for Foods 2024,13, 2659 22 of 29 utilization in various food categories, including BFs and IFs. The FDA requires detailed evidence of safety and efficacy, predominantly concerning microbial inactivation and nutritional quality preservation. Any process must comply with the FDA Food Safety Modernization Act (FSMA), ensuring that foods produced by non-thermal techniques meet stringent safety standards [ 145 , 146 ]. In Europe, the EFSA oversees the regulation of non-thermal technologies. This EU-funded agency evaluates new processing methods under the Novel Foods Regulation, requiring comprehensive safety assessments. Some of these technologies, like HPP and PEF, are generally recognized, provided that safety and quality are maintained without introducing harmful byproducts. However, EFSA demands robust scientific evidence to demonstrate the safety of any food processed using these methods, mainly when intended for vulnerable populations like infants [ 145 ]. In regions such as Asia and South America, the regulatory landscape is more variable. Countries like Japan and South Korea have well-defined regulations that increasingly accommodate non-thermal technologies, driven by consumer demand for minimally processed foods. In contrast, in many developing countries, the regulatory frameworks are either still evolving or lack specific guidelines for non-thermal methods. As a result, the commercialization of these technologies in certain regions can be hindered due to some reasons such as including high initial investment requirements, restricted access to reliable electricity and clean water, variations in food regulations across different countries, as well as unclear regulatory pathways and inconsistent enforcement [ 147 ]. These differences in the available regulations to apply non-thermal technologies in processing food products show the importance of establishing internationally harmonized standards to promote the global acceptance and implementation of non-thermal processing technologies in the food industry. 7. Conclusions and Future Trends Several studies have demonstrated the efficacy of non-thermal processing technologies, such as high hydrostatic pressure, radio frequency, ultrasound, and pulsed electric field, in deactivating key pathogens in infant and baby products, while also reducing the formation of harmful compounds like furans. Some of these methods, particularly when combined with mild heat treatments, have shown more significant potential than when used individually. However, it is important to note that certain non-thermal technologies, such as pulsed light, supercritical fluid, microfluidization, and plasma technology, remain relatively underexplored in the context of IFs and BFs. Additionally, most research in this area has been conducted at the laboratory or pilot plant level, where conditions may differ significantly from industrial-scale production, including variations in temperature, time, pressure, and the mass or volume of food products. Validation procedures for legal acceptance and advancements in packaging technologies are also crucial considerations. Furthermore, establishing standardized definitions and labeling conventions for infant foods processed with these technologies is essential to ensure clarity and foster consumer trust. Overall, continued research and development in this area are needed to optimize the application of non-thermal processing methods in the production of safe, nutritious, and high-quality IFs and BFs. Author Contributions: All authors contributed to this paper’s different parts, including conceptualization, investigation, methodology, writing—original draft preparation, and writing—review and editing. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Data Availability Statement: This review article does not include any original data. We also acknowledge that there are cartoon faces depicted in two images. These cartoon faces are fictional and do not represent any real individuals. Therefore, no consent for publication was required for these images. Acknowledgments: S.M.T.G. would like to acknowledge the support of the Alexander von Humboldt Foundation for his Georg Forster Research Fellowship. Foods 2024,13, 2659 23 of 29 Conflicts of Interest: The authors declare no conflicts of interest. Abbreviations BFs Baby foods CAGR Compound annual growth rate FAO Food and agriculture organization FPCs Food processing contaminants FOF Follow-on formula FPC Food-processing contaminants FUF Follow-up formula HACCP Hazard analysis critical control point HHP High hydrostatic pressure HMF 5-hydroxymethyl-2-furfural HPP High-pressure processing HPTS High-pressure thermal sterilization IB Infant botulism IFs Infant formulas MWH Microwave heating OH Ohmic heating PATS Pressure assisted thermal sterilization PEF Pulsed electric field PFUF Powdered follow-up formulas PIF Powdered infant formula PIFM Powdered infant formula milk RDA Recommended dietary Allowance RF Radio frequency RPIFM Reconstituted powdered infant formula milk UHT Direct ultrahigh temperature US Ultrasound References 1. Fragkou, P.C.; Karaviti, D.; Zemlin, M.; Skevaki, C. 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