B I RT H T H R O U G H 23 M ONTHS

Introduce Infants to Potentially Allergenic Foods

Along With Other Complementary Foods
Potentially allergenic foods (e.g., peanuts, egg, cow milk products,
tree nuts, wheat, crustacean shellfish, fish, and soy) should be
introduced when other complementary foods are introduced to an
infant’s diet. Introducing peanut-containing foods in the first year
reduces the risk that an infant will develop a food allergy to peanuts.
Cow milk, as a beverage, should be introduced at age 12 months
or later (see “Establish a Healthy Beverage Pattern”). There is no
For Infants at High Risk of
evidence that delaying introduction of allergenic foods, beyond
Peanut Allergy, Introduce
when other complementary foods are introduced, helps to prevent
Peanut-Containing Foods
food allergy. For more information, see “For Infants at High Risk
at Age 4 to 6 Months
of Peanut Allergy, Introduce Peanut-Containing Foods at Age
If an infant has severe eczema,
4 to 6 Months.”
egg allergy, or both (conditions
that increase the risk of peanut
allergy), age-appropriate, peanut-
containing foods should be
introduced into the diet as early
as age 4 to 6 months. This will
reduce the risk of developing
peanut allergy.

Caregivers should check with

the infant’s healthcare provider
before feeding the infant peanut-
containing foods. A blood test
or skin prick may be
recommended to determine
whether peanut should be
introduced to the infant, and, if
so, the safest way to introduce it.
More information is available in
the Addendum Guidelines for the
Prevention of Peanut Allergy in the
United States at niaid.nih.gov/
sites/default/files/addendum-
peanut-allergy-prevention-
guidelines.pdf.

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B IRTH TH ROUGH 2 3 M O NT HS

Encourage Infants and Toddlers To iron, calcium, potassium, dietary fiber, and vitamin D are
Consume a Variety of Complementary available at DietaryGuidelines.gov.
Foods and Beverages To Meet Energy and
Nutrient Needs
INTRODUCE IRON-RICH FOODS TO INFANTS
Parents, caregivers, and guardians are encouraged
STARTING AT ABOUT 6 MONTHS OLD
to introduce foods across all the food groups—as
described below and carrying forward the principles Iron-rich foods (e.g., meats and seafood rich in heme
in Chapter 1—including items that fit within a iron and iron-fortified infant cereals) are important
family’s preferences, cultural traditions, and budget. components of the infant’s diet from age 6 through
Complementary foods and beverages should be rich in 11 months to maintain adequate iron status, which
nutrients, meet calorie and nutrient requirements during supports neurologic development and immune function.
this critical period of growth and development, and Infants are typically born with body stores of iron
stay within limits of dietary components such as added adequate for about the first 6 months of life, depending
sugars and sodium. Although the Dietary Guidelines does on gestational age, maternal iron status, and timing of
not provide a recommended dietary pattern for infants umbilical cord clamping. By age 6 months, however,
ages 6 through 11 months, infants should be on the infants require an external source of iron apart from
path to a healthy dietary pattern that is recommended human milk.
for those ages 12 through 23 months (see Appendix 3:
USDA Dietary Patterns). Caregivers of infants exclusively fed human milk should
talk with their pediatric care provider about whether
In the United States, some dietary components are there may be a need for infants supplementation with
of public health concern for infants and toddlers. Iron iron before age 6 months. A complementary food source
is a dietary component of public health concern for of iron beginning at about 6 months is particularly
underconsumption among older infants ages 6 through important for infants fed human milk because the iron
11 months who are fed primarily human milk and content of human milk is low and maternal iron intake
consume inadequate iron from complementary foods. during lactation does not increase its content. In the
Older infants who are fed primarily human milk also United States, an estimated 77 percent of infants fed
underconsume zinc and protein from complementary human milk have inadequate iron intake during the
foods, and vitamin D, choline, and potassium are notably second half of infancy, highlighting the importance of
underconsumed by all older infants. During the second introducing iron-rich foods starting at age 6 months.
year of life, the dietary components of public health
concern for underconsumption are vitamin D, calcium, Infants receiving most of their milk feeds as iron-
dietary fiber, and potassium and for overconsumption fortified infant formula are likely to need less iron from
are added sugars and sodium. Lists of dietary sources of complementary foods beginning at 6 months of age. After

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 B I RT H T H R O U G H 23 M ONTHS

age 12 months, children have a lower iron requirement,

but good food sources of iron are still needed to maintain
adequate iron status and prevent deficiency.

