Background Breakfast cereals remain popular with UK children. Although they are eaten primarily at breakfast time, they are regularly consumed between meals, because they are quick and easy to prepare. However, many breakfast cereals contain high levels of sugar, based on total product weight - with some values exceeding one-third sugar. Regular consumption of high-sugar breakfast cereals is concerning in terms of dental and general health, due to their relationship with dental caries and excess energy intake, which can lead to obesity and its associated conditions, including type 2 diabetes and coronary heart disease. Aim To investigate oral and general health messages contained on breakfast cereal packaging of brands popular with UK children. Methods Nine of the most popular branded cereals available in the UK, marketed to children, were evaluated in this study. One breakfast cereal (Coco Pops) was examined in greater detail, using all branded and UK supermarket own brand versions; culminating in a total of 13 breakfast cereals included in the study. The content of the packaging was analysed with regard to their imagery, health claims and nutritional content. Results At the manufacturer's suggested portion size, 8 of the 13 cereals provided over one-half of the recommended daily sugar intake for a 4-6-year-old child. Moreover, the imagery of the portion size on the front of the packaging was misleading - manufacturer's recommended portion sizes were at least two thirds less than those depicted. Nutritional claims focused on 'vitamins', especially folic acid and minerals, notably 'iron'. 'Whole grains' and 'no artificial colours or flavours' were legitimate claims. Only two cereals did not use the voluntary front-of-pack labelling system, both of which were supermarket brands. Cartoon characters, royal endorsements and QR codes were used to promote the breakfast cereals. Conclusions Most of the breakfast cereals contained high sugar levels, and although marketers made legitimate claims about other nutritional constituents, these claims might mislead consumers into thinking the cereals are healthier than they are. Imagery of portion size was grossly misleading and gives cause for concern. Dental and other health professionals need to be aware of the high sugar content of these cereals and the marketing techniques that are used by their manufacturers when giving advice to children and their parents. It is crucial that these professionals keep up to date with current evidence-based healthy eating guidelines.
