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Department of Health and Human Services issued dietary guidelines specifically for children 24 months and younger Children's Wisconsin

Food for thought: New dietary guidelines for children under 24 months

Every five years, the United States Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) reviews and issues dietary guidelines. For the first time ever, they issued dietary guidelines specifically for children 24 months and younger (a lot of my patients!). 

As I read the guidelines — a broad document with adult and kid recommendations — I thought it might be best to break down the recommendation for the new 24 month and younger group. It should be noted that these are recommendations only. Many children will do well with these guidelines, but parents and pediatricians should work together to best serve the needs for each individual child. Further, if your family follows a vegan or vegetarian diet, consult your pediatrician for how best to get all the nutrients your child needs. 


The first recommendation from the USDA and HHS is exclusive breastfeeding for the first 6 months for those who can, or if breast milk isn’t available, an iron-fortified infant formula for the first year. My colleagues at Children’s Wisconsin have posted a number of blogs about breastfeeding for mothers and baby. You can read them here: The amazing benefits of breastfeeding and How to make sure your baby is getting enough to eat. Additionally, babies should get supplemental Vitamin D beginning the first few days of life.

With breastfeeding, moms need to make sure they are getting good nutrition, which will affect their milk. Choosing nutrient dense foods like low mercury fish, lean protein, fruits and vegetables will help with your baby’s development.

Sugar and food allergens

Beyond breastfeeding, the guidelines focused on two main areas of nutrition that my colleagues and I have been talking to our families about for a while now, so it is good to see it reflected in a broad recommendation. They are added sugar and food allergens. Since babies can start eating other foods around 4-6 months, it is never too early to incorporate healthy habits.

There’s no way around it, added sugar isn’t good and it’s found everywhere. The new dietary guidelines recommend that children under the age of 2 should not consume food with added sugar. Prior research shows that infants consume a teaspoon of added sugar a day while toddlers consume about 6 teaspoons a day. Added sugar has been found to contribute to childhood obesity and chronic illnesses down the road. It should be noted that added sugars differ from naturally occurring sugars. For example, fruit has natural sugar but is nutrient dense.

As I mentioned, added sugar is found everywhere, including sweetened beverages such as fruit juice and sodas, desserts, snacks, candy, cereals and breakfast bars.

Understanding the food label

Added sugar comes in many forms. When you’re reading food labels, look for brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, lactose, malt syrup, maltose, molasses, raw sugar and sucrose, and do your best to avoid them. Added sugars are listed separately on the nutrition label, under total sugars. I like to tell families to stick with whole foods like fruits and vegetables. It will take a little more effort, but their kids’ health is worth it.

Food allergens

We used to tell families to avoid food allergens like nuts until age 2, but that’s all changed over the last few years. I am happy that the USDA and HHS have also recognized that introducing potential food allergens earlier may help prevent allergies. Introducing allergens such as peanuts, eggs, cow’s milk products, tree nuts, wheat, soy, shellfish and other fish earlier could reduce a child’s risk of developing an allergy to that food.

Please introduce these foods at the recommendation of your child’s pediatrician who will have an understanding of your family’s history and be able to give you best practices for introducing these foods. For example, don’t give your baby an actual nut, as it is a choking hazard, but rather spread a natural nut butter on piece of bread and cut into bite size pieces. When my child started solids, I would mix a little peanut butter into her baby cereal, which worked great!

It is important to remember that the above recommendations are just that, recommendations. While parents always need to look out for their children’s nutritional needs, it’s important to work with your child’s pediatrician on what will suit their needs best. I love seeing my patients grow from infants into toddlers and beyond, and it is so gratifying to hear when they are doing so with a healthy focus on nutrition.