INTRODUCE ZINC-RICH FOODS TO INFANTS

STARTING AT ABOUT 6 MONTHS OLD
Zinc-rich complementary foods (e.g., meats, beans, zinc-
fortified infant cereals) are important from age 6 months
onwards to support adequate zinc status, which supports
growth and immune function. Although the zinc content
of human milk is initially high and efficiently absorbed, the
concentration declines over the first 6 months of lactation
and is not affected by maternal zinc intake. During the
second half of infancy, approximately half (54%) of U.S.
infants fed human milk have inadequate zinc intake.
Prioritizing zinc-rich foods starting at 6 months of age to
complement human milk feedings will help infants meet
their requirement for zinc.
• Vegetables and fruits, especially those rich in
potassium, vitamin A, and vitamin C, should be offered
ENCOURAGE A VARIETY OF FOODS FROM ALL
to infants and toddlers age 6 through 23 months. The
FOOD GROUPS TO INFANTS STARTING AT ABOUT
vegetable subgroup of beans, peas, and lentils also
6 MONTHS OLD
provides a good source of protein and dietary fiber.
To support nutrient adequacy, foster acceptance of
healthy foods, and set intakes on a path toward a healthy • For dairy, families can introduce yogurt and cheese,
pattern, it is important to encourage foods from all food including soy-based yogurt, before 12 months.
groups. Because very young children are being exposed However, infants should not consume cow milk, as
to new textures and flavors for the first time, it may take a beverage, or fortified soy beverage, before age 12
up to 8 to 10 exposures for an infant to accept a new type months as a replacement for human milk or infant
of food. Repeated offering of foods such as fruits and formula (see “Cow Milk and Fortified Soy Beverages”).
vegetables increases the likelihood of an infant accepting In the second year of life, when calcium requirements
them. A nutrient-dense, diverse diet from age 6 through increase, dairy products, including milk, yogurt,
23 months of life includes a variety of food sources from cheese, and fortified soy beverages and soy yogurt
each food group. provide a good source of calcium. Vitamin D-fortified
milk and soy beverages also provide a good source of
• Protein foods, including meats, poultry, eggs, vitamin D. For those younger than the age of 2, offer
seafood, nuts, seeds, and soy products, are important dairy products without added sugar (see “Avoid
sources of iron, zinc, protein, choline, and long Added Sugars”).
chain polyunsaturated fatty acids. The long-chain
polyunsaturated fatty acids, specifically the essential • Grains, including iron-fortified infant cereal, play an
omega-3 and omega-6 fatty acids supplied through important role in meeting nutrient needs during this
seafood, nuts, seeds, and oils, influence the infant’s life stage. Infant cereals fortified with iron include oat,
fatty acid status and are among the key nutrients barley, multigrain, and rice cereals. Rice cereal fortified
needed for the rapid brain development that occurs with iron is a good source of nutrients for infants, but
through the infant’s first 2 years of life. Some types of rice cereal shouldn’t be the only type of cereal given
fish such as salmon and trout are also natural sources to infants. Offering young children whole grains more
of vitamin D. To limit exposure to methylmercury from often than refined grains will increase dietary fiber as
seafood, the U.S. Food and Drug Administration and well as potassium intake during the second year
the U.S. Environmental Protection Agency issued joint of life and help young children establish healthy
guidance regarding the types of seafood to choose.1 dietary practices.
1 U.S. Food and Drug Administration and U.S. Environmental Protection Agency. Advice About Eating Fish. Available at FDA.gov/fishadvice;
EPA.gov/fishadvice.

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B IRTH TH ROUGH 2 3 M O NT HS

DIETARY COMPONENTS TO LIMIT

While encouraging intake from each food group, some dietary
components should be limited.

