TABLE 1.

References to children <2 y in DGA and related documents¹

2nd edition DGA (1985): guidance relevant to infants2

• “Infants also have special nutritional needs. Infants should be breast-fed unless there are special problems. The nutrients in human breast milk tend to be more available than those in cow's milk. In addition, breast milk serves to transfer immunity to some diseases from the mother to the infant.” (p 4).

• “Normally most babies are not given solid foods until they are 3 to 6 months old. At that time, other foods can be introduced gradually. Prolonged breast- or bottle-feeding—without solid foods or supplemental iron—can result in iron deficiency.” (p 4).

• “You should not add salt or sugar to the baby's foods. Infants do not need these inducements if they are really hungry. The foods are nourishing and extra flavoring with salt and sugar is not necessary.” (p 4).

• “To ensure your infant receives an adequate diet:

○ Breastfeed unless there are special problems

○ Delay other foods until the infant is 3–6 mo old

○ Do not add salt or sugar to the infant's food” (p 4).

3rd edition DGA (1990)3

• “The guidelines in this bulletin are not intended for infants. Food and nutrient needs of infants are different from those of older children and adults.” (p 7)

• “Mother's milk is the best food for nearly all infants. It contains the ideal balance of nutrients and other substances to promote growth. It also transfers immunity to some diseases from the mother to the infant.” (p 7).

• “To help prevent tooth decay in newly growing teeth, infants should not use as pacifiers nursing bottles containing any beverage other than water.”

• “Babies are generally not given solid foods until they are 4–6 months old. The foods are introduced gradually—no more than one new food each week. The doctor should advise on how to get adequate iron into the baby's diet.” (p 7).

• “Salt and sugar should not be added to an infant's food; they are not needed as inducements to eat.” (p 7).

• The DGAC recognized some specific needs to be addressed by the DGA including the need to “give attention to special guidance for groups within the population such as infants, children, and elderly persons” (p 15).

• With regard to the audience for the DGA: “Children under 2 years of age are specifically excluded as users of these guidelines because their nutritional needs and dietary patterns differ from those of older children and adults” (p 20).

• “Infants. The Committee specifically excluded children under 2 years of age in developing these guidelines because their nutritional needs and eating patterns differ from those of older children and adults. However, the Committee wanted to include some dietary advice for this important part of the population. The text for the variety guideline seemed the best place for the advice. It appears near the front of the bulletin and earlier editions included some advice about diets of infants here. Also, the concepts in this guideline—meeting nutritional needs and consuming a variety of foods—are the main factors that distinguish the infant's diet from diets of older people” (p 22).

• “The brief advice on infants’ diets included is consistent with advice from the AAP and the AAPD.” (p 22).

• “A caution about using bottles as pacifiers was added because of the increased risk for tooth decay. Infants who use nursing bottles containing milk, formula, or juice as pacifiers and who breast feed on demand at times other than normal feedings and throughout the evening often develop early, multiple caries lesions. The AAPD believes that a meaningful portion of the caries observed in young children (12–24 mo of age) is traceable to such practices. The infant's need for adequate iron from foods and possibly a supplement as advised by a physician is emphasized.” (p 22).

• With regard to the use of dietary guideline regarding fat: “The Committee notes that this guideline is not for children under 2 years, recognizing that a few over-zealous parents have severely limited their infants’ intakes of fat, thus causing them to fail to thrive. The AAP Committee on Nutrition recommends against fat reduction for children under 2 years of age” (p 27).

4th edition DGA (1995)4

• “Although limiting fat intake may help to prevent excess weight gain in children, fat should not be restricted for children younger than 2 years of age.” (p 27).

7th edition DGA (2010)5: questions and answers

• “Why are the Dietary Guidelines only for ages 2 years and older? The DGA has always focused on adults and children 2 years of age and older. Children under 2 years of age are not included because their nutritional needs and eating patterns vary by their developmental stage and differ substantially from those of older children and adults. A separate committee for reviewing nutrition and physical activity needs of pregnant women and children from birth to 2 years old could be beneficial as it would be made up of scientists and nutrition professionals who are experts in those very specialized topic areas of infant development and infant feeding practices.”

¹AAP, American Academy of Pediatrics; AAPD, American Academy of Pediatric Dentistry; DGA, Dietary Guidelines for Americans; DGAC, Dietary Guidelines Advisory Committee.

²US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 1985. Washington DC: US Department of Health and Human Services, US Department of Agriculture, 1985.

³US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 1990. Washington DC: US Department of Health and Human Services, US Department of Agriculture, 1990.

⁴US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 1995. Washington DC: US Department of Health and Human Services, US Department of Agriculture, 1995.

⁵US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. Washington DC: US Government Printing Office, 2010.