NEWS

Infant Feeding Guidelines Globally Consistent, Report Shows

Feeding baby in high chair
Feeding baby in high chair.

 monkeybusinessimages/Getty Images

Key Takeaways:

  • A committee from the National Academies of Sciences, Engineering, and Medicine compared baby feeding guidelines globally and found consistency around the world, with a few exceptions.
  • The Dietary Guidelines for Americans, 2020-2025 (DGA) now provide guidance on feeding babies from birth to 24 months of age, and align with global guidelines.
  • The DGA includes age-appropriate advice on starting solids, managing food allergy risk and avoiding sugar.

In 2020, the National Academies of Sciences, Engineering and Medicine (NASEM) released the Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. The report looked at 43 feeding guidelines from high-income countries around the world, and examined the consistencies and inconsistencies between them.

A recent research commentary in the Journal of the Academy of Nutrition and Dietetics (JAND) provided an overview of the NASEM guidelines.

The good news? Feeding guidelines are quite consistent between organizations and across the globe, and also mesh with Dietary Guidelines for Americans, 2020-2025 (DGA), which provided guidance for babies from birth to 24 months of age for the first time.

Elizabeth Yakes Jimenez, PhD, a research associate professor in the Department of Pediatrics at University of New Mexico Health Sciences Center in Albuquerque, NM, is one of the authors of the JAND commentary, and a committee member of the NASEM paper. 

“Overall, I feel that the key recommendations for infants and toddlers in the DGA for Americans and the guidance from other high-income countries that was summarized in the NASEM report were generally aligned,” says Jimenez.

Feeding a baby? Here are some of the guidelines from the DGA, along with commentary of what's consistent with global infant feeding guidelines.

Breast milk and Formula

The early feeding recommendations from the DGA are consistent with other guidance worldwide, and offer these recommendations:

  • For about the first 6 months of life, exclusively feed infants human milk. Continue to feed infants human milk for the first year of life, and longer if desired.
  • If human milk is not available, feed infants iron-fortified commercial infant formula during the first year of life.
  • Infants fed exclusively human milk or a combo of human milk and infant formula require a daily vitamin D supplement of 400 IU.
  • Vitamin D supplementation is not needed if the baby is exclusively formula fed, since formula is fortified with vitamin D.

Introducing Solids

In the past, there has been mixed advice globally on when to introduce solids to your baby.

Jimenez says this is one place where the global guidelines are not exactly aligned, but they are generally consistent in saying that complementary foods shouldn't be introduced before four months and should be introduced by or around six months of age. 

The DGA recommendation says to introduce solids at about six months of age to compliment human milk or infant formula feedings. Note the key word is “about.”

“This flexible wording allows for some level of healthcare provider and caregiver judgement regarding when it is appropriate to start complementary feeding for a specific child,” says Jimenez.

Gabrielle McPherson, a registered dietitian in St. Louis, MO works with young families and encourages parents to start solid foods when their baby is around six months of age and shows signs of readiness.

Being ready for solids is more important than the exact age of the baby, so there is some leeway here.

“If the baby can demonstrate good head, neck, and trunk control and can sit up on their own for a least one minute, that is a readiness sign,” says McPherson.

The DGA lists these additional signs to show if a baby is ready for solids:

  • Shows interest in eating foods.
  • Opens mouth when food is offered.
  • Can bring objects to mouth.
  • Tries to grasp small objects.
  • Can swallow food rather than push it back out.

The first food you introduce to baby can be vegetables, fruit, fortified infant cereal, meat or beans—as long as the texture, size and shape are appropriate for a baby.

Avoid foods that are choking hazards, such as hot dogs, candy, nuts, raw carrots, grapes or popcorn.

Nutrients of Concern

In addition to vitamin D, there are other nutrients to pay special attention to in a baby’s diet.

Iron and zinc stores start to deplete at around six months of age. Babies should be offered foods rich in iron and zinc daily, including meat, dark poultry, beans, lentils and fortified infant cereals.

