Would it surprise you to know that Federal dietary guidance for young children is literally in its infancy? The Dietary Guidelines for Americans (DGA), the food and nutrition policy for the United States, have been around since 1980 and have applied only to Americans ages two and older. All this changed when the 2020-2025 DGA were released and contained guidance for all Americans, including those from birth to 24 months of age (B24).
Here we take a high-level look at the new B24 guidance, starting with two core themes emphasizing: 1) starting early to build healthy eating patterns over the course of the life span; and 2) making every bite count. We also compare current eating behavior to recommendations and provide PBH’s research-informed insights on increasing produce intake in children.
Start Building Healthy Eating Patterns Early
In food and nutrition circles, we’ve become accustomed to talking about “B24” as a whole. However, from a dietary pattern perspective, there are three distinct time periods associated with B24: birth to less than six months; 6-11 months; and 12-24 months. From birth to six months, the focus is on breast milk or formula as the baby’s predominant source of calories and nutrients. Solids are introduced around six months. Between six months and one year, children should be offered nutrient-dense, age-appropriate foods from all the food groups. In the second year of life, the goal is to work toward enjoying a variety of foods and beverages to achieve healthy dietary patterns and build habits that can be sustained over time.1
Make Every Bite Count
Some nutrients are of particular concern during the B24 timeframe. Older infants (6-11 months) tend to consume inadequate amounts of iron, zinc, vitamin D, potassium, choline, and protein. During the second year of life, toddlers still underconsume vitamin D and potassium, but also calcium and dietary fiber. The DGA explicitly recommends fruits and vegetables for infants and toddlers, particularly those rich in potassium and vitamins A and C. They also advise including beans, peas, and lentils for protein and dietary fiber.
Current Fruit and Vegetable Eating Behaviors
The good news is that most children three years and younger are meeting recommendations for fruit. However, intake decreases throughout childhood with just one in five kids ages nine years and older consuming recommended amounts of fruit. Usually, infants are started out with baby food and this trend extends through the first year. Close to 60% of fruit intake in infants ages 6-12 months comes from baby food; about one-quarter comes from whole fruit; and 14% from beverages. Average intake of fruit in this age group is 0.6 cup eq/day. Fruit juice consumption decreases with age during childhood and remains small thereafter. Average consumption is ~0.5 cup/day. Almost all toddlers are offered fruits on any given day, with an average intake of 1.2 cup/day. Depending on calorie level, 0.5 – 1 cup of fruit is recommended for children aged 12-24 months. Fruit consumption typically levels out in elementary school and remains at less than 1 cup eq/day through adulthood.
Children notoriously do not hit the mark when it comes to vegetable consumption. That said, close to 80% of infants 6-12 months of age are provided vegetables on any given day. Average total vegetable intake in this age group is about 0.4 cup/day. Toddlers consume, on average, about 0.7 cup of vegetables/day. This is compared to a recommendation of 2/3 – 1 cup/day.2
Apples and bananas are the most commonly consumed fruits across the lifespan. Among the most commonly consumed vegetables by children are tomatoes, carrots and green peas. Intake is low for dark green vegetables and legumes.2
Recently released research from the Produce for Better Health Foundation (PBH) indicates that annual eating occasions of fruit have decreased in children one to three years from 2015 to 2020. This is particularly concerning because 1) they consume fruit more frequently than all other age groups with just over six eating occasions weekly; and 2) the decline is larger than other age groups, with a loss of close to one and a half eating occasions of fruit/month. Frequency of vegetable intake also declined between 2015 and 2020, remarkably in five of eight age groups. Children one to three years of age eat vegetables close to six times/weekly and, between 2015 and 2020, lost about one eating occasion every two months.
Addressing Our Consumption Crisis Head On
One of the biggest public health threats is the underconsumption of produce across the lifespan, as they are core to healthy dietary patterns and provide essential vitamins and minerals for optimal growth and development. Trends show that healthy eating patterns break down relatively early in life with children typically adopting their family eating patterns by age two. Hence the advice that, “It is never too early or too late to eat healthfully.”1
If the goal is to develop and build and maintain healthy fruit and vegetable habits early in life (which PBH believes is critical to improving consumption), it stands to reason that we must begin with what we know about consumption habits and build from there: 3
- Although we talk about them collectively, consumption habits differ between fruits and vegetables;
- Fruit consumption is versatile across the day, while vegetables are most often associated with dinnertime and, specifically, side dishes;
- Most fruits, vegetables, and juices are purchased from grocery retail and the majority are eaten at home;
- Prior to the pandemic, just over one-quarter of vegetables were sourced from foodservice outlets, compared to 6% of fruits; 30% of vegetables were eaten in a foodservice setting, compared to 15% of fruits;
- Beginning in 2018, consumers reported a desire to get more vitamin C – a trend that no doubt intensified during this past year plus of COVID.
Predominant trends impacting fruit and vegetable consumption include decreased intake of fruit juice and a reduction in vegetable side dishes.3 On the other hand, food category sources that are often paired with vegetables in toddlers include grain-based mixed dishes; meat, poultry, and seafood mixed dishes; soups; and savory snacks. Vegetables are often eaten in combination together. Potatoes tend to be a vehicle for other vegetable consumption.2 These trends point to ripe opportunity to pair fruits and vegetables with other nutrient-rich foods to positively impact produce consumption and overall dietary patterns as well as build long-term healthful habits.
Clearly, empowering and supporting families to increase fruit and vegetable intake each day, week, month, and year to build healthy eating patterns over the lifespan is not a one and done proposition. Feeding infants and toddlers lots of fruits and vegetables, does not guarantee lifelong produce lovers, but it’s a place to start to normalize fruit and vegetable intake as a top-of-mind priority. It will be essential to help and empower parents and other adults to establish new fruit and vegetable habits and role model these behaviors for children. And, finally, as an industry and public health community, we must work together and double down on efforts to make consumption EASY – a core tenet for long-term and in this case, generational behavior change.
 U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov.
 Dietary Guidelines Advisory Committee. 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC.
 Produce for Better Health Foundation. State of the Plate: 2020 Study on America’s Consumption of Fruits and Vegetables.