Delay the introduction of cow’s milk until the second year after birth.

AAP, 1992a, 2004, 2005

Cow’s milk fed during the second year after birth (that is, ages 1–1.9 y) should be whole milk.

AAP, 1992b, 1998

Developing Healthy Eating Patterns


Provide children with repeated exposure to new foods to optimize acceptance and encourage development of eating habits that promote selection of a varied diet.

ADA, 1999c, 2004

Prepare complementary foods without added sugars or salt (i.e., sodium).

AAP, 2004

Promote healthy eating early in life.

ADA, 1999c, 2004

Promoting Food Safety


Avoid feeding hard, small, particulate foods up to age 2–3 y to reduce risk of choking.

Kleinman, 2000; AAP, 2004

aThere is acknowledged disagreement among experts on the subject of timing of introduction of complementary foods (AAP, 2004, 2005). Many organizations that support maternal and child health currently recommend exclusive breastfeeding (i.e., feeding of no food or beverages other than breast milk with the exception of medications and vitamin or mineral supplements) for the first six months after birth (AAP, 1997; UNICEF, 1999; ACOG, 2000; AAFP, 2005; WHO, 2001b). The rationale for the recommendation to encourage breastfeeding with exclusion of other foods until infants are around six months of age is summarized in the following quotes from the most recent policy statement from the American Academy of Pediatrics (AAP, 2005).

• “Exclusive breastfeeding is sufficient to support optimal growth and development for approximately the first 6 months after birth and provides continuing protection against diarrhea and respiratory tract infection.” “There is a difference of opinion among AAP experts on this matter. The Section on Breastfeeding acknowledges that the Committee on Nutrition supports introduction of complementary foods between 4 and 6 months of age when safe and nutritious complementary foods are available.”

• Regarding exclusive breastfeeding of infants—“Complementary foods rich in iron should be introduced gradually beginning around 6 months of age.”

• Regarding exclusive breastfeeding of infants—“Introduction of complementary feedings before 6 months of age generally does not increase total caloric intake or rate of growth and only substitutes foods that lack the protective components of human milk.”

DATA SOURCES: Dietary guidance is from: the American Academy of Pediatrics (AAP, 1992a, 1992b, 1997, 1998, 1999, 2001a, 2001b, 2004, 2005; Kleinman, 2000); the American Dietetic Association (ADA, 1999c, 2004); and the World Health Organization (WHO, 2001a, 2002).

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