FEBRUARY 16, 2021 — For 40 years, the U.S. Dietary Guidelines for Americans have been providing recommendations about what to eat and drink for better health.
The newest edition issued at the end of December — Dietary Guidelines for Americans, 2020-2025 — had some big changes. These are the first guidelines that include infants and toddlers (children under 2 years), and breastfeeding and pregnant women.
Since 1980, an updated version of the Dietary Guidelines was released every five years. The basic guidelines have remained the same over the years: Eat more whole grains; fruits and vegetables; lean meats and dairy; and a small amount of healthy fats like avocados, nuts and olive oil. Each update contained some small changes that reflected the advances in nutrition research and how the foods and drinks we consume play an important role in preventing diseases.
Stephanie Shryock is a registered dietitian, International Board-Certified Lactation Consultant and coordinator of the Women, Infants and Children Program (WIC) for the Kodiak Area Native Association. Shryock said she was excited about the new Dietary Guidelines, calling them a “wonderful resource for families and health care workers.”
Shryock has worked with infants, toddlers, pregnant and breastfeeding women for the past 10 years.
“These categories of people need special guidelines for several reasons, but primarily due to their body going through an especially critical time in the lifespan,” she said. “For example, a pregnant or breastfeeding mother’s eating habits and lifestyle choices may not only affect her health, but may also affect her child’s health too.”
Science shows that early food preferences influence later food choices.
“The time from birth until two is vital for establishing healthy dietary patterns and eating habits that may influence a person’s health throughout the rest of their life,” Shryock said.
Guidelines for infants and toddlers through 2 years old
The new Dietary Guidelines align with the feeding recommendations from the American Academy of Pediatrics that have been around for several years: Feed infants only human milk for the first 6 months if possible. If breast milk is not available, an infant should have only iron-fortified commercial formula.
Babies should continue to drink human milk for at least the first year of life even as solid foods are slowly introduced around 6 months old. At that age, infants are developing the skills needed to eat solid foods, such as holding their head and neck upright and bringing their hand and objects to their mouth. Babies’ first foods should be nutrient-rich foods from all the food groups: iron- and zinc-fortified baby cereal, pureed or soft meats, seafood, beans, eggs, plain yogurt, cheese, fruits and vegetables. Infants under age 1 should not have cow’s milk, plant milks, fruit juice, soda, or caffeinated drinks. These beverages do not contain the correct amount of nutrients to replace human milk or iron-fortified infant formula. Cow’s milk can be hard for an infant’s system to process. These beverages may also contain added sugars that can lead to children growing up at an unhealthy weight.
The new Dietary Guidelines recommend introducing infants to potentially allergenic foods at 4- to 6- months old, along with other foods. Typical foods that may cause an allergic response include foods that contain peanuts, tree nuts, eggs, fish, shellfish, and cow’s milk. These foods should be slowly introduced early in life to prevent allergic reactions from developing. Parents with infants with severe eczema or an egg allergy should check with their health care provider before feeding foods with peanuts. Cow’s milk should be slowly added beginning at age 1.
Introduce infants to one single-ingredient new food every three to five days, said Diane Peck, registered dietitian with Alaska’s Physical Activity and Nutrition program. Watch to see if there are any reactions, such as a rash. Start small with ½ ounce to 1 ounce of a single food once a day. Slowly increase the amount and number of foods. Within a few months of starting solid foods, a baby's daily diet should include small amounts of a variety of foods with different flavors and textures from all food groups.
Additional guidelines for toddlers ages 1-2
In the second year of life, toddlers may continue to drink human milk, but should be getting the majority of their calories and nutrients from healthy, age-appropriate foods and beverages.
“During this period, nutrients critical for brain development and growth must be provided in adequate amounts,” Shryock said. “Children in this age group consume small quantities of foods, so it’s important to make every bite count!”
Toddlers should be eating the same healthy foods as infants ages 6 months and older, with increasing variety in tastes and textures. Whole, vitamin-D fortified cow’s milk and fortified soy milk can be introduced at 1 years old. Cereals should include whole grains. Whole fruit is best, but if parents and caregivers are serving 100% fruit juice, toddlers should have no more than 4 ounces (1/2 cup) in a day. The best drinks for toddlers are water, plain cow’s milk, unsweetened soy milk, or human milk.
Infants and young children have no room in their diet for the added calories that come from added sugars. Added sugars are those not found naturally in a food, but instead added during processing. That includes sugars added to foods, like some yogurts and cereals, and to drinks, like soda and flavored milk. Those added sugars can lead to childhood obesity, dental cavities, and chronic diseases, such as diabetes that can develop even in young children.
Sugary drinks provide much of the added sugar consumed by little children. For the best health, toddlers should not drink toddler milks, flavored milk like chocolate or strawberry, and sugary drinks. Sugary drinks include soda, powdered drink mixes, sports drinks, vitamin-enhanced waters, and fruit-flavored drinks or punch.
Play Every Day’s recent messages promote giving water and milk to little children instead of sugary drinks. Children watch what their parents and caregivers are eating and drinking. If adults choose a bottle of water instead of a bottle of a soda or vitamin drink, children watching them will be more likely to want that healthy option, too.
Guidelines for pregnant or breastfeeding women
Women who are pregnant or breastfeeding should follow the same dietary recommendations as other age groups, but with extra calorie and nutrient needs at different stages, especially during the second and third trimester of pregnancy, and when providing breast milk to their babies and toddlers. Pregnant women should work with their health care provider to determine the appropriate supplements and amount of healthy weight gain during their pregnancy.
Helpful meal pattern and healthy food ideas
There are helpful resources online if you’re wondering what all these Dietary Guidelines actually look like on your plate, or what you should feed your infant or toddler. Visit the Dietary Guidelines Food Sources of Select Nutrients to see which foods are good sources of important recommended nutrients.
Learn more about healthy eating from birth through all stages of life and get personalized calorie and meal patterns at MyPlate.gov. Parents can find a wide variety of nutrition and other useful health information for children of all ages at HealthyChildren.org.