Avoid Added Sugars

Infants and young children have virtually no room in their diet for
added sugars. This is because the nutrient requirements for infants
and young children are quite high relative to their size, but the amount
of complementary foods they consume is small. Complementary
foods need to be nutrient-dense and not contain additional calories
from added sugars. In addition, low- and no-calorie sweeteners, which
can also be called high-intensity sweeteners, are not recommended
for children younger than age 2. Taste preferences are being formed
during this time period, and infants and young children may develop
preferences for overly sweet foods if introduced to very sweet foods
during this timeframe. For more information on added sugars,
see Chapter 1.

Avoid Foods Higher in Sodium

Sodium is found in a number of foods, including some salty snacks,
commercial toddler foods, and processed meats. In addition to
keeping sodium intake within limits for toddlers (see Appendix 1),
another reason to avoid high-sodium foods is that taste preferences
for salty food may be established early in life. Choose fresh or
low-sodium frozen foods, when available, and low-sodium canned
foods to minimize sodium content. For more information on sodium,
see Chapter 1.

Avoid Honey and Unpasteurized Foods and Beverages

Infants should not be given any foods containing raw or cooked
honey. Honey can contain the Clostridium botulinum organism that
could cause serious illness or death among infants. Infants and
young children also should not be given any unpasteurized foods or
beverages, such as unpasteurized juices, milk, yogurt, or cheeses, as
they could contain harmful bacteria.

Establish a Healthy Beverage Pattern

An important part of establishing an overall healthy dietary pattern is
careful consideration of beverages. Guidance for different beverage
categories is provided below.

WATER
For healthy infants with adequate intake of human milk or infant
formula, supplemental water is typically not needed in the first
6 months. Small amounts (up to 4 to 8 ounces per day) of plain,
fluoridated drinking water can be given to infants with the introduction
of complementary foods. Plain, fluoridated drinking water intake
can slowly be increased after age 1 to meet hydration and
fluoride needs.

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 B I RT H T H R O U G H 23 M ONTHS

COW MILK AND FORTIFIED SOY BEVERAGES

Infants should not consume cow milk or fortified soy
beverages before age 12 months to replace human milk
or infant formula. Cow milk does not have the correct
amount of nutrients for infants, and its higher protein
and mineral content are hard for an infant’s kidneys
and digestive system to process. Plain cow milk (whole
milk) or fortified unsweetened soy beverage can be
offered beginning around 12 months of age to help
meet calcium, potassium, vitamin D, and protein needs.
Flavored milks for children age 12 through 23 months
should be avoided because they contain added sugars.

PLANT-BASED MILK ALTERNATIVES

Plant-based milk alternatives, which are sometimes
referred to as milk alternatives, include beverages made
from plants, such as soy, oat, rice, coconut, and almond.
These beverages should not be used in the first year of
life to replace human milk or infant formula. They may
come in different flavors and some forms have added
sugars. Unsweetened versions of these beverages may
be accommodated in small amounts in the diet during
the second year of life, but most have significantly
less protein than cow milk and are not always fortified
with calcium and vitamin D. Among plant-based milk
SUGAR-SWEETENED BEVERAGES
alternatives, only fortified soy beverage is currently
considered a dairy equivalent. Thus, consuming other Sugar-sweetened beverages (e.g., regular soda, juice
plant-based beverages does not contribute to meeting drinks [not 100% fruit juice], sports drinks, and flavored
dairy recommendations. water with sugar) should not be given to children
younger than age 2. Drinks labeled as fruit drinks or
fruit-flavored drinks are not the same as 100% fruit juice
100% FRUIT JUICE
and contain added sugars. These beverages displace
Before age 12 months, 100% fruit or vegetable juices nutrient-dense beverages and foods in the diet of young
should not be given to infants. In the second year of children. Infants and toddlers do not have room in their
life, fruit juice is not necessary, and most fruit intake diets for the additional calories from added sugars
should come from eating whole fruit. If 100% fruit juice found in these beverages. In addition, sugar-sweetened
is provided, up to 4 ounces per day can fit in a healthy beverage intake in infancy and early childhood may
dietary pattern. Juices that contain added sugars should predispose children to consume more of these
be avoided. beverages later in life.