Gabrielle McPherson, RD

Infants need good nutrition to help them thrive. They grow very rapidly in the first year of life and need lots of nutrients to support this growth.

— Gabrielle McPherson, RD

There is some inconsistency in the guidelines as to which infants may require iron supplements, so that's best discussed with your doctor. 

Another nutrient of concern is vitamin B12. “If a mother is exclusively breastfeeding and is deficient in vitamin B12—a concern for those following a vegan lifestyle—supplementation for the infant may be indicated.” says Lauren Manaker, a Charleston, SC-based dietitian and author of Fueling Male Fertility

But do babies require multivitamins? “Although there are always exceptions to the rule, a multivitamin is not routinely required for babies if they are eating a wide variety of foods,” says Manaker.

Minimizing Food Allergy Risk

“In the past, parents were told to avoid potentially allergenic foods until the baby turns two years old” says Manaker. “Now, guidelines have taken a 180-degree turn and babies should now be exposed to these foods in an age-appropriate way early and often to reduce allergy risk.”

Jimenez says the recommendation to not delay the introduction of allergenic foods is consistent with guidance from other organizations globally.

Potential allergens, such as peanuts, tree nuts, and eggs, can be introduced as baby’s first foods beginning as early as four months, but ideally at six months.

Studies show that introducing peanut-containing foods in the first year reduces the risk that an infant will develop a peanut allergy.

Note: If your baby has eczema or an egg allergy, read the full report on how to safely introduce peanuts.

Limit Sugar

The DGA says that children under age two should avoid foods and beverages with added sugars, and Jimenez says these guidelines are consistent across the guidelines reviewed by NASEM.

At this age, the average baby takes in about 100 calories (about six teaspoons) from added sugar—and that’s too much.

“I advise clients to avoid giving sweet treats to their babies,” says McPherson. “Infants need good nutrition to help them thrive. They grow very rapidly in the first year of life and need lots of nutrients to support this growth. They have their whole lives to eat foods with added sugars—for now, each bite they take is shaping their health, so make every bite count.”

If babies fill up on sugary foods, such as soda or cookies, they won’t be hungry for more nutritious foods, such as vegetables and milk (breast, formula or other). Plus, if babies get used to sugary foods, it will affect their taste preferences and they may always desire sweets.

What’s Next?

Manaker says she was thrilled that guidelines for feeding infants and toddlers were provided in the DGA. Now the advice needs to make its way to parents and caregivers.

Lauren Manaker, MS, RDN, LD

Having guidelines available will hopefully give parents more confidence when making food choices for their children, which will ultimately support their children's overall health.

— Lauren Manaker, MS, RDN, LD

“Having guidelines available will hopefully give parents more confidence when making food choices for their children, which will ultimately support their children's overall health,” says Manaker.  

The NASEM report highlights the need for additional research related to the length of breastfeeding and the age of intruding solids and allergenic foods, and which infants require vitamin D and iron supplementation.

Jimenez says the NASEM report highlighted several gaps related to how to best communicate and disseminate infant feeding guidelines to stakeholders, such as parents, healthcare providers, early care and education providers, program administrators, and policy makers.

Figuring out the best way to communicate infant feeding guidelines to parents and caregivers is what comes next.

What This Means For You:

if you’re feeding a baby, turn to the Dietary Guidelines for Americans for up-to-date and evidence-based feeding guidelines that are consistent with advice that’s used globally. 

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4 Sources
Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Dewey K, Harrison M, eds. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. The National Academies Press; 2020.

  2. Jimenez EY, Pérez-Escamilla R, Atkinson SA. Existing guidance on feeding infants and children from birth to 24 months: implications and next steps for registered dietitian nutritionists. J Acad Nutr Diet. 2021 Apr;121(4):647-654. doi:10.1016/j.jand.2020.12.016

  3. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020.

  4. Du Toit G, Sayre PH, Roberts G, et al. Effect of avoidance on peanut allergy after early peanut consumptionN Engl J Med. 2016 Apr 14;374(15):1435-1443. doi:10.1056/NEJMoa1514209