FEEDING INFANTS AND CHILDREN FROM BIRTH TO 24 MONTHS
Summarizing Existing Guidance
Recommendations for feeding infants and young children are everywhere—you see them on websites, social media, brochures, books, and more. With so much information available, the landscape is constantly changing. Recognizing these challenges, the Centers for Disease Control and Prevention asked the National Academies of Sciences, Engineering, and Medicine to form an ad hoc committee that would compile a comprehensive list of the topics addressed across relevant documents on feeding infants and children under 2 years of age, note the type of evidence cited in support of each recommendation, and assess the documents for strategies to support communication and dissemination of feeding guidelines.
Feeding Infants and Children From Birth to 24 Months: Summarizing Existing Guidance reviews the current landscape of feeding recommendations for infants and young children and identifies the level of consistency on a number of topics. To read the full report, visit nationalacademies.org/feeding-infants-and-children.
Click on a tab below to view the different recommendations for "what" and “how” to feed.
WHAT TO FEED
HOW TO FEEDConsistency of Recommendations on What to Feed Infants and Young Children
Overall, the recommendations on what to feed infants and young children were consistent or generally consistent. When there were inconsistencies, they were often related to the age or age range specified in the recommendation.
The majority of authoritative documents reviewed by the committee included recommendations on what to feed infants and children under 2 years of age. The committee organized these recommendations into 18 categories.
Select a filter below to filter by level of consistency.
Unfortunately, your device isn't wide enough to support viewing this interactive table. Come back and explore this table when you have access to a larger screen. While you're on the go, you can still view the summary of the committee’s findings regarding consistency of recommendations in Table 4-3 of the online report.
Select a filter below to filter by level of consistency.
| The guideline documents were | |||||
| Category | Recommendation | Consistent | Generally Consistent | Somewhat Consistent | Not Consistent |
| Exclusive breastfeeding | in terms of recommending exclusive breastfeeding for up to, about, or around 6 months of age | generally consistent | |||
| Continuation of breastfeeding | in being in support of continuing breastfeeding for at least 12 months | generally consistent | |||
| Continuation of breastfeeding | in terms of the specific age to which breastfeeding should be continued | Not consistent | |||
| Supplementary formula feedings | in indicating that breastfed infants should not be routinely given supplementary formula feedings | Consistent | |||
| Duration of formula use | in indicating that infant formula is not needed beyond 12 months of age | Consistent |
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| Duration of formula use | in recommending that, for formula-fed infants, commercial infant formula should be used until 12 months of age | generally consistent | |||
| Type of infant formula | in recommending cow milk-based infant formulas for formula-fed infants | ||||
| Type of infant formula | in recommending that the use of soy-based formula be limited to special circumstances | ||||
| Toddler milks and follow-on formulas | in recommending against the general use of toddler milks | ||||
| Milk and milk-based products | in recommending against cow milk before 9 months of age | generally consistent | |||
| Milk and milk-based products | regarding suitability of cow milk for infants 9–12 months of age | Not consistent | |||
| Milk and milk-based products | in whether milk can be added to complementary foods before 12 months of age | Not consistent | |||
| Milk and milk-based products | in indicating that whole milk should be provided to children in the age range of 12–24 months | generally consistent | |||
| Milk and milk-based products | in indicating that the amount of cow milk should be limited for children 12–24 months of age | ||||
| Milk and milk-based products | in the recommended limit for the amount of cow milk for children 12–24 months of age | somewhat consistent | |||
| Milk and milk-based products | in recommending against providing flavored milk to infants and young children | ||||
| Fluids: Water, juice, sugar-sweetened beverages, and other nonmilk beverages | in discouraging the provision of water to breastfed infants 0–6 months of age | ||||
| Fluids: Water, juice, sugar-sweetened beverages, and other nonmilk beverages | in recommending provision of water to infants 6–12 months of age and children older than 1 year | ||||
| Fluids: Water, juice, sugar-sweetened beverages, and other nonmilk beverages | in stating that juice should not be provided in the first 12 months of life | generally consistent | |||
| Fluids: Water, juice, sugar-sweetened beverages, and other nonmilk beverages | in recommending that juice intake for toddlers not exceed 4 ounces per day | generally consistent | |||
| Fluids: Water, juice, sugar-sweetened beverages, and other nonmilk beverages | in recommending against providing infants and young children with sugar-sweetened beverages | ||||
| Fluids: Water, juice, sugar-sweetened beverages, and other nonmilk beverages | in recommending against providing coffee, tea, and caffeinated beverages to infants and young children | ||||
