Development of food pattern recommendations for infants and toddlers 6–24 months of age to support the dietary guidelines for Americans, 2020–2025

Kathryn G. Dewey, Tusa Rebecca Pannucci, Kellie O. Casavale, Teresa A. Davis, Sharon M. Donovan, Ronald E. Kleinman, Elsie M. Taveras, Regan L. Bailey, Rachel Novotny, Barbara O. Schneeman, Jamie Stang, Janet de Jesus, Eve E. Stoody

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


BACKGROUND: Developing food-based dietary guidelines (FBDGs) for infants and toddlers is a complex task that few countries have attempted.

OBJECTIVES: Our objectives are to describe the process of food pattern modeling (FPM) conducted to develop FBDGs for the Dietary Guidelines for Americans, 2020-2025 for infants 6 to <12 mo and toddlers 12 to <24 mo of age, as well as the implications of the results and areas needing further work.

METHODS: The US 2020 Dietary Guidelines Advisory Committee, with the support of federal staff, conducted FPM analyses using 5 steps: 1) identified energy intake targets; 2) established nutritional goals; 3) identified food groupings and expected amounts, using 3 options for the amount of energy from human milk in each age interval; 4) estimated expected nutrient intakes for each scenario, based on nutrient-dense representative foods; and 5) evaluated expected nutrient intakes against nutritional goals.

RESULTS: For human milk-fed infants (and toddlers), example combinations of complementary foods and beverages were developed that come close to meeting almost all nutrient recommendations if iron-fortified infant cereals are included at 6 to <12 mo of age. These combinations would also be suitable for formula-fed infants. For toddlers not fed human milk, 2 patterns were developed: the Healthy US-Style Pattern and the Healthy Vegetarian Pattern (a lacto-ovo vegetarian pattern). Achieving nutrient recommendations left virtually no remaining energy for added sugars.

CONCLUSIONS: It is challenging to meet all nutrient needs during these age intervals. Added sugars should be avoided for infants and toddlers <2 y of age. Further work is needed to 1) establish a reference human milk composition profile, 2) update and strengthen the DRI values for these age groups, and 3) use optimization modeling, in combination with FPM, to identify combinations of foods that meet all nutritional goals.

Original languageEnglish (US)
Pages (from-to)3113-3124
Number of pages12
JournalJournal of Nutrition
Issue number10
StatePublished - Oct 1 2021

Bibliographical note

Publisher Copyright:
© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition. All rights reserved.


  • Child
  • Complementary foods
  • Dietary guidelines
  • Dietary pattern
  • Infant
  • Nutrient adequacy
  • Toddler

PubMed: MeSH publication types

  • Journal Article
  • Research Support, U.S. Gov't, Non-P.H.S.


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