TODDLER MILK AND TODDLER DRINKS CAFFEINATED BEVERAGES

There are no clear needs for toddler milks or drinks. Concerns exist about potential negative health effects of
Needed nutrients can be obtained from cow milk caffeine for young children, and no safe limits of caffeine
or fortified soy beverage and appropriate solid have been established for this age group. Caffeine
foods. Toddler milks and toddler drinks are drinks is a stimulant that can occur naturally in foods and
supplemented with nutrients, and typically contain added beverages or as an additive. Major sources of caffeine
sugars. A variety of nutrient-dense complementary for Americans include beverages such as soft drinks, tea,
foods and beverages without added sugars should be coffee, and sports drinks. Beverages containing caffeine
emphasized for achieving nutrient recommendations. should be avoided for children younger than age 2.

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B IRTH TH ROUGH 2 3 M O NT HS

pattern includes a variety of nutrient-dense fruits,

Healthy Dietary vegetables, grains, protein foods (including lean

Pattern During a meats, poultry, eggs, seafood, nuts, and seeds), dairy
(including milk, yogurt, and cheese), and oils. Based on
Toddler’s Second FDA and EPA’s joint “Advice About Eating Fish,” young
children should eat seafood lowest in methylmercury,
Year of Life and certain species of seafood should be avoided.2 If
young children are lower in body weight, they should eat
In the second year of life, toddlers consume less less seafood than the amounts in the Healthy U.S.-Style
human milk, and infant formula is not recommended. Dietary Pattern. More information is available on the FDA
Calories and nutrients should predominantly be met or EPA websites at FDA.gov/fishadvice and EPA.gov/
from a healthy dietary pattern of age-appropriate foods fishadvice.
and beverages. The Healthy U.S.-Style Dietary Pattern
presented here is intended for toddlers ages 12 through After food group and subgroup recommendations are
23 months who no longer consume human milk or met, a small number of calories are allocated to oils.
infant formula. The pattern represents the types and The recommendation to limit saturated fat to less than
amounts of foods needed to meet energy and nutrition 10 percent of calories per day does not apply to those
requirements for this period (Table 2-1). For toddlers who younger than age 2, and the inclusion of higher fat
are still consuming human milk (approximately one-third versions of dairy is a notable difference in the pattern
at 12 months and 15 percent at 18 months), a healthy for toddlers ages 12 through 23 months compared
dietary pattern should include a similar combination of to patterns for ages 2 and older. However, no calories
nutrient-dense complementary foods and beverages. remain in the pattern for additional saturated fat or
for added sugars. To illustrate the concept of nutrient
Table 2-1 displays the Healthy U.S.-Style Dietary density, Figure 2-1 shows examples of foods and
Pattern to illustrate the specific amounts and limits beverages appropriate for this life stage in forms
for food groups and other dietary components that that are not in nutrient-dense forms compared to those
make up healthy dietary patterns. The pattern is that are in nutrient-dense forms. This dietary pattern
provided at calorie levels ranging from 700 to 1,000 requires careful choices of foods and beverages but
calories per day, which are appropriate for most does not require inclusion of fortified products
toddlers ages 12 through 23 months (see Appendix 2. specifically formulated for infants or toddlers to meet
Estimated Calorie Needs). A healthy dietary nutrient recommendations.

Figure 2-1
Make Healthy Shifts To Empower Toddlers To Eat Nutrient-Dense Foods in Dietary Patterns
Science shows that early food preferences influence later food choices. Make the first choice the healthiest choices
that set the toddlers on a path of making nutrient-dense choices in the years to come. Examples of shifts in common
choices to healthier, more nutrient-dense food choices include:

Cereal with Added Cereal with Minimal Fruit Products with Fruit (e.g., canned in Fried Vegetables Roasted Vegetables
Sugars Added Sugars Added Sugars 100% juice)