| Fluids: Water, juice, sugar-sweetened beverages, and other nonmilk beverages | in recommending against providing plant-based beverages to infants or young children1 | generally consistent | |||
| Substances to avoid or limit2 | in recommending that foods for infants and young children should be prepared without added sugars | ||||
| Substances to avoid or limit2 | in recommending that if pre-prepared foods and snacks are offered to young children, they should contain no or limited added or total sugars | ||||
| Substances to avoid or limit2 | in recommending that if foods with sugars are consumed, they should be consumed at mealtimes instead of as snacks | ||||
| Substances to avoid or limit2 | in advising against dipping pacifiers or bottle teats in substances with sugars | ||||
| Substances to avoid or limit2 | in recommending that foods for infants and young children be prepared without adding salt | ||||
| Substances to avoid or limit2 | in recommending that if pre-prepared foods and snacks are offered to young children, they should contain no or limited salt | ||||
| Variety and healthy, nutritious foods | in recommending that a variety of foods and food groups, textures, and flavors can help meet nutritional requirements | ||||
| Fruits and vegetables | in recommending consumption of a variety of fruits and vegetables | ||||
| Vegetarian and vegan diet | in stipulating the need for a carefully planned diet to meet requirements for several key nutrients | ||||
| Vegetarian and vegan diet | in explicitly mentioning a need for fortified products or nutrient supplements for vegans | somewhat consistent | |||
| Vegetarian and vegan diet | in mentioning plant-based beverages as an option for toddlers in the context of specific dietary preferences | generally consistent | |||
| Foods associated with food allergy and celiac disease | in recommending that introduction of potentially allergenic foods should not be delayed | ||||
| Foods associated with food allergy and celiac disease | in recommending when and how to introduce peanuts based on the infant’s risk for peanut allergy | Not consistent | |||
| Foods associated with food allergy and celiac disease | in recommending not delaying introduction of allergenic food beyond 6 months of age, including eggs | generally consistent | |||
| Iron | in acknowledging the importance of iron-rich complementary foods | ||||
| Iron | in recommended age of introduction of iron-rich complementary foods | Not consistent | |||
| Iron | in recommending that formula-fed infants be given iron-fortified infant formulas until at least 6 months of age | ||||
| Iron | in duration of use of iron-fortified formulas for formula-fed infants, and suggested iron content of infant formulas | somewhat consistent | |||
| Iron | in advising against general use of iron supplements3 | generally consistent | |||
| Iron | in recommending the need for adequate intake of iron among infants fed vegetarian or vegan diets | ||||
| Vitamin D | in recommending vitamin D supplementation among breastfed infants | generally consistent | |||
| Vitamin D | in relating the need for vitamin D supplementation for formula-fed infants to the total amount of daily infant formula intake | ||||
| Vitamin D | regarding the amount of infant formula intake that necessitates vitamin D supplementation | Not consistent | |||
| Vitamin D | in recommending vitamin D supplementation for high-risk or vitamin D deficient children 12–24 months of age | ||||
| Iodine | in recommending against the use of iodine supplements | ||||
| Other nutrient supplements (other than iron, vitamin D, or iodine) | in stating that nutrient supplements are not needed for infants and young children consuming a healthy, varied diet4 | generally consistent | |||
| Other nutrient supplements (other than iron, vitamin D, or iodine) | in recommending that fluoride supplementation for infants and young children be contingent on the fluoride status of the water supply | ||||
| Dietary fat | in noting the importance of diets with adequate fat content | ||||
| Dietary fat | in recommending against foods high in saturated and/or trans fats | ||||
| Dietary fat | in recommending plant oils | ||||
1 This statement pertains to general use of plant-based beverages. A caveat is noted in the “Vegetarian and vegan diet” section.
2 Recommendations regarding foods to avoid or limit based on food safety considerations (e.g., unpasteurized beverages, honey due to the risk of botulism) are summarized in the How to Feed section on “Safety of foods and feeding practices”.
3 A recommendation in a 2010 guideline document predated the acceptance of delayed cord clamping in the United States, which changed iron supplementation recommendations for infants. The statement of consistency reflects only the more recent guideline documents.
4 This statement pertains to nutrient supplements generally. Consistency of recommendations related to supplementing specific nutrients is noted elsewhere.
Consistency of Recommendations on How to Feed Infants and Young Children
Overall, recommendations on how to feed infants and young children under 2 years of age were consistent or generally consistent. Guideline documents included recommendations across 8 topic areas. Most of the differences related to the specific age or age group specified in each recommendation.
