Nutrition guidelines include kids aged younger than 2 years for first time ever


A close look at the dietary needs of infants and toddlers and the recent nutrition guideline update.

The nutritional guidelines have shifted over the years from food groups to the food pyramid to choosing the plate wisely. Those guidelines are set to be updated once more by the end of 2020. For the first time ever those guidelines will include guidance for mothers who are breastfeeding their children as well as the first 2 years of life. In her presentation “Birth to 24 months: Putting new dietary guidelines into practice” at the virtual 2020 American Academy of Pediatrics National Conference & Exhibition, Joan Younger Meeks, MD, MS, RD, FAAP, FABM, IBCLC, professor of clinical sciences at the Florida State University College of Medicine in Orlando offered a look at what was in the initial report on the guidelines released earlier this year.

The guidelines are focused on life stages, which include pregnancy, lactation, birth to 24 months, childhood, adolescence, and adulthood. When improvements are made to the recommended food pattern at one stage, those improvements can help influence the nutritional choices made in the next stage. Having a dietary pattern that is high in quality can help promote health, ensure adequate nutrient intake, and reduce the risk of chronic diseases related to diet.

Meeks spoke on the healthy dietary patterns in pregnancy and lactation. Those patterns included:

  • Pregnancy – consuming 8 to 12 ounces of seafood per week for omega-3; preventing iron deficiency anemia because babies rely on iron stores early in life; not restricting egg or milk consumption, if being done to decrease allergy or asthma risk; utilizing folic acid and iron supplements because sufficient amounts can’t be maintained with diet alone.
  • Lactation – ingesting an additional 500 calories per day during the first 6 months and an additional 400 calories per day during the next 6 months; stopping prenatal supplements; continuing the consumption of 8 to 12 ounces of seafood per week.

The draft recommendations for nutrition noted that the nutrition a child receives in the first 1000 days of life help set up long-term health and are instrumental in shaping future taste preferences and food choices. Formula or human milk should be the primary nutrition source until age 6 months, when complementary food and beverages are introduced, and the child transitions to the family’s diet through the next 18 months. Introducing complementary foods and beverages are not recommended before age 4 months and limited evidence indicates that very early introduction is linked to higher odds of overweight and obesity. Introduction of peanut and egg after age 4 months may mitigate the risk of allergy and there is no evidence that restricting either food is necessary. Sugar-sweetened beverages should not be given to children aged younger than 2 years because they replace more nutritious foods and could begin the habit of consuming sugar sweetened beverages for life.

For toddlers, Meeks noted that the recommendations included encouraging the consumption of a variety of protein sources. Toddlers should be eating fruits and vegetables rich in potassium. Oils should be the preferred form of fats instead of saturated or solid fats. Whole grains should be consumed more often than non-whole grains and increased consumption of seafood and fish should be encouraged. All foods given to a toddler should be prepared in a way that is developmentally appropriate for the child.

When discussing diet with the families of very young children, clinicians should remember that their advice should:

  • Take into consideration the family’s cultural preference
  • Allow for flexibility
  • Ensure that food costs are taken into account
  • Expose the child to a wide variety of nutritious food


The updated nutritional guidelines presented at the 2020 American Academy of Pediatrics National Conference & Exhibition by Dr Joan Meeks is an important addition in providing complete nutritional guidance for all the life stages.

Per the guidelines, providing the most appropriate nutrition during the first 1000 days of life is instrumental in setting up long-term health and shaping future taste preferences and food choices. Guidance is also provided for which foods and supplementary foods are appropriate at the different ages. Discussion points for clinicians are provided when speaking to families of very young children to ensure that appropriate anticipatory guidance on diet is provided.

—Dr Tina Q Tan, professor of Pediatrics, Feinberg School of Medicine, Northwestern University, Pediatric Infectious Diseases attending, medical director of the International Patient Services Program (IPS): co-director of the Pediatric Travel Medicine Clinic; director of the International Adoptee Clinic at Ann and Robert H. Lurie Children’s Hospital of Chicago, Illinois, and editor-in-chief of Contemporary Pediatrics.

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