One of the basic responsibilities of every parent/guardian and caregiver/teacher is to offer clean, safe, and nourishing food choices daily that are developmentally appropriate for all children. Food is essential in any early care and education program to keep infants and children free from hunger. Children also need easily available, clean drinking water. Feeding should be in a relaxed and pleasant environment that encourages healthy digestion and positive social behavior. Food gives energy and nutrients that infants and children need during an important time in their growth and development.

Breastfeeding is the beginning step for an infant to form healthy attachments. The American Academy of Pediatrics, the United States Breastfeeding Committee, the Academy of Breastfeeding Medicine, the American Academy of Family Physicians, the World Health Organization, and the United Nations Children’s Fund (UNICEF) all recommend that women breastfeed exclusively for the first 6 months, adding age-appropriate complementary foods at about 6 months, and continue breastfeeding for at least 2 years.¹

Human milk has all the nutrients for the best growth and is the most developmentally appropriate food for infants. Human milk changes during each feeding and over time to meet the growing child’s changing nutritional needs. All caregivers/teachers should be trained to encourage, support, and advocate for breastfeeding. Caregivers/teachers have a unique opportunity to support breastfeeding mothers, who are often unsure about continuing to breastfeed as they return to work. Early care and education programs can lower a breastfeeding mother’s anxiety by welcoming breastfeeding families and by training their staff well to properly handle human milk and feed breastfed infants.

Families may choose not to breastfeed their infant for reasons that include: human milk not being available, inadequate supply of human milk, an infant not gaining weight, a medical condition that affects the production or quality of human milk, or not wanting to breastfeed. Today infant formulas vary in nutrients and meet the specific needs of individual infants. A primary care provider should prescribe the specific infant formula for an individual infant. When infant formula supplements human milk, programs should encourage the parent to continue to breastfeed or to pump human milk, as milk production may decrease if not stimulated by breastfeeding or pumping.

Given enough opportunities, help, and age-appropriate equipment, children learn to self-feed as age-appropriate solid foods are introduced. Self-feeding encourages children to reach growth miles stones, such as motor coordination, cognitive and social skills. When early care and education programs staff model healthy eating, this helps a child develop lifelong healthy eating habits. Six months old is a good time for children to learn more about the world around them by expressing their independence, and they can choose from different kinds and combinations of foods. To make sure children get a variety of healthy foods, programs should offer choices from these groups:

• Grains 
  • Serve whole grain breads, cereals, and pastas.
• Vegetables
  • Serve a variety of vegetables (such as dark green, orange, deep yellow vegetables, and root vegetables, such as potatoes and viandas).
• Fruits
  • Serve a variety of deep orange, yellow, and red whole fruits.
  • Serve only 100% fruit juices with no added sugars.
    • Limit to 4–6 oz. per day for children 1 and over.
    • Only serve juice during meal or snack time.
• Milk 
  • Serve whole pasteurized milk to children 12 to 24 months old.
  • Serve reduced fat (2%) pasteurized milk to children 12 to 24 months old who are at risk for obesity or who have other health conditions that need lower fat milk.
  • Serve only skim or 1% milk to children 2 and older.
  • Serve low-fat or fat-free milk-equivalent products (such as yogurt and cottage cheese), for children 2 and older.
• Meats and Beans
  • Serve lean meats (including chicken and fish), and beans and legumes, and avoid fried meats.
• Oils
  • Limit oils to monounsaturated and polyunsaturated fats (such as olive oil or safflower oil), and avoid trans fats, saturated fats, and fried foods.

Current research supports a diet based on a variety of foods that have a lot of important nutrients that people need ¾ carbohydrates; protein; healthy fats and oils; vitamins and minerals ¾ and enough calories to meet the child’s needs. The nutrition and food service standards, and their appendices, discuss age-appropriate foods and feeding techniques beginning with the very first food, preferably human milk ¾ and when human milk is not available, infant formula based on the recommendation of the infant’s primary care provider and family. As part of their development, toddlers often change their eating habits compared to when they were infants. Children may have eating sprees, wanting to eat the same food for several days. Others may have picky eating behaviors that can include picking or dawdling over food, or refusing to eat a food because it is new. If these or other food behaviors keep up, families, caregivers/teachers, and the primary care provider together should find out why and come up with a plan. The consistency of the plan is important in helping a child build healthy eating habits when they are focused on becoming more independent and often have unpredictable appetites. All early care and education settings can guide and support children’s healthy eating habits and food learning experiences.^2-4

