Infant Nutrition and Feeding Guidelines

Dietary Guidelines for Americans, 2020-2025

• Intended for nutrition and health professionals
• Life-stage specific presentation
• Can be used as a standalone presentation or combined with other slides
• Permission to use:
  • Content, figures, graphs, tables are in the public domain
  • Photos/illustrations in Figures 1-8 & 1-9 are in the public domain
  • Other photos/illustrations require no permission but should be used as designed & properly cited
• Recommended citation: U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. DietaryGuidelines.gov

Infants & Toddlers: Key Recommendations

• Exclusively feed infants human milk for first 6 months
• Continue feeding human milk for at least first year, or longer
• If human milk is unavailable, feed iron-fortified infant formula
• Provide supplemental vitamin D soon after birth
• Introduce nutrient-dense complementary foods at around 6 months
• Introduce infants to potentially allergenic foods along with other complementary foods
• Encourage infants and toddlers to eat a variety of foods from all food groups, rich in iron and zinc
• Avoid foods and beverages with added sugars and limit sodium

Putting the Key Recommendations Into Action

• 0-23 months old

Feed Infants Human Milk for the First 6 Months, if Possible

• Human milk provides nutrients, bio-active substances, and immunologic properties that support infant health
• Feed infants iron-fortified infant formula if human milk is unavailable
• Homemade and improperly regulated infant formulas should not be used
• Take precautions to ensure proper handling and storage of expressed human milk and infant formula
• Donor human milk should only be obtained from screened sources who follow safety precautions

Supplemental Vitamin D

• All infants, including those exclusively fed human milk or receiving a mixture of human milk and formula, need vitamin D supplementation of 400 IU per day soon after birth
• Supplemental needed if not getting full formula feeds, due to fortifying of formula with Vitamin D
• Young children may need to continue supplementation after age 12, consult with healthcare professional

Introduce Nutrient-Dense Complementary Foods at About 6 Months

• Complementary foods complement human milk and infant formula to ensure adequate nutrition
• Some infants show developmental signs of readiness before 6 months, but it is not recommended introducing complementary foods before 4 months, or after 6 months
• Important to include iron and zinc rich foods for infants fed human milk
• Introduce age and developmentally appropriate foods to prevent choking

Readiness for Beginning Solid Foods

• Signs of readiness include control of head and neck, sitting, bringing objects to mouth, attempting to grasp objects, and swallowing rather than pushing food back out
• Developmentally appropriate foods are crucial to prevent choking

Introduce Potentially Allergenic Foods When Other Complementary Foods Are Introduced

• Delaying introduction of allergenic foods isn't supported by evidence
• Introduce foods like peanuts, egg, cow's milk, tree nuts, wheat, crustacean shellfish, fish, and soy at the time other complementary foods are introduced
• Introducing peanut-containing foods in the first year can reduce risk of peanut allergy
• Provide cow's milk as a beverage at age 12 months or later

Infants at High Risk for Peanut Allergy

• If severe eczema, or egg allergy (or both) are presented as an infant, introduce age-appropriate peanut-containing foods at 4-6 months to reduce the risk of developing peanut allergy
• Caregivers of high-risk infants should consult healthcare professionals before feeding peanut-containing foods

Encourage Consumption of a Variety of Complementary Foods

• Complementary foods and beverages should be nutrient-rich, meet calorie and nutrient requirements, and are limited with added sugars and sodium
• Introduce iron-rich foods (e.g., meats, seafood, iron-fortified cereals), zinc-rich foods (e.g., meats, beans, fortified cereals), and a variety of foods from all food groups (knowing it could take up to 8-10 exposures for a child to accept new foods)

A Nutrient-dense, Diverse Diet from Age 6 through 23 Months

• Protein foods, including meats and poultry, eggs, seafood, nuts, soy, etc. are important sources of iron, zinc, protein, choline, and long chain polyunsaturated fatty acids
• Include vegetables and fruits high in potassium, vitamin A, and vitamin C
• Beans, peas, and lentils provide good protein and dietary fiber
• Introduce yogurt and cheese(including soy) before 12 months of age; do not introduce whole or fortified cow milk before 12 months
• Grains, including iron-fortified infant cereals play an important role during this life stage

Dietary Components to Limit

• Avoid added sugars—young children don't need added sugars in their diets
• Avoid foods high in sodium—preferences for salty food can be developed early in life
• Avoid honey and unpasteurized foods/beverages—can contain Clostridium botulinum (causing illness or death in infants)

Establish a Healthy Beverage Pattern

• Offer small amounts of plain, fluoridated water with complementary foods. Do not provide cow milk or fortified soy beverages before 12 months to replace human milk or infant formula
• Introduce plain cow's milk (whole milk) as a beverage at around 12 months to help meet calcium, potassium, vitamin D, and protein needs
• Plant-based alternatives (like rice, oat, coconut, almond) and 100% fruit/vegetable juices should not be given to infants in the first year of life; and for the second year of life, 100% fruit juices are not needed; if consumed, limit to 4 ounces or less per day;
• Sugar-sweetened beverages should not be given to children under age 2
• Toddler milk or drinks containing added sugars are not needed

Healthy Dietary Pattern During the Toddler's Second Year of Life

Healthy U.S. Style Dietary Pattern: Toddlers Ages 12 Through 23 Months Who Are No Longer Receiving Human Milk or Infant Formula

• Provide calorie levels for different food groups

Make Healthy Shifts to Empower Toddlers to Eat Nutrient-Dense Foods in Dietary Patterns

• Early preference for food can influence long term choices
• Make healthy choices to support toddlers long-term health and well-being

Current Intakes: 12 Through 23 Months

• Average daily food consumption for toddlers
• Comparison with recommended intake ranges
• Show data on added sugars, saturated fats, and sodium

Average Intakes of Subgroups Compared to Recommended Intake Ranges

Supporting Healthy Eating

• Parents, guardians, and caregivers are crucial in feeding infants and toddlers correctly
• Learn when a child is hungry and full

Resources

• Federal programs like WIC, CACFP, SNAP, and Head Start provide support for nutrition needs of families