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.

The committee used the following phrases to describe consistency of recommendations:

  Consistent indicates alignment across the recommendations.
generally consistent Generally consistent indicates that the recommendations tended to provide similar guidance, although there were some differences in details or wording.
somewhat consistent Some inconsistencies indicates mixed recommendations, some of which align.
not consistent Not consistent indicates recommendations provided different guidance on a topic.

Click on a tab below to view the different recommendations for “what” and “how” to feed.

Consistency 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.

photo of baby

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.

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    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

 

 

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.

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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.

photo of baby

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 5-2 of the online report.

FILTER BY:


    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


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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.

photo of baby

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.
Read Compounded Feeding Infants and Children from Birth to 24 Months Report

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.