Early food and eating experiences form attitudes and opinions about food which can affect healthy eating habits and food patterns. Responsive feeding, where the parents/guardians or caregivers/teachers recognize and respond to infant and child cues, helps foster trust and lowers overfeeding. Eating and enjoying a variety of healthful foods forms healthy food habits. Offering culturally specific family foods is a dietary goal for feeding infants and young children. Current research shows that a balanced diet, with daily age-appropriate physical activity, can lower diet-related risks of being overweight, being obese, and having chronic disease later.² Two essentials ¾ eating healthy foods and having physical activity every day ¾ promote a healthy beginning during the early years and throughout life. The 2020-2025 Dietary Guidelines for Americans and the U.S. Department of Agriculture’s MyPlate are designed to support lifestyle behaviors that promote health, including a diet made up of a variety of healthy foods and physical activity at age 2 and older.^2,3,5

Besides feeding nutritious foods, programs should offer age-appropriate daily physical activity and play time for the healthy physical, social, and emotional development of infants and young children. There is strong evidence that physical activity can prevent fast weight gain that leads to childhood obesity. The early care and education program is an ideal place to encourage offering supervised, age-appropriate physical activity during these important years when children develop health habits and patterns for life. The overall benefits of practicing healthy eating patterns while being physically active every day are significant. Children develop physical, social, and emotional habits during the early years and into adulthood; thus, they can improve these habits in early childhood to prevent and lower obesity and certain chronic diseases. Active play and supervised, structured physical activities encourage healthy weight by improving fitness, bone development, cardiovascular health, mental health, and the development of social skills. (For more information on physical activity, see Standards 3.1.3.1 Active Opportunities for Physical Activity, 3.1.3.4 Caregivers/Teachers Encourage of Physical Activity, 9.2.3.1 Policies and Practices that Promote Physical Activity, Appendix S: How Much is Need?)

COMMENTS

ADDITIONAL RESOURCES:

American Academy of Pediatrics

Infant Food and Feeding – https://www.aap.org/en/patient-care/healthy-active-living-for-families/infant-food-and-feeding/

Healthy Active Living for Families - https://www.aap.org/en/patient-care/healthy-active-living-for-families/

U.S Department of Agriculture Food and Nutrition Services. Child and Adult Food Care Program -https://www.fns.usda.gov/cacfp

TYPE OF FACILITY

Center; Large Family Child Care Home; Small Family Child Care Home, Head Start, Early Head Start

REFERENCES

1. Meek JY, Noble L. Breastfeeding policy statement: breastfeeding and the use of human milk. Pediatrics. July 2022;150 (1): e2022057988. 10.1542/peds.2022-057988. https://publications.aap.org/pediatrics/article/150/1/e2022057988/188347/Policy-Statement-Breastfeeding-and-the-Use-of?autologincheck=redirected. Published July 2022. Accessed December 19, 2022
2. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary guidelines for Americans, 2020-2025. 9th Edition. DietaryGuidelines.gov Web site. www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials. Published December 2020. Accessed November 8, 2022
3. U.S. Department of Agriculture. Learn how to eat healthy with MyPlate. MyPlate.gov Web site. www.choosemyplate.gov. Accessed November 8, 2022
4. U.S Department of Agriculture. Food and Nutrition Service. Study of nutrition and activity in childcare settings in USDA’s Child and Adult Care Food Program (SNACS). USDA.gov Web site. https://www.fns.usda.gov/cn/study-nutrition-activity-childcare-settings-usdas-cacfp. Updated October 25, 2021. Accessed November 8, 2022
5. Dev DA, Garcia AS, Dzewaltowski DA, et al. Provider reported implementation of nutrition-related practices in childcare centers and family childcare homes in rural and urban Nebraska. Preventive Medicine Reports. http://www.sciencedirect.com/science/article/pii/S2211335519301925? the new Breastfeeding policy statement?. Published March 2020. Accessed November 8, 2022

NOTES

Content was modified on 2/9/2023.