The first 1,000 days after birth can shape a young human's taste preferences and impact his or her health for decades to come.
So it may be odd that much of this period was generally missing from the U.S. government’s official advice on diet and nutrition.
No more: This month, a panel of experts working on the 2020-2025 Dietary Guidelines for Americans revealed its recommendations for babies and toddlers as part of its final scientific report.
It will inform the new edition of the guidelines, to be published at the end of this year, which will cover “appropriate nutrition during the earliest stages of life” — from birth until 2 years of age — for the first time.
Experts say diet during this period can impact everything from the growth of a child’s body and organs to neurological development.
“For pediatricians, we consider that a hugely critical time,” Dr. Jae Kim, director of neonatology at Cincinnati Children’s Hospital Medical Center in Ohio, told TODAY.
“We know that a significant amount of brain development and growth occurs in that two-year period. That’s why you can see a child grow to the age of 2 and their head size is pretty close to an adult’s size by that age, so you know a lot is happening.”
The proposed advice contains established guidelines, said Dr. Claire McCarthy, a pediatrician at Boston Children's Hospital and an assistant professor of pediatrics at Harvard Medical School.
Kim called the addition very helpful for parents and doctors, and a good way to encourage more research in areas of infant nutrition where there are still gaps.
The recommendations include:
Introduce peanut and egg in the first year of life
Adding these items to the menu after babies are 4 months old may reduce the risk of allergy to these foods, the report noted.
“We used to have parents hold off on foods that commonly cause allergy, and now we give the exact opposite advice,” McCarthy said.
Parents should talk with their pediatricians about exactly when and how to give peanut products, she advised. It’s particularly important when it comes to kids with eczema since they might be at higher risk of developing a peanut allergy, but doctors like to do some allergy testing first in some cases. Most babies don’t need the testing, but parents should check with their doctors, McCarthy noted.
Breast milk is best
Any breastfeeding may reduce a child’s risk of becoming overweight or obese, and having type 1 diabetes or asthma, compared to never being breastfed, the report noted.
“It is the food that was specifically designed for babies, and breast feeding is associated with all sorts of good outcomes,” McCarthy said. “But if mothers can’t breastfeed, or really don’t want to for some reason, there is far more to good outcomes than breastfeeding.”
Women should discuss it with their doctors, and should definitely reach out for help if they have problems with breastfeeding, she added.
Vitamin D: More than the recommended amount isn’t better
The American Academy of Pediatrics recommends all infants and children should start getting a minimum of 400 international units of vitamin D a day soon after birth. Kids who don’t get enough of the nutrient can develop rickets, a weakening of the bones.
But the report found no evidence to recommend a bigger dose of the vitamin, which the body can manufacture when the skin is exposed to the sun. Supplements are necessary for babies who are exclusively or partially breastfed, the AAP noted.
“It wasn’t that Mother Nature got it wrong and breast milk doesn’t have enough vitamin D,” Kim explained. “It’s just that physically, we’re meant to be outside… so lactating mothers would normally be generating a lot more vitamin D if they were exposed to a lot more sunlight.”
Since people are protecting their skin from the sun, both mom and baby get vitamin D supplements for optimum health, he noted.
Introduce first foods at 6 months
Many parents are confused about when to start feeding babies solid foods and the report offers guidance: Babies shouldn’t be given “complementary foods and beverages” before the age of 4 months, and adding them to the menu at age 4 or 5 months didn’t offer any real benefit compared to starting at 6 months.
“Babies don’t need solid foods before 6 months. They are fine with breast milk or formula,” McCarthy said. “It’s certainly not a good idea to give a baby solid foods before 4 months — their bodies aren’t ready for it.”
Avoid added sugar during first 2 years of life
Sugary drinks and foods leave less room for energy from more nutritious options, potentially leading to nutrient gaps, the report noted. Plus, they may raise the risk of a child becoming overweight and set the stage for wanting more such sweet treats in the years to come.
That’s “really, really important” advice because marketing leads many parents to believe their kids should get juices and other drinks that contain a lot of sugars, which are not necessary, Kim advised.
Sugary drinks are also bad for a child’s teeth and carrying around a bottle or cup of juice increases the risk of cavities, McCarthy added.
Water, unsweetened milk, formula or breast milk are all kids need to drink, she said.
“Even juice that is 100% juice is discouraged,” McCarthy cautioned.
“There is research that shows that babies who are overweight turn into toddlers who are overweight who grow into adolescents who are overweight. The bottom line is that obesity starts early, and starting healthy eating habits early — like not drinking sugar-sweetened beverages — is key.”
The U.S Department of Agriculture and U.S. Department of Health and Human Services, which are co-developing the 2020-2025 Dietary Guidelines for Americans, are holding a public meeting on the scientific report on Aug. 11.