For the first time, the United States government has added infants and toddlers from birth to age two to its official advice on diet and nutrition. Specifically, the federal guidelines now weigh in about when to introduce solid food, when to introduce common allergens such as peanuts, and what to avoid completely.
The 2020-2025 edition of the Dietary Guidelines for Americans, which is written primarily for a professional audience, was released last week. It “provides advice on what to eat and drink to meet nutrient needs, promote health, and prevent disease” and “reflects the current body of nutrition science,” according to its website.
The inclusion of recommendations for younger children marks a change from past versions of the guide. An advisory report produced by a committee of dietary scientists in July stated that “nutritional exposures during the first 1,000 days of life not only contribute to long-term health but also help shape taste preferences and food choices.” That report, published by a committee of independent nutrition experts brought together by the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS), helped advise the final guidelines.
Birth to age six months
Not surprisingly, the USDA and HHS guidelines advise for exclusive breastfeeding (or human milk feeding) for the first six months of age. If that’s not possible, an iron-fortified infant formula is recommended.
The USDA and HHS also recommend waiting until “about age six months” before starting infants on solid foods to complement human milk or infant formula. That differs slightly from the American Academy of Pediatrics recommendations, which advise to starting complementary feeding between four and six months of age. Either way, these foods should be nutrient-dense and developmentally appropriate.
Introducing egg and peanut early
In 2019, the AAP shifted from recommending delaying allergen introduction to recommending early allergen introduction, particularly for infants at risk for developing a food allergy. The new Dietary Guidelines for Americans concurs with these recommendations, saying that allergenic foods—including peanuts, egg, cow milk products, tree nuts, wheat, crustacean shellfish, fish, and soy—should be given alongside other complementary foods as they are introduced into an infant’s diet. (Cow’s milk as a beverage, however, should not be introduced until at least 12 months of age.)
If your child is at a high risk for a peanut allergy, the Dietary Guidelines recommend early introduction—after seeking advisement from the child’s pediatrician:
If an infant has severe eczema, egg allergy, or both (conditions that increase the risk of peanut allergy), age-appropriate, peanut-containing foods should be introduced into the diet as early as age 4 to 6 months. This will reduce the risk of developing peanut allergy. Caregivers should check with the infant’s healthcare provider before feeding the infant peanut-containing foods. A blood test or skin prick may be recommended to determine whether peanut should be introduced to the infant, and, if so, the safest way to introduce it.
Avoid added sugars
We commonly celebrate a child’s first birthday by placing a cake the size of their head (or bigger!) in front of them and allowing them to stuff as much of it into their face as they possibly can—or stare at it in confusion for a while, as my son did. That’s a special occasion, though, and not how kids should eat regularly. The Dietary Guidelines advises avoiding feeding kids food or drinks with added sugar before age two:
Infants and young children have virtually no room in their diet for added sugars. This is because the nutrient requirements for infants and young children are quite high relative to their size, but the amount of complementary foods they consume is small. Complementary foods need to be nutrient-dense and not contain additional calories from added sugars.
The guidelines also recommend avoiding foods high in sodium, which can include some salty snacks, commercial toddler foods, and processed meats.
View the USDA and HHS’ full guidelines for all ages here.
This article was originally published in July 2020 and was updated on Jan. 4, 2021 to reflect current information.