AN ASPHN BRIEF

THE 2020-2025 DIETARY GUIDELINES FOR AMERICANS:
FOCUS ON INFANT, TODDLER AND TRANSITION FEEDING

The transition from milk feedings to a mixed diet, with the introduction of first complementary or weaning foods, is an important milestone in an infant’s development, a basis for their emerging taste preferences as well as their lifelong health, and a key period for the child’s caregiver and family. For the first time, the U.S. Departments of Agriculture and Health and Human Services included dietary recommendations for infants and toddlers in the 2020-2025 Dietary Guidelines for Americans, or DGA. ASPHN is providing these complementary feeding briefs to assist nutrition professionals in supporting families’ cultural preferences. Learn more below.

last update: 2023-01-20

OVERVIEW

Throughout time, support for the process of transition feeding — particularly, the “what and when” of which foods introduced at what age or stage of baby’s development — has historically been based on oft-repeated — though unlikely research-informed — advice from friends, family and even healthcare providers.

For the first time, the U.S. Departments of Agriculture and Health and Human Services included dietary recommendations for infants and toddlers in the 2020-2025 Dietary Guidelines for Americans, or DGA. This lifespan approach drew from and contributes to the research base addressing the “why” aspect of transition feeding.

Though the approach of the 2020-2025 DGA includes specific recommendations for all life stages, particularly pertinent to this writing is the inclusion of infants and toddlers, and pregnant and lactating women. As a note from the agency secretaries states, “science … shows it’s never too late to start and maintain a healthy dietary pattern, which can yield health benefits in the short term and cumulatively over years.” Implied but not stated in the note, and supported by evolving research and the DGA, is that it is also never too early to start.

OVERVIEW

Throughout time, support for the process of transition feeding — particularly, the “what and when” of which foods introduced at what age or stage of baby’s development — has historically been based on oft-repeated — though unlikely research-informed — advice from friends, family and even healthcare providers.

For the first time, the U.S. Departments of Agriculture and Health and Human Services included dietary recommendations for infants and toddlers in the 2020-2025 Dietary Guidelines for Americans, or DGA. This lifespan approach drew from and contributes to the research base addressing the “why” aspect of transition feeding.

Though the approach of the 2020-2025 DGA includes specific recommendations for all life stages, particularly pertinent to this writing is the inclusion of infants and toddlers, and pregnant and lactating women. As a note from the agency secretaries states, “science … shows it’s never too late to start and maintain a healthy dietary pattern, which can yield health benefits in the short term and cumulatively over years.” Implied but not stated in the note, and supported by evolving research and the DGA, is that it is also never too early to start.

DGA POSITION ON DIET AND HEALTH RELATIONSHIPS: BIRTH TO AGE 24 MONTHS

First 1,000 Days

The foods an infant receives during the first 1,000 days of life provide the basis for taste preferences and food choices going forward, but also contribute to lifelong health.

First Six Months of Life

For the first six months of life or so, human milk or infant formula typically supply all nourishment, followed by the gradual introduction of complementary foods and beverages, or CFB.

Six Months to 24 Months

The complementary feeding period, from around six months of age until age 24 months, fully transitions the child to family foods.

COMPLEMENTARY FOODS AND BEVERAGES

The reviews of scientific literature considered for the DGA support existing guidelines that CFBs should not be introduced to infants before four months of age. The Dietary Guidelines Advisory Committee (DGAC) also found that introduction of CFB at age four to five months, compared to the generally accepted six month recommendation, offers neither long-term advantages nor disadvantages.

INCLUDE IRON-RICH FOODS. Iron-rich foods, and food sources of zinc, continue to be recommended during the second six months of life for breastfed infants.

INTRODUCE PEANUTS AND EGGS. DGAC’s findings support recent recommendations of introducing peanut and egg, in forms appropriate for the child’s age, in the first year of life (after four months of age) in order to reduce the risk of food allergy to those foods. No benefit was found in avoidance of other types of potentially allergenic foods in the first year of life.

AVOID SUGAR-SWEETENED BEVERAGES. Strong support is provided for the avoidance of sugar-sweetened beverages (SSB) by children younger than two years of age.

  • Energy or calories provided by SSB leave less “room” for more nutrient-dense CFBs, allowing for possible nutrient gaps.
  • Some evidence suggests that SSB consumption by infants and young children may lead to child overweight.
  • Early intake of SSB may predispose a child to greater intake of SSB later in life, with potential negative health impact.

CREATING USDA FOOD PATTERNS

Because of the importance of healthy dietary patterns across the lifespan, including early childhood, the Dietary Guidelines Advisory Committee (DGAC) explored the possibility of creating USDA Food Patterns for infants and children age six months to 24 months. The DGAC was not able to establish a recommended food pattern for the youngest group, ages six to twelve months, but did identify potential combinations of CFB that neared meeting the nutrient needs.

FOOD PATTERN FOR CHILDREN AGED 12-24 MONTHS

For toddlers ages twelve to 24 months who are not fed human milk or infant formula, a recommended Food Pattern was established. Additionally, a Food Pattern (pictured left) was also established for toddlers ages twelve to 24 months who receive lacto-ovo vegetarian diets and neither human milk nor infant formula.

The establishment of Food Patterns, rather than the identification of a specific, prescriptive listing of food types, allows families and caregivers flexibility in considering both culture and cost when introducing young children to a wide variety of healthful foods.

SOURCES

  1. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. U.S. Department of Agriculture and U.S. Department of Health and Human Services.
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