Diet and Health: Birth to 24 Months

Diet and Health: Birth to 24 Months

This guidance about the healthiest diet for infants and toddlers is based on the scientific evidence about the best nutrition during the earliest stages of life presented in the Scientific Report of the 2020 Dietary Guidelines Advisory Committe1 and in the most recent version of the Dietary Guidelines for Americans, 2020-2025. 2

Research confirms that a healthy diet during early life stages is essential to support healthy growth and development during infancy and childhood and to promote health and prevent chronic disease through childhood, adolescence, and adulthood.3

Most Americans have one or more chronic diet-related health conditions, including overweight and obesity, heart disease, stroke, type 2 diabetes, hypertension, liver disease, certain types of cancer, dental caries, and/or metabolic syndrome. The risk of chronic disease begins early in life, with important health consequences for the fetus based on the dietary intake of the mother and subsequent feeding behaviors in infancy and early childhood. Early life nutritional exposures have emerged as a risk factor associated with later-life chronic disease risk.

At every life stage—infancy, toddlerhood, childhood, adolescence, adulthood, pregnancy, lactation, and older adulthood—it is never too early or too late to eat healthfully. 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. It is therefore important to follow a healthy dietary pattern at every life stage.

For about the first six months of life, exclusively feed infants human milk. Continue to feed infants human milk through at least the first year of life and longer if desired. Infants fed human milk have reduced risks of communicable diseases in infancy and non-communicable diseases later in life, including ear, gastrointestinal, and respiratory infections, asthma, and sudden infant death syndrome, compared to infants who were not breastfed. Feed infants iron-fortified infant formula during the first year of life when human milk is unavailable. Caregivers of infants exclusively fed human milk should talk with their pediatric healthcare provider about whether there may be a need for infants to get supplementation with iron before age six months. Provide infants with supplemental vitamin D beginning soon after birth.

Signs that an infant is ready for complementary foods include:

  • Being able to control head and neck.
  • Sitting up alone or with support.
  • Bringing objects to the mouth.
  • Trying to grasp small objects, such as toys or food.
  • Swallowing food rather than pushing it back out onto the chin.

Infants and young children should be given age- and developmentally appropriate foods to help prevent choking. Foods such as hot dogs, candy, nuts and seeds, raw carrots, grapes, popcorn, and chunks of peanut butter are some of the foods that can be a choking risk for young children.

Parents, guardians, and caregivers are encouraged to take steps to decrease choking risks, including:

  • Offering foods in the appropriate size, consistency, and shape that will allow an infant or young child to eat and swallow easily.
  • Making sure the infant or young child is sitting up in a high chair or other safe, supervised place.
  • Ensuring an adult is supervising feeding during mealtimes.
  • Not putting infant cereal or other solid foods in an infant’s bottle. This could increase the risk of choking and will not make the infant sleep longer.

At about six months, introduce infants to nutrient-dense complementary foods. Introducing complementary foods before age four months is not recommended. Introduction at age 4 to 5 months, as compared to 6 months, does not offer long-term advantages or disadvantages with regard to growth, size, body composition, overweight or obesity; iron status; or risk of developing food allergy, atopic dermatitis/eczema, or asthma during childhood. On the advice of health professionals, introduce infants to potentially allergenic foods such as peanuts and eggs along with other complementary foods. Encourage infants and toddlers to consume a variety of foods from all food groups. Include foods rich in iron and zinc, particularly for infants fed human milk. Zinc-rich complementary foods (e.g., meats, beans, zinc-fortified infant cereals) are important from age six months onwards to support adequate zinc status.

Complimentary Food group examples include:

  • Protein food, including meats, poultry, eggs, seafood, nuts, seeds, and soy products, are important sources of iron, zinc, protein, choline, and the long-chain polyunsaturated fatty acids needed for the rapid brain development that occurs in the infant's first two years of life. Some types of fish, such as salmon and trout, are also natural sources of vitamin D. To limit exposure to methylmercury from seafood, the U.S. Food and Drug Administration and the U.S. Environmental Protection Agency issued joint guidance regarding the types of seafood to choose. Available at FDA.gov/fishadvice. 
  • Vegetables and fruits, especially those rich in potassium, vitamin A, and vitamin C, should be offered to infants and toddlers age 6 through 23 months. The vegetable subgroup of beans, peas, and lentils also provides a good source of protein and dietary fiber.
  • Dairy, introduce yogurt and cheese, including soy-based yogurt, before 12 months. However, infants should not consume cow milk, as a beverage, or fortified soy beverage, before age 12 months as a replacement for human milk or infant formula. Plant-based milk alternatives, which are sometimes referred to as milk alternatives, include beverages made from plants, such as soy, oat, rice, coconut, and almond. These beverages should not be used in the first year of life to replace human milk or infant formula. In the second year of life, when calcium requirements increase, dairy products provide a good source of calcium. Vitamin D-fortified milk and soy beverages also provide a good source of vitamin D. For those younger than the age of 2, offer dairy products without added sugar.
  • Grains, including iron-fortified infant cereal, help in meeting nutrient needs during the 6 to 23 month life stage. Infant cereals fortified with iron include oat, barley, multigrain, and rice cereals. Rice cereal fortified with iron is a good source of nutrients for infants, but rice cereal shouldn’t be the only type of cereal given to infants. Offering young children whole grains more often than refined grains will increase dietary fiber as well as potassium intake during the second year of life and help young children establish healthy dietary practices.

