New DGA Recommendations for Infants, Pregnancy and Lactation
For the first time ever, the Dietary Guidelines for Americans (DGA) includes specific recommendations for infants (birth to age 2), pregnancy and lactation – highlighting this critical window of human development. The 2020-2025 DGA also underscores the social and nurturing aspect of feeding and eating, providing ideas to embrace cultural nutrition practices as well as economic challenges faced by families. This perspective corresponds to the World Health Organization (WHO) life-course approach to health and to the approach taken by the Maternal and Child Health Bureau.
Pregnancy and Lactation
Pregnancy sets the stage for the health of an infant. Optimal nutrition for the expectant mother offers the best opportunity for health of the mother during pregnancy, adequate nutrient stores in the newborn, and preparation for successful lactation and breastfeeding. The concept of the first 1,000 days acknowledges the importance of early exposure to adequate nutrition and adherence to best practice infant feeding on the immediate health of the mother and infant. Three servings of dairy products are recommended to meet needs for calcium, phosphorus and a protein source that provides vitamin B12 in an economical and easily accessible form. Calcium needs are higher in pregnancy and lactation and current intakes of dairy foods in this population fall below recommended intakes.
Infants: Birth to 2 Years of Age
Timing is everything. Early food experiences impact food choices and eating behaviors later in life. Milk is the cornerstone of a nutrient-rich diet for infants and young children, providing high-quality protein as a building block of lean body mass and cell structure with calcium and phosphorus to support a developing skeleton.
Consistent with recommendations from the American Academy of Pediatrics and WHO, breastfeeding is preferred for infants. Breast milk, even if provided via bottle for infants unable to nurse, provides unparalleled support for the developing infant. If breast milk is not available infants should be provided an infant formula manufactured consistent with the Infant Formula Act to support optimal growth and development.
Feeding Infants Solid Food
Introduction of solid foods that complements breast or bottle feeding should not occur before age 4 months. Developmental readiness for complementary feeding in the developing infant usually occurs around 6 months: These infants demonstrate good trunk and head control and show interest in food consumed by their family. Dairy products – such as yogurt, cheese, kefir and cream – can be safely introduced along with other foods. This follows specific guidance for early exposure to highly allergenic foods as part of food allergy prevention guidelines while offering a source of calcium and phosphorus for a growing skeleton as well as high-quality protein.
Once a child demonstrates that they are a competent eater of solid foods (ranging between 12-18 months) weaning from breast milk or baby formula to whole, full-fat cow’s milk can be considered. Lactose-free whole cow’s milk is widely available to manage lactose intolerance. Fortified soy beverages are recommended in the Dietary Guidelines for Americans for cow’s milk allergy; however, individuals with a complex allergy may require alternatives to soy beverages.
Sugar-sweetened beverages and juice, even 100% juice, are not recommended for infants less than 12 months of age, and children under age 2 should avoid them – though some 100% juice in small amounts is acceptable. Water is used to help infants learn to drink from cups and straws in preparation for weaning from breast or bottle feeding and builds on the 2019 Robert Wood Johnson Foundation Healthy Eating Research recommendations of milk with meals and water in between.
Dairy for Decades
The need for high-quality dairy foods does not end at age 2. Growing children have increasing lean body mass that includes a larger skeleton, our bodies primary depot of calcium. Development of peak bone density occurs in the first three decades of life. Children and adolescents currently have intakes of dairy below recommended amounts, with females consuming less than males contributing to risk for entering pregnancy with less than adequate stores and leading to risk of osteopenia and osteoporosis in middle to late adulthood. Incorporating dairy in a balanced and nutrient-rich dietary pattern provides a foundation for a body that is healthy, strong and ready to enjoy and experience all that life has to offer.
Start Simple and Sustain for a Lifetime of Health
The USDA MyPlate tool shows individuals how to implement the new guidelines for any age group. Hand-sized portions of MyPlate sections help adults manage weight while meeting nutrient needs and help parents gauge adequate portions for children of varying ages (i.e., babies need baby handfuls, and children need child-sized handfuls) in an easy-to-understand visual tool.
Help your patients, regardless of life stage, make every bite count with the 2020 Dietary Guidelines for Americans.