Erythritol is a sugar alcohol about 70% as sweet as sugar. It occurs naturally in small amounts in some fruits and fermented foods; commercially it's produced by fermenting corn glucose. The FDA classifies erythritol as GRAS. It's been used as a sweetener in the US since 2001 and is the most common sugar alcohol in "keto" baking products and many monk-fruit blends (Lakanto, Swerve).
The 2023 Nature Medicine study by Hazen et al. put erythritol back on parents' radar. The study reported associations between elevated blood erythritol levels and a 2× higher risk of cardiovascular events (heart attack, stroke) in adults at high cardiovascular risk over a 3-year follow-up. The findings are observational, not causal — meaning the study can't tell whether erythritol is the cause or just a marker. The food industry pushed back hard; subsequent reviews (including a 2024 EFSA opinion) maintained the GRAS classification but called for more research. For kids, the relevant takeaway is: (1) cardiovascular endpoints don't translate cleanly to pediatric populations; (2) we don't yet have kid-specific data; (3) GI tolerance is the more immediate concern.
GI tolerance is where erythritol matters most for kids in practice. The FDA-recognized laxative threshold for adults is ~50g/day; for children it's proportionally much lower (~15–20g for a 50-lb child). A bowl of "sugar-free" cereal sweetened with a monk-fruit + erythritol blend can contain 5–8g — usually fine, but stacking multiple erythritol-sweetened snacks in the same day can trigger bloating, gas, or loose stools.
How to spot it on a label: "Erythritol," "E968," or sometimes bundled in brand names like "Truvia" (stevia + erythritol) or "Lakanto" (monk fruit + erythritol). Many "0g added sugar" baking mixes use erythritol as the primary bulk sweetener. If your kid is sensitive to sugar alcohols (which is common), prefer stevia, monk fruit, or allulose alone.