Children under 2 years should avoid all added sugars, says Dietary Guidelines Advisory Committee

“The importance of carefully choosing these foods may not be fully appreciated by the public,”​ warned Kay Dewey, a maternal and child nutrition expert and chair of the 2020 Dietary Guidelines advisory subcommittee tasked with creating the first ever dietary guidelines for children younger than 24 months.

She explained during the 2020 Dietary Guidelines advisory committee draft advisory report meeting on June 17 that “there’s a rhyme that says ‘food before one is just for fun,’ and that implies that the only [feeding] goal during the infants to one [year age range] is fostering pleasant, soothing eating experiences and that the nutritional contribution of complementary feeding is not critical.”​

However, she said, “that’s really not true.”​ Rather, she explained, the nutritional needs of children younger than 2 years are high relative to their energy requirements – meaning there is very little room for discretionary energy intake, including from added sugars and oil.

While this recommendation is potentially controversial given how many young children consume flavored milks, sugar sweetened beverages and other sweetened purees or standbys, Dewey supported her statement by pointing to sample diet modeling created by the subcommittee.

To meet children’s nutritional needs without exceeding energy intake, she said, the committee found “the combinations of foods needed to achieve recommended intake of key nutrients for ages six to 24 months leave virtually no remaining dietary energy for added sugars, apart from the very small amounts (less than 3 grams per day) already inherent in foods used in modeling.”​

Moreover,​ Dewey pointed out in her presentation, "consumption of sugar-sweetened beverages is linked with increased risk of overweight or obesity,”​ and could adversely influence the development of food preferences and patterns which begin to form during this life stage..

In slides, she explained, “taste and flavor preferences appear to be more malleable in this life stage than in older children, [thus] it is important that caregivers limit consumption of foods that contain added sugars, while encouraging consumption of nutrient-dense foods.”​

With this in mind, she asked the federal agencies to directly address in the upcoming 2020 Dietary Guidelines for Americans common misconceptions about diets for infants and children and clearly communicate that “a more appropriate message is that ‘every bite counts,’ which emphasizes the nutrients of concern while also conveying the need to make eating enjoyable and the importance of responsive feeding practices.”​

Offer a variety of food​

To further foster acceptance of a variety of nutritious foods and build healthy dietary habits, the subcommittee also recommends that beginning between six and 12 months of age children be offered a variety of animal-sourced foods, fruits and vegetables, nuts and seeds and whole grain products.

Recognizing that not all families consume animal products, Dewey noted that a vegan diet free from animal products could not provide sufficient nutrient intake for this age group without supplementation. But, she said, a carefully crafted lacto- ovo- vegetarian diet could provide key nutrients of desire while also minimizing nutrients of concern.

Special attention should be paid to iron, fatty acids​

Even when following a healthy diet, some nutrients are more difficult to obtain and therefore will require a more conscious effort, Dewey noted.

For example, the subcommittee recommends that infants fed human milk at six to 12 months should be fed iron-fortified infant cereals or similar products to ensure adequate iron intake. Children fed formula or mix fed may not need additional iron fortified food as their formula likely has sufficient amounts.

Omega-3 and -6 fatty acids are another key nutrient of concern that can be provided through low methylmercury seafood beginning between six and 12 months, according to the subcommittee.

The subcommittee also recommends that children between six and 12 months be introduced to peanut products in forms that do not pose a choking risk as building evidence suggests exposure could help reduce the risk of allergies. Evidence regarding benefits of introducing other potential allergens, such as tree nuts, shellfish or fish in the first year of life is limited, but “there is no reason to avoid them,”​ Dewey said.

A starting point​

While the subcommittee crafted several examples of dietary patterns that would achieve the nutrient needs of children six to 24 months without exceeding their necessary energy intake, it also emphasized that the recommendations were just that – recommendations.

“These findings are not intended to provide a combination of complementary feeding or food patterns that is right for every infant or toddler, because children develop at different rates and many different circumstances influence feeding needs and decisions,”​ Dewey reported.

For example, she said, toddlers with relatively low energy intakes may benefit from food combinations that resemble those for six to 12 months, with a gradual shift to patterns presented for older children aged 12 to 24 months.

“A general principle is to view the period of six to 24 months as a continuous transition form diets appropriate for infants to diets that resemble family food patterns,”​ she said.

“Food patterns are not necessary for infants younger than six months”​

While the subcommittee was tasked with researching and developing, if possible, dietary patterns for children from birth to 24 months, the committee determined that no such pattern is necessary for infants younger than six months.

Dewey explained that most health experts agree that breast feeding infants exclusively for the first six months is best, if possible. If breast feeding or breast feeding exclusively is not an option, commercial infant formula generally is recommended until 12 months.

The subcommittee also was unable to craft dietary patterns for older children who were breast fed, but they did provide examples of combinations of foods.

While yesterday’s meeting gave experts a chance to present and ask questions about the Dietary Guidelines Advisory Committee’s draft recommendations, the full recommendations will not be presented to USDA and HHS until the end of the month. At that time, the agencies will consider the committee’s scientific review as it develops the full 2020-2025 Dietary Guidelines for Americans, slated for delivery later this year.