From 12 months through older ages, focus on nutrient-dense foods. They are foods and beverages that provide vitamins, minerals, and phytochemicals and have very little added sugars, saturated fats, or sodium. Emphasize fruits, vegetables, legumes (beans, peas, lentils,) whole grains, nuts, seeds, fat-free dairy and fortified soy alternatives, and lean meats.

Avoid Added Sugars
Infants and young children have virtually no room in their diet for added sugars. Complementary foods need to be nutrient-dense and not contain additional calories from added sugars. In addition, low- and no-calorie sweeteners, which can also be called high-intensity sweeteners, are not recommended for children younger than age 2. Taste preferences are being formed during this time period, and infants and young children may develop preferences for overly sweet foods if introduced to very sweet foods during this timeframe.

Avoid Foods Higher in Sodium
Sodium is found in many foods, including some salty snacks, commercial toddler foods, and processed meats. In addition to keeping sodium intake low, another reason to avoid high-sodium foods is that taste preferences for salty food may be established early in life. Choose fresh or low-sodium frozen foods, when available, and low-sodium canned foods to minimize sodium content.

Avoid Honey and Unpasteurized Foods and Beverages
Infants should not be given any foods containing raw or cooked honey. Honey can contain the Clostridium botulinum organism that could cause serious illness or death. Infants and young children also should not be given any unpasteurized foods or beverages, such as unpasteurized juices, milk, yogurt, or cheeses, as they could contain harmful bacteria.

Avoid 100% fruit juice
Before age 12 months, 100% fruit or vegetable juices should not be given to infants. In the second year of life, fruit juice is not necessary, and most fruit intake should come from eating whole fruit. If 100% fruit juice is provided, up to 4 ounces per day can fit in a healthy dietary pattern. Juices that contain added sugars should be avoided.

Avoid toddler milk and toddler drinks
There are no clear needs for toddler milks or drinks. Needed nutrients can be obtained from cow milk or fortified soy beverage and appropriate solid foods. Toddler milks and toddler drinks are drinks supplemented with nutrients and typically contain added sugars. A variety of nutrient-dense complementary foods and beverages without added sugars should be emphasized for achieving nutrient recommendations

Avoid sugar-sweetened beverages
Sugar-sweetened beverages (e.g., regular soda, juice drinks [not 100% fruit juice], sports drinks, and flavored water with sugar) should not be given to children younger than age 2. Drinks labeled as fruit drinks or fruit-flavored drinks are not the same as 100% fruit juice and contain added sugars. These beverages displace nutrient-dense beverages and foods in the diet of young children. Infants and toddlers do not have room in their diets for the additional calories from added sugars found in these beverages. In addition, sugar-sweetened beverage intake in infancy and early childhood may predispose children to consume more of these beverages later in life.

The advantages of recommended dietary patterns for infants at birth through 23 months:  

  • Lower risk of overweight and obesity
  • Lower risk of type 1 diabetes
  • Adequate iron status and lower risk of iron deficiency
  • Lower risk of peanut allergy
  • Lower risk of asthma
  • From 12 months through older adulthood, follow a healthy dietary pattern across the lifespan to meet nutrient needs, help achieve a healthy body weight, and reduce the risk of chronic disease.

This report presents opinions and ideas and is intended to provide helpful general information. Catalyst for Children is not engaged in rendering advice or services to the individual reader. The ideas, procedures, and suggestions that are presented are not in any way a substitute for the advice and care of the reader's own physician or other medical professional based on the reader's own individual conditions, symptoms, or concerns. If the reader needs personal medical, health, dietary, exercise, or other assistance or advice, the reader should consult a physician and/or other qualified health professionals. Catalyst for Children specifically disclaims all responsibility for any injury, damage, or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this report or participating in any programs described in this report.

1 Dietary Guidelines Advisory Committee. 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC.

2 U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov.

3 Stoody EE, Spahn JM, Casavale KO. The Pregnancy and Birth to 24 Months Project: a series of systematic reviews on diet and health. Am J Clin Nutr. 019;109(Suppl_7):685s-697s. doi:10.1093/ajcn/nqy372.

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