Select a filter below to filter by level of consistency.
| The guideline documents were | |||||
| Category | Recommendation | Consistent | Generally Consistent | Somewhat Consistent | Not Consistent |
| Bottle use and propping | in recommending against certain foods and fluids being added to bottles | ||||
| Bottle use and propping | in recommending that bottle use be discontinued at about 12 months of age | ||||
| Bottle use and propping | in recommending that infants not go to bed or to sleep with a bottle | ||||
| Bottle use and propping | in recommending against bottle propping | ||||
| Cup use | in recommending that infants should transition to cups at 6–12 months of age | ||||
| Cup use | in recommending that milk should be served to toddlers in a cup | ||||
| Safety of foods and feeding practices | in recommending that milk, milk products, and juice given to children should be pasteurized | ||||
| Safety of foods and feeding practices | in recommending against giving honey to children under 1 year of age due to risk of botulism | ||||
| Safety of foods and feeding practices | in recommending against consumption of raw or undercooked eggs | ||||
| Safety of foods and feeding practices | in advising about choking hazards, although examples provided varied across guideline documents | ||||
| Safety of foods and feeding practices | in recommending that infants and young children be supervised while eating | ||||
| Introduction of complementary foods | in recommending that complementary foods not be introduced before 4 months of age nor delayed to after 6 months of age | ||||
| Introduction of complementary foods | in whether the recommended age of introduction is an age range (4–6 months) or is focused on introduction at (approximately) 6 months | Not consistent | |||
| Introduction of complementary foods | in recommending that the first foods offered to infants be iron rich or iron fortified | ||||
| Introduction of complementary foods | in recommending gradual introduction of new foods | ||||
| Food consistency and texture | in recommending that food consistency and texture be tailored to the developmental needs of the child | ||||
| Food consistency and texture | in recommending that consistencies and textures of foods offered should change as the child gets older | ||||
| Meal frequency | in recommending that a consistent meal schedule be established | ||||
| Meal frequency | in recommending that young children need several eating occasions, both meals and snacks, over the course of the day | ||||
| Hunger and satiety cues | in emphasizing the importance of using hunger and satiety cues to guide infant and child feeding | ||||
| Responsive feeding | in recommending that the feeding environment be pleasant and include nurturing behaviors (e.g., verbalization, eye-to-eye contact, not forcing the child to eat) | ||||
| Responsive feeding | in recommending that repeated exposure is needed for children to accept new foods | ||||
| Responsive feeding | in recommending that self-feeding and self-regulation be encouraged in infants and toddlers | ||||
Harmonizing the Process for Development of Future Guidelines
Different approaches have been used to develop feeding guidelines for infants and young children. However, there are opportunities to harmonize the process to achieve greater efficiency and more consistency.
Planning to Develop Guidelines
- Leverage collaborative advantages by using multiple stakeholder organizations or a consortium of organizations to participate in the guideline development process
- Engage key stakeholders, communication experts, and representatives of the target audience at the beginning of the process to help ensure that the final product is appropriately designed and disseminated
Developing the Guidelines
- Use existing criteria and tools for high-quality guideline development
- Determine how to deal with special considerations and common challenges in the field of nutrition, such as:
- The appropriate tools for assessing the quality of available evidence
- How to establish and communicate recommendations when only expert consensus is available
- How to communicate uncertainties when the available evidence is limited but guidance is still needed on a certain topic
Planning for Guideline Dissemination and Implementation
- Develop effective and timely strategies to support the communication, dissemination, and implementation of feeding guidance, and to promote the systematic uptake of guidelines
Committee’s Recommendation: Agencies, organizations, and groups developing guideline documents related to feeding infants and young children should consider the principles of dissemination and implementation (D&I) science as a means to enhance the reach and impact of the recommendations that are developed.
- D&I science is focused on best practices for communicating evidence-based solutions, and includes strategies for adoption, implementation, and maintenance of guidelines in a variety of settings. There are several D&I frameworks that can be used to guide:
- the process of translating dietary guidelines into practice
- understanding what influences implementation outcomes (barriers and facilitators), and
- assessing process (e.g., coverage, quality) and impact outcomes with a focus on effectiveness
- A continuous system that includes feedback and participation from multiple authoritative groups on D&I plans and practices will ensure that timely adaptations are made to successfully implement feeding guidelines.
- Adaptations to D&I activities will likely be needed to address issues of equity and account for socioeconomic, cultural, demographic, and health care and food systems differences across contexts. These adaptations need to be carefully documented.
To learn more about the consistency of recommendations for feeding infants and children under 2 years, visit nationalacademies.org/feeding-infants-and-children.
This resource was developed with support from the International Food Information Council.