High-sodium Snacks Vegetables High-sodium Meats Ground Lean Meats Beverages with Added Unsweetened
Sugars Beverages
2 If consuming up to 2 ounces of seafood per week, children should only be fed cooked varieties from the “Best Choices” list in the FDA/EPA joint “Advice About
Eating Fish,” available at FDA.gov/fishadvice and EPA.gov/fishadvice. If consuming up to 3 ounces of seafood per week, children should only be fed cooked varieties
from the “Best Choices” list that contain even lower methylmercury: flatfish (e.g., flounder), salmon, tilapia, shrimp, catfish, crab, trout, haddock, oysters, sardines,
squid, pollock, anchovies, crawfish, mullet, scallops, whiting, clams, shad, and Atlantic mackerel. If consuming up to 3 ounces of seafood per week, many commonly
consumed varieties of seafood should be avoided because they cannot be consumed at 3 ounces per week by children without the potential of exceeding safe
methylmercury limits; examples that should not be consumed include: canned light tuna or white (albacore) tuna, cod, perch, black sea bass. For a complete list please
see: FDA.gov/fishadvice and EPA.gov/fishadvice.

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 B I RT H T H R O U G H 23 M ONTHS

Table 2-1
Healthy U.S.-Style Dietary Pattern for Toddlers Ages 12 Through 23 Months Who Are No Longer
Receiving Human Milk or Infant Formula, With Daily or Weekly Amounts From Food Groups,
Subgroups, and Components

CALORIE LEVEL OF PATTERNa 700 800 900 1,000

Daily Amount of Food From Each Groupd

FOOD GROUP OR SUBGROUPb,c
(Vegetable and protein foods subgroup amounts are per week.)

Vegetables (cup eq/day) ⅔ ¾ 1 1

Vegetable Subgroups in Weekly Amounts

Dark-Green Vegetables (cup eq/wk) 1 ⅓ ½ ½

Red and Orange Vegetables (cup eq/wk) 1 1¾ 2½ 2½

Beans, Peas, Lentils (cup eq/wk) ¾ ⅓ ½ ½

Starchy Vegetables (cup eq/wk) 1 1½ 2 2

Other Vegetables (cup eq/wk) ¾ 1¼ 1½ 1½

Fruits (cup eq/day) ½ ¾ 1 1

Grains (ounce eq/day) 1¾ 2¼ 2½ 3

Whole Grains (ounce eq/day) 1½ 2 2 2

Refined Grains (ounce eq/day) ¼ ¼ ½ 1

Dairy (cup eq/day) 1⅔ 1¾ 2 2

Protein Foods (ounce eq/day) 2 2 2 2

Protein Foods Subgroups in Weekly Amounts

Meats, Poultry (ounce eq/wk) 8¾ 7 7 7¾

Eggs (ounce eq/wk) 2 2¾ 2½ 2½

Seafood (ounce eq/wk)e 2-3 2-3 2-3 2-3

Nuts, Seeds, Soy Products (ounce eq/wk) 1 1 1¼ 1¼

Oils (grams/day) 9 9 8 13

a Calorie
level ranges: Energy levels are calculated based on median length and body weight reference individuals. Calorie needs vary based on
many factors. The DRI Calculator for Healthcare Professionals, available at usda.gov/fnic/dri-calculator, can be used to estimate calorie needs
based on age, sex, and weight.
b Definitions for each food group and subgroup and quantity (i.e., cup or ounce equivalents) are provided in Chapter 1 and are compiled in
Appendix 3.
c All foods are assumed to be in nutrient-dense forms and prepared with minimal added sugars, refined starches, or sodium. Foods are also lean
or in low-fat forms with the exception of dairy, which includes whole-fat fluid milk, reduced-fat plain yogurts, and reduced-fat cheese. There are no
calories available for additional added sugars, saturated fat, or to eat more than the recommended amount of food in a food group.
d In some cases, food subgroup amounts are greatest at the lower calorie levels to help achieve nutrient adequacy when relatively small number
of calories are required.
e If consuming up to 2 ounces of seafood per week, children should only be fed cooked varieties from the “Best Choices” list in the FDA/EPA joint
“Advice About Eating Fish,” available at FDA.gov/fishadvice and EPA.gov/fishadvice. If consuming up to 3 ounces of seafood per week, children
should only be fed cooked varieties from the “Best Choices” list that contain even lower methylmercury: flatfish (e.g., flounder), salmon, tilapia,
shrimp, catfish, crab, trout, haddock, oysters, sardines, squid, pollock, anchovies, crawfish, mullet, scallops, whiting, clams, shad, and Atlantic
mackerel. If consuming up to 3 ounces of seafood per week, many commonly consumed varieties of seafood should be avoided because they
cannot be consumed at 3 ounces per week by children without the potential of exceeding safe methylmercury limits; examples that should not be
consumed include: canned light tuna or white (albacore) tuna, cod, perch, black sea bass. For a complete list please see: FDA.gov/fishadvice and
EPA.gov/fishadvice.

