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Every bite counts

Pediatrician digests new dietary guidelines for babies and toddlers.

Article Author: Juice Staff

Article Date:

baby boy smashing a cake with his hand with cake all over his face

A first birthday isn’t complete without a personal cake for the baby to devour and, more importantly, smash. Known as a “smash cake,” the celebratory tradition is an entertaining way to give babies a first real taste of sugar.

But parents might want to rethink contributing to a developing sweet tooth so early, as new dietary guidelines recommend feeding babies only breast milk or formula for at least the first six months of life and not giving children under 2 anything with added sugar. After age 2, the guidelines recommend added sugar be kept below 10% of daily calories consumed.

Issued every five years by the United States Department of Agriculture and the Department of Health and Human Services, this is the first time the guidelines have included recommendations for babies and toddlers.

“Although I don’t see the celebratory smash cake going away, I would like to see parents think more about the sugar intake in a child’s life and promote healthy choices as little ones are learning about food,” said Stephen Silberman, MD, a board-certified pediatrician with Baptist Pediatrics and Wolfson Children’s Hospital of Jacksonville. “It’s never too early to start following a healthy dietary pattern, as eating habits established early in life have been shown to shape later eating behaviors.”

Keep it simple

According to the guidelines, babies should be exclusively breastfed until they are 6 months old, at which point parents can begin to introduce nutrient-dense, complementary foods such as cooked spinach and sweet potatoes. Breastfeeding should continue through at least the first year. Infants who are exclusively breastfed may require supplementation as breast milk contains very little iron and vitamin D. Parents should consult their child’s pediatrician to ask about the proper doses and types of supplements.

If a parent is unable or does not want to breastfeed, the guidelines recommend an iron-fortified formula.

“Formula companies have done extensive research to match the nutritional composition of breast milk as closely as possible,” said Dr. Silberman. “For babies who are healthy and full-term, I typically recommend starting out with a cow’s milk-based formula because most do well on that protein. It is also an iron-fortified formula, which can help reduce the rate of iron deficiency anemia in infants.”

Reducing the risks

Recommendations for food allergy prevention are a complete reversal of guidelines from two decades ago.

“New knowledge in the science of food allergy suggests babies should be introduced to allergenic foods between 6 months and 1 year,” said Dr. Silberman. “Prior to contrary belief, avoiding food allergens early on in infancy, when the immune system is still developing, can actually play a role in forming these allergies down the road.”

Allergenic foods that babies should be introduced to include:

  • Dairy products
  • Egg
  • Fish
  • Peanuts and tree nuts (in the form of powder or butter)
  • Shellfish
  • Soy
  • Wheat

“There are a variety of safe ways to introduce these foods and avoid choking risks,” said Dr. Silberman. “Try pureed fish or spreading a thin smear of peanut butter on the baby’s hand or teething ring. There are also products parents can buy to make it even easier, such as powder mix-ins and specially formulated baby foods.”

Beware of added sugars

A recent analysis of national data found 98% of toddlers and two-thirds of infants consumed added sugars each day.

The majority of sugars in the typical American diet are those added to packaged foods and beverages during processing and preparation. These differ from naturally occurring sugars found in fruits, certain dairy products and vegetables.

“When shopping at the grocery store, look at the product labels,” said Dr. Silberman. “Common names for sugars include anything containing the word ‘syrup,’ like high-fructose corn syrup or malt syrup, or anything ending in ‘-ose,’ such as dextrose or sucrose. Nutrition labels now also list ‘total sugars’ separately from ‘added sugars,’ making it easier to differentiate between what is natural and what isn’t.”

Common foods that are high in added sugars include:

  • Breakfast cereals and bars
  • Candy
  • Desserts
  • Jarred baby foods
  • Packaged snack foods
  • Sweetened beverages

Some ways to reduce added sugar in a child’s diet include:

  • Serve water and milk instead of soda, tea, juice or sports drinks.
  • Keep an eye out for hidden sources of added sugar in processed foods such as ketchup, dried cranberries and baked beans.
  • Satisfy sweet tooth cravings with whole fruit.

“Because babies and toddlers are growing so rapidly, they need a lot of nutrient-dense foods,” said Dr. Silberman. “The best advice to parents is to prioritize feeding children a diverse diet that includes a variety of fruits and veggies, whole grains, healthy fats and proteins.”


Every child needs a pediatrician, and parents need a partner in their child's health who can answer questions about diet and nutrition. To find an expert provider for your little one, request an appointment online today.

Sources: Dietary Guidelines for Americans, American Academy of Allergy, Asthma & Immunology, Journal of the Academy of Nutrition and Dietetics

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