Updated Dietary Guidelines Now Include Infant and Toddler Nutrition Advice

For the first time in history, dietary recommendations for infants and children under the age of two were included in the updated Dietary Guidelines for Americans (DGAs) for 2020-2025. These guidelines were published on December 29, 2020 by the Departments of Agriculture (USDA) and Health and Human Services (HHS).

“These guidelines will help families, childcare providers, and healthcare professionals better understand the nutritional needs of the population which we know can have long health impacts,” Stephanie Hodges, MS, MPH, RD, registered dietitian and owner of TheNourishedPrinciples.com, tells Verywell. “Because the guidelines also inform federal nutrition programs, those implementing the programs will have a set of guidelines to follow for this population as well." 

Experts have already established that the nutritional choices during the first 1,000 days of a child’s life can have a profound impact on its risk of developing obesity and other chronic diseases. Now that recommendations for this population are included in the guidelines, an evidence-based foundation is available to support infants and young children. 

What Are The Dietary Guidelines for Americans?

Now more than ever before, nutrition advice is available at your fingertips. But whether the information you are getting is reliable or not is another story.

It is widely accepted that eating patterns can impact a person’s health and certain disease risk. To better understand which dietary patterns should be included or avoided, the Dietary Guidelines for Americans are developed and updated every five years, based on the most up-to-date and evidence-based information available. These guidelines can provide guidance to empower the public to make healthy dietary decisions and reduce their risk of obesity, heart disease, and other health conditions.

Since 18.5% of children ages two and up were obese in 2016 in the US, there is a clear need to offer similar guidance to those making nutrition decisions on behalf of infants and young children. 

Dietary Guidelines for Infants and Toddlers

The USDA suggests that infants be provided human milk exclusively for the first six months of life, along with supplemental vitamin D. Iron fortified infant formula should be offered when human milk is not available. 

Nutrient-dense foods should be introduced at around 6 months of age, but not before 4 months, as long as the selection is developmentally appropriate for the infant.

While families typically lean on pureed fruits and veggies as staples in an infant’s diet, the USDA now recommends including a wide variety of foods, with a focus on nutrients like iron, zinc, choline, and long chain polyunsaturated fatty acids. Food choices that contain many of these nutrients include eggs, meat, and poultry.

Sugar, including added sugars like honey and maple syrup, should be avoided during the first two years of life. 

Avoid Plant-Based Milks

According to the new guidelines, until 12 months old, babies should only drink human milk or fortified infant formula, along with small sips of water.

After 12 months of age, parents and caregivers can incorporate cow’s milk or fortified soy milk into a child's diet. 

Plant-based milk alternatives like oat, rice, coconut, cashew, hemp, and almond milks should not be used during the first year of life to replace human milk or infant formula. Unsweetened versions of these drinks may be provided in small amounts after 12 months, but should not replace cow’s milk or soy milk. Plant-based beverages other than soy milk do not help infants meet the dairy recommendations suggested by these guidelines.

Introduce Allergens to Infants

Food allergies are on the rise, and can be lethal in some cases. According to one recent study published in the Journal of the American Medical Association, an estimated 10.8% of American adults have a food allergy. Nearly half of food-allergic adults had at least one adult-onset food allergy, and 38% reported at least one food allergy-related emergency department visit in their lifetime.

Experts are now suggesting that early exposure to highly allergenic foods can reduce the risk of a person developing allergies. For the first time, these recommendations are included in the USDA's dietary guidelines.

Specific potentially-allergenic foods babies should be exposed to include:

• Peanuts
• Egg
• Cow milk products
• Tree nuts
• Wheat
• Crustacean shellfish
• Fish
• Soy

The guidelines “make the important recommendation to introduce infants to potentially allergenic foods along with other complementary foods,” Sherry Coleman-Collins, MS, RDN, a registered dietitian and Senior Manager of Marketing and Communications for the National Peanut Board, tells Verywell. The guidelines specifically dictate that “introducing peanut-containing foods in the first year reduces the risk that an infant will develop a food allergy to peanuts.” 

If an infant has severe eczema, an egg allergy, or both (conditions that increase the risk of peanut allergy), the guidelines advise that age-appropriate, peanut-containing foods should be introduced into the diet as early as age 4 to 6 months, including peanut “puffs” or a bit of watered down creamy peanut butter mixed with baby food or breast milk. This can reduce the risk of developing peanut allergy. 

Practical Tips For Feeding Infants and Toddlers In Accordance with The Dietary Guidelines

Introducing solids can be a fun experience, but can also be nerve-wracking if you don’t have any guidance. The first step is to make sure that the baby is developmentally ready to eat solid food, meaning the baby is:

• Able to control their head and neck independently
• Sitting up alone or with support
• Bringing objects to their mouth 
• Trying to grasp small objects, such as toys or food 
• No longer having the tongue-thrust reflex and is actively swallowing food 
• Showing interest in food

Foods that are choking hazards should not be provided, including whole grapes, whole peanuts, and popcorn.

Once safety is established, the following can help guide you on your baby’s feeding journey:

• Add a couple of teaspoons of powdered peanut butter to applesauce to introduce peanut proteins
• Instead of only leaning on fruits and vegetables as infant-friendly foods, offer the strips of cooked egg, soft ground beef, and no-sugar-added plain yogurt for exposure to important nutrients and various proteins.
• Offer low-mercury seafood options like salmon to provide important omega-3 fatty acids to support the rapid brain development that occurs through the first two years of life 
• Swap cereals with added sugars to cereals that are free from added sugars
• Swap out high sodium processed meats for fresh options