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B IRTH TH ROUGH 2 3 M O NT HS

Current Intakes
Figure 2-2 and 2-3 highlight the dietary intakes of toddlers during the second year of life. Average intakes of the
food groups are compared to the range of recommended intakes at the calorie levels most relevant to males and
females in this age group (Figure 2-2). Additionally, the average intakes and range of intakes of added sugars,
saturated fat, and sodium are displayed. Average intakes compared to recommended intake ranges of the subgroups
for grains are represented in daily amounts; subgroups for vegetables and protein foods are represented in weekly
amounts (Figure 2-3).

Figure 2-2
Current Intakes: Ages 12 Through 23 Months
Average Daily Food Group Intakes Compared to
Recommended Intake Ranges

Recommended Intake Ranges Average Intakes

3.5

3.0

2.5
CUP or OZ EQUIVALENT

2.0

1.5

1.0

0.5

0
Total Total Total Total Total
Vegetables Fruits Grains Dairy Protein Foods
cup eq/day cup eq/day oz eq/day cup eq/day oz eq/day

FOOD GROUPS

Average Intakes of Added Sugars, Saturated Fat, and Sodium

Added Sugars Saturated Fat Sodium

Limit: Avoid Limit: N/A Limit: 1,200 mg
Average Intakes Average Intakes Average Intakes

104 kcals 167 kcals 1,586 mg

Data Sources: Average Intakes: Analysis of What We Eat in America, NHANES 2007-2016, day 1 dietary intake data, weighted. Recommended
Intake Ranges: Healthy U.S.-Style Dietary Patterns (see Appendix 3).

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Ages 12-23 months
 B I RT H T H R O U G H 23 M ONTHS

Figure 2-3 Approximately 60 percent of toddlers meet or exceed

Average Intakes of Subgroups Compared to recommended intakes for fruit. A majority of fruit
Recommended Intake Ranges: Ages 12 Through is consumed as whole fruit (fresh, canned, puréed,
23 Months frozen) or as 100% fruit juice. Average intake of total
vegetables is below the range of recommended
Recommended Intake Ranges Average Intakes
amounts, with nearly 90 percent of toddlers falling short
Vegetables of recommendations. About one-half of vegetables are
3.0
consumed on their own, one-quarter are consumed as
2.5 part of a mixed dish, and nearly 5 percent are consumed
as savory snacks (e.g., potato chips).
CUP EQUIVALENT

2.0
Total grains, particularly refined grains, are consumed
1.5
in amounts that exceed recommendations. Conversely,
1.0 intakes of whole grains fall short of recommended
amounts for more than 95 percent of toddlers. A
0.5 majority of grains are consumed through breads, rolls,
tortillas, or other bread products or as part of a mixed
0
dish. Ten percent of grains come from sweet bakery
Total Dark- Red & Beans, Starchy Other
Vegetables Green Orange Peas, products and approximately 15 percent come from
cup eq/day Lentils crackers and savory snacks. Many of these categories
cup eq/week are top sources of sodium or added sugars in this
Grains age group.
3.5

3.0 Average intakes of dairy foods, most of which is

consumed as milk, generally exceed recommended
2.5 amounts in this age group. Intakes of yogurt and cheese
OZ EQUIVALENT

2.0 account for about 10 percent of dairy intakes. Plant-

based beverages and flavored milks each make up
1.5
about 2 percent of dairy intakes among toddlers.
1.0
Protein foods intakes fall within recommended range,
0.5
on average. Intakes of meats, poultry, and eggs make
0 up a majority of protein foods intakes, however seafood
Total Whole Grains Refined Grains
Grains intakes in this age group is low. Children in this age
oz eq/day group can reduce sodium intake by eating less cured or
processed meats including hot dogs, deli meats,
Protein Foods and sausages.
12

