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:
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:
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:
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
Avoid Foods Higher in Sodium
Avoid Honey and Unpasteurized Foods and Beverages
Avoid 100% fruit juice
Avoid toddler milk and toddler drinks
Avoid sugar-sweetened beverages
The advantages of recommended dietary patterns for infants at birth through 23 months:
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.