HHS offers new dietary guidelines for infants, young children

Published on Monday, February 1, 2021

By: Annie Oeth, aoeth@umc.edu

For the first time, the importance of breastfeeding - and foods to avoid feeding young children - are part of U.S. dietary guidelines.

Issued in December 2020 by the U.S. Department of Agriculture and every five years by the U.S. Department of Health and Human Services, the guidelines are used by health care professionals to guide patients in their food choices and often provide a foundation for federal nutrition programs.

“The time from birth until a child’s second birthday is a critically important period for proper growth and development,” the guidelines state. “It also is key for establishing healthy dietary patterns that may influence the trajectory of eating behaviors and health throughout the life course.

“During this period, nutrients critical for brain development and growth must be provided in adequate amounts. Children in this age group consume small quantities of foods, so it’s important to make every bite count.”

Krista King, a UMMC dietitian and part of the care team at the Children’s of Mississippi Pediatric Weight Management Clinic, applauds the new guidelines.

“I could not be more pleased with this, as the age of patients we see in clinic continues to decrease and the percentage of patients with diet-related conditions increase,” King said. “Developing a healthy eating pattern is not only imperative early in life, but also benefits all individuals, regardless of current health condition, as these healthy habits are carried forward into the next life stage.”

Here are five key take-aways from the guidelines for parents and caregivers of young children:

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  • Breastfeeding is best

With the advice of “follow a healthy dietary pattern at every life stage,” the new guidelines recommend breastmilk exclusively for a baby’s first six months.

“Continue to feed infants human milk through at least the first year of life, and longer if desired,” the guidelines state, noting that if breastfeeding is not possible, babies should be fed iron-fortified formula.

The breastfeeding recommendation is applauded by Dr. Mobolaji Famuyide, chief of the Division of Newborn Medicine at UMMC.

“Breast milk is the optimal form of nutrition for babies,” Famuyide said. “For babies, breast milk is not only nutrition; It is medicine. Mothers transfer immune protective substances to their babies through breast milk to help their immune systems to develop.”

The U.S. Centers for Disease Control and Prevention note that only one of every four American infants is breastfed, something medical experts would like to change, given the benefits of breast milk. Breastfeeding reduces a child’s risk for developing asthma, obesity, Type 1 diabetes, ear infections, gastrointestinal infections and Sudden Infant Death Syndrome.

The guidelines recommend vitamin D supplements for babies soon after birth unless breastfeeding mothers take vitamin D supplements.

At about 6 months of age, infants can be introduced to “nutrient-dense complementary foods," including iron-rich foods and iron-fortified infant cereals, the guidelines say.

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  • No Added Sugar

Added sugars of any kind are a “no” during a baby’s first year, the new U.S. dietary guidelines declare. Additional sugar can increase a child’s chances of developing obesity or other chronic health conditions in the future.

Added sugars come from processed foods and beverages and differ from the natural sugars in fruit or milk. According to the guidelines, nearly 70 percent of added sugars in Americans’ diets come from sweetened beverages, desserts and snacks, coffee and tea, candy, and breakfast cereals and bars.

“We see a lot of children that are given juice, sports drinks and even soda,” King said. “Recommendations promote avoiding all sources of added sugar.”

The new guidelines recommend that, starting at age 2, less than 10 percent of a child’s daily calories should come from added sugars. Parents should avoid giving their children younger than 2 added sugars.

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• Introduce Possible Allergens

Foods such as eggs, peanuts, dairy products, wheat, soy and other potential allergens have been avoided by parents when feeding their young children. The new guidelines say introducing these foods to a child at about 6 months of age could reduce the risk of developing a food allergy.

"You should also introduce potentially allergenic foods along with complementary foods when your child starts showing developmental signs that he or she is ready to start trying solid foods,” King said.

Potentially allergenic foods include peanuts, egg, dairy products, tree nuts, wheat, shellfish, fish and soy. The guidelines recommend waiting until a child is 12 months old to introduce cow’s milk as a beverage.

Other dairy products, such as yogurt and cheese, can be introduced earlier than a child’s first birthday.

Infants should not be given honey and unpasteurized foods and beverages.

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  • Keep Sodium and Fat Low

According to the guidelines, less than 10 percent of the calories consumed by a child younger than 2 should come from saturated fat. These are fats that often come from animal sources and turn solid at room temperature.

Sources of saturated fat include butter, cheese, meats and stick margarine.

Sodium should be limited to less than 2,300 milligrams per day for children younger than 12 months old and 1,200 milligrams for children 12 to 23 months old.

King said families are encouraged to shift to healthy, nutrient-rich foods through the Pediatric Weight Management Clinic.

“It is a myth that healthy eating is too expensive or hard,” she said. “We should be meeting nutrient recommendations almost exclusively with nutrient-dense foods and beverages that contain beneficial vitamins and minerals while limiting added sugars, saturated fat and sodium.”

The CDC reports that much of children’s sodium intake comes from foods such as pizza, breads, cold cuts, savory snacks, sandwiches, cheese, soups and chicken nuggets. Enjoying these foods in moderation will help keep children’s sodium levels in check.

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  • Start Healthy Beverage Habits

Beverages can contain plenty of added sugars, so starting children with the best beverage habits will help them now and in years to come.

While water is a healthy beverage, it’s typically not needed for an infant’s first six months. Small amounts of drinking water can be given to babies when complementary foods are introduced.

Infants should not drink cow’s milk or plant-based milks to replace breast milk or formula before their first birthday. After then, whole milk can be introduced.

Fruit juice should not be given to infants younger than 1 year old, and the new dietary guidelines encourage children 1 to 2 years old get most of the fruit in their diet from the actual fruits and not juice.

Federal guidelines say children ages 2 and older can enjoy up to four ounces of 100 percent fruit juice each day as part of a healthy diet. What’s forbidden are sugar-sweetened beverages, such as soft drinks and sports drinks, and caffeinated beverages for children younger than 2.

"Sugar-sweetened drinks have no place in a young child’s diet,” King said.

Following the new U.S. dietary guidelines will help family members of all ages stay healthier, she said.

“The bottom line is that we all need to be eating more real food. Spending one hour planning the following week’s meals, shopping with only those meals and snacks in mind, and prepping as much as possible is not only financially wise, but also provides your child with nourishment to keep them healthy and strong.”

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