New 2021 U.S. Dietary Guidelines

new dietary guidelines for babies and toddlers

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In January, the U.S. Department of Agriculture and the Department of Health released its updated set of dietary guidelines that’ll be in place through 2025. Many health experts lamented that current recommendations on added sugar didn’t really change much, among other concerns. The federal health experts behind the report did, however, recommend new restrictions for added sugar in the first-ever set of advice for parents of babies and toddlers. Per the report, no amount of added sugar is acceptable for kids under the age of 2; the guidelines’ authors cite the strong link between childhood obesity and health issues later in life as the reasoning behind their new stance.

But parents (and parents to be!) may raise eyebrows over a new data-driven suggestion on dietary exposure to peanuts and other allergens, which is the opposite of what they may have heard in the past.

New guidelines ask parents to introduce “nutrient-dense” foods to infants in addition to milk or formula starting at 6 months old, including known allergens that many parents may have historically avoided. “Peanuts, egg, cow milk products, tree nuts, wheat, crustacean shellfish, fish, and soy should be introduced when other complementary foods are introduced to an infant’s diet,” the guidelines instruct. “Introducing peanut-containing foods in the first year reduces the risk that an infant will develop a food allergy to peanuts.”

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The shift in advice has to do with breakthrough research known as the LEAP (Learning Early About Peanut Allergy) study, explains Sanjeev Jain, M.D., Ph.D., an immunologist and founder of Columbia Allergy clinics across the Pacific Northwest. In the 1980s, Dr. Jain explains, when food allergies began to become increasingly more common, allergists believed delaying oral introduction to potential allergens (namely peanuts) was necessary to stave off allergic reactions later on in life. The American Academy of Pediatrics had even asked parents to wait to introduce peanuts to kids until they turned 3 years old, and eggs at 2 years old, in guidelines published in 2000. But the LEAP study, published just after the last set of USDA dietary guidelines were made public in 2015, “clearly showed that early introduction of peanuts, starting as early as four months of life, reduced the risk of developing peanut allergies,” he adds.

According to Dr. Jain, experts in the allergy field have a surplus of data that confirms a baby’s immune system and digestive tract can adapt to foreign foods — things they’ve never eaten before — almost naturally. “The immune system in the first six months of life is especially malleable; it can adapt to whatever environmental exposure it’s getting at that age much more so than later in life,” he explains.

Actually getting a baby or toddler to ingest allergens is important if that food is in the home environment around them. For peanuts, in particular, a baby can easily become sensitized to peanuts if their skin is in frequent contact with its antigens (or proteins) — especially if they already have eczema or another skin issue, says Michael Pistiner, M.D., a member of the Asthma and Allergy Foundation of America‘s Medical Scientific Council. “That [sensitization] can drive a child in the direction of developing a food allergy,” he explains, adding that other non-peanut allergies can also develop this way. “That’s why it seems that when these kids start having their exposures to the food through their mouth and eating it, then it may help decrease the chance that they’ll develop an allergy to that food.”

But what about soy, eggs, or other nuts? Robert Coles, M.D., a pediatrician within the University of California San Diego Health System, says that while evidence isn’t as clear cut for these allergens, experts are treating them similarly to peanuts based on logic. “Given the data for peanuts and eggs specifically, we now recommend that — from an allergy perspective — complementary foods and other highly allergenic foods may be introduced into the child’s diet at any time after four to six months of age,” he explains. A few exceptions may be thicker staples like peanut butter or honey, which can pose choking hazards if not properly prepared, with the latter holding some botulism risk for babies (“Even highly processed honey can carry spores of bacteria,” Dr. Jain adds).

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For children out of the recommended age range of four-to-six months, allergy clinician Dr. Jain says that slowly adding traces of nuts or small amounts of soy for toddler-aged kids is largely still recommended. “It’s never too late… You have a window of opportunity to introduce [foods] before allergies develop,” he adds. “Exposure through the skin route without getting equal exposure through the oral and dietary route isn’t ideal, as it leads to possible sensitization of that food.”

Maybe the most significant takeaway for parents — either those who are welcoming their first child or those who are anxious around the kitchen due to another child’s allergy development — is that introducing food to babies and younger toddlers at home comes with a very low risk for a serious allergic reaction. Dr. Jain explains anaphylaxis is rare in this case: “The current guidelines are that the risk of introducing your food at home is so low, when it comes to a life-threatening allergic reaction, that it’s considered safe to do so.”

Regardless of your child’s age or whether or not you’ve dipped into new foods at home, there’s always an option of doing what’s called an “oral challenge,” available to families in an office setting. “We give common allergens in the office to confirm that child isn’t allergic to that food, which may take a while to pinpoint each food, but at least we’re attempting it,” Dr. Jain says. Moving forward, it seems that most allergists can agree on one thing: Not feeding your little ones allergens out of fear could end up leading to that food allergy you’re dreading.

Always consult your child’s physician before introducing new food into their routine. If you’re concerned about a child and potential food allergies, keep an eye out for known visual reactions to known allergens. The most common symptoms of an allergic reaction include rashes, itching, or hives, swelling or puffiness, shortness of breath, stomach pain and dizziness. For more information on common reaction signs, and instructions on getting emergency help, visit the Asthma and Allergy Foundation of America.

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