TABLE 5-1

Evidence-Based Recommendations for Diet and Nutrition: CHILD-1

Birth to 6 moInfants should be exclusively breastfed (no supplemental formula or other foods) until the age of 6 moaGrade B Strongly recommend
6 to 12 moContinue breastfeeding until at least 12 mo of age while gradually adding solids; transition to iron-fortified formula until 12 mo if reducing breastfeedingaGrade B Strongly recommend
Fat intake in infants <12 mo of age should not be restricted without medical indicationGrade D Recommend
Limit other drinks to 100% fruit juice (≤4 oz/d); no sweetened beverages; encourage waterGrade D recommend
12 to 24 moTransition to reduced-fatb (2% to fat-free) unflavored cow's milkc (see supportive actions)Grade B Recommend
Limit/avoid sugar-sweetened beverage intake; encourage waterGrade B Strongly recommend
Transition to table food with:
    Total fat 30% of daily kcal/EERdGrade B Recommend
    Saturated fat 8%–10% of daily kcal/EERGrade B Recommend
    Avoid trans fat as much as possibleGrade D Strongly recommend
    Monounsaturated and polyunsaturated fat up to 20% of daily kcal/EERGrade D recommend
    Cholesterol < 300 mg/dGrade B Strongly recommend
Supportive actions
    The fat content of cow's milk to introduce at 12–24 mo of age should be decided together by parents and health care providers on the basis of the child's growth, appetite, intake of other nutrient-dense foods, intake of other sources of fat, and potential risk for obesity and CVD
    100% fruit juice (from a cup), no more than 4 oz/d
    Limit sodium intake
    Consider DASH-type diet rich in fruits, vegetables, whole grains, and low-fat/fat-free milk and milk products and lower in sugar (Table 5-3)
2 to 10 yPrimary beverage: fat-free unflavored milkGrade A Strongly recommend
Limit/avoid sugar-sweetened beverages; encourage waterGrade B Recommend
Fat content:
    Total fat 25%–30% of daily kcal/EERGrade A Strongly recommend
    Saturated fat 8%–10% of daily kcal/EERGrade A Strongly recommend
    Avoid trans fats as much as possibleGrade D, recommend
    Monounsaturated and polyunsaturated fat up to 20% of daily kcal/EERGrade D Recommend
    Cholesterol < 300 mg/dGrade A Strongly Recommend
Encourage high dietary fiber intake from foodseGrade B recommend
Supportive actions:
    Teach portions based on EER for age/gender/age (Table 5-2)
    Encourage moderately increased energy intake during periods of rapid growth and/or regular moderate-to-vigorous physical activity
    Encourage dietary fiber from foods: age + 5 g/de
    Limit naturally sweetened juice (no added sugar) to 4 oz/d
    Limit sodium intake
    Support DASH-style eating plan (Table 5-3)
11 to 21 yPrimary beverage: fat-free unflavored milkGrade A Strongly recommend
Limit/avoid sugar-sweetened beverages; encourage waterGrade B Recommend
Fat content:
    Total fat 25%–30% of daily kcal/EERdGrade A Strongly recommend
    Saturated fat 8%–10% of daily kcal/EERGrade A Strongly recommend
    Avoid trans fat as much as possibleGrade D Recommend
    Monounsaturated and polyunsaturated fat up to 20% of daily kcal/EERGrade D Recommend
Cholesterol < 300 mg/dGrade A Strongly recommend
Encourage high dietary fiber intake from foodseGrade B Recommend
Supportive actions:
    Teach portions based on EER for age/gender/activity (Table 5-2)
    Encourage moderately increased energy intake during periods of rapid growth and/or regular moderate-to-vigorous physical activity
    Advocate dietary fiber: goal of 14 g/1000 kcale
    Limit naturally sweetened juice (no added sugar) to 4–6 oz/d
    Limit sodium intake
    Encourage healthy eating habits: breakfast every day, eating meals as a family, limiting fast-food meals
    Support DASH-style eating plan (Table 5-3)
  • Grades reflect the findings of the evidence review; recommendation levels reflect the consensus opinion of the expert panel. Supportive actions represent expert consensus suggestions from the expert panel provided to support implementation of the recommendations; they are not graded. EER indicates estimated energy requirement.

  • a Infants who cannot be fed directly at the breast should be fed expressed milk. Infants for whom expressed milk is not available should be fed iron-fortified infant formula.

  • b For toddlers 12 to 24 mo of age with a family history of obesity, heart disease, or high cholesterol, parents should discuss transition to reduced-fat milk with pediatric care provider after 12 months of age.

  • c Continued breastfeeding is still appropriate and nutritionally superior to cow's milk. Reduced-fat milk should be used only in the context of an overall diet that supplies 30% of calories from fat.

  • d Estimated energy requirements per day for age/gender (Table 5-2).

  • e Naturally fiber-rich foods are recommended (fruits, vegetables, whole grains); fiber supplements are not advised. Limit refined carbohydrates (sugars, white rice, and white bread).