10 Due to the relatively high nutrient needs of toddlers, a

healthy dietary pattern has virtually no room for added
8 sugars. Toddlers consume an average of more than 100
OZ EQUIVALENT

calories from added sugars each day, ranging from 40 to

6
250 calories a day (about 2.5 to 16 teaspoons). Sugar-
4 sweetened beverages, particularly fruit drinks, contribute
more than 25 percent of total added sugars intakes and
2 sweet bakery products contribute about 15 percent.
Other food category sources contribute a smaller
0
Total Meats, Eggs Seafood Nuts, Seeds, proportion of total added sugars on their own, but the
Protein Foods Poultry Soy Products wide variety of sources, which include yogurts, ready-to-
oz eq/day oz eq/week eat cereals, candy, fruits, flavored milk, milk substitutes,
Data Sources: Average Intakes: Analysis of What We Eat in baby food products, and breads, points to the need to
America, NHANES 2007-2016, day 1 dietary intake data, weighted. make careful choices across all foods.
Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns
(see Appendix 3).

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B IRTH TH ROUGH 2 3 M O NT HS

Vegetarian Dietary Pattern During the Second Year of Life

A Healthy Vegetarian Dietary Pattern for young children ages 12 through 23 months who
are not fed human milk or infant formula is included in Appendix 3. This pattern describes
a lacto-ovo vegetarian diet that includes regular consumption of eggs, dairy products, soy
products, and nuts or seeds, in addition to vegetables including beans, peas, and lentils, fruits,
grains, and oils. Iron may be of particular concern because plant source foods contain only
non-heme iron, which is less bioavailable than is heme iron. Food source lists for both heme and non-heme
iron are available at DietaryGuidelines.gov. Vitamin B12 also may be of concern because it is present only in
animal source foods. When feeding infants and toddlers a lacto-ovo vegetarian diet, parents, caregivers, and
guardians should consult with a healthcare provider to determine whether supplementation of iron, vitamin
B12, and/or other nutrients is necessary and if so, appropriate levels to meet their unique needs.

Supporting Healthy Eating

Parents, guardians, and caregivers play an important role in nutrition during this life stage because infants and
toddlers are fully reliant on them for their needs. In addition to “what” to feed children, “how” to feed young children
also is critical. As noted above, repeated exposure to foods can increase acceptance of new foods. Another
important concept is responsive feeding, a feeding style that emphasizes recognizing and responding to the hunger
or fullness cues of an infant or young child (see “Responsive Feeding”).

Responsive Feeding Table 2-2

Responsive feeding is a term Signs a Child is Hungry or Full
used to describe a feeding style
that emphasizes recognizing Birth Through Age 5 Months
and responding to the hunger or
fullness cues of an infant or young A child may be hungry if he or she: A child may be full if he or she:
child. Responsive feeding helps • Puts hands to mouth. • Closes mouth.
young children learn how to self- • Turns head toward breast or bottle. • Turns head away from breast or bottle.
• Puckers, smacks, or licks lips. • Relaxes hands.
regulate their intake. • Has clenched hands.

See Table 2-2 for some examples

Age 6 Through 23 Months
of signs a child may show for
hunger and fullness when he or
she is a newborn through age 5 A child may be hungry if he or she: A child may be full if he or she:
• Reaches for or points to food. • Pushes food away.
months, and signs a child may
• Opens his or her mouth when offered a • Closes his or her mouth when food is
start to show between age 6 spoon or food. offered.
through 23 months. • Gets excited when he or she sees food. • Turns his or her head away from food.
• Uses hand motions or makes sounds to • Uses hand motions or makes sounds to
let you know he or she is still hungry. let you know he or she is still full.
It is important to listen to the
child’s hunger and fullness cues
to build healthy eating habits during this critical age. If parents, guardians, or caregivers have questions or concerns, a
conversation with a healthcare provider will be helpful.

For more information on signs a child is hungry or full, see: cdc.gov/nutritioninfantandtoddlernutrition/mealtime/

signs-your-child-is-hungry-or-full.html. More information on infant development skills, hunger and satiety cues, and
typical daily portion sizes is available at wicworks.fns.usda.gov/sites/default/files/media/document/Infant_Nutrition_
and_Feeding_Guide.pdf.

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