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\nIntroduction: This study aimed to investigate the effectiveness of a nutritional counseling program for mothers of newborns to prevent sugar consumption in the first year of life on the occurrence of early childhood caries (ECC). Methods: A multicentric randomized clinical trial (ClinicalTrials.gov – NCT03841123) was conducted in three state capitals of Brazil (n = 516). Mothers were randomly assigned to the intervention group (IG) or control group (CG) after delivery. The IG received face-to-face nutritional counseling based on UNICEF dietary guidelines after delivery, followed by monthly phone calls. The CG received standard counseling. Dietary intake was measured through structured questionnaires and 24-h recalls at 6 and 12 months. Dental clinical examination for ECC diagnosis was performed by calibrated dentists after the children completed the first year of life. Results: The prevalence of ECC was 17.4% in the overall sample (49/290). The number of affected teeth ranged from 0 to 6 (mean 0.43). The IG had a 2.4 times probability of not consuming sugar in the first 6 months of life (RR 2.44; 95% CI: 1.18–5.00) and a significantly lower mean number of sweet items consumed at 12 months (p = 0.016). However, no significant differences between groups were found with regard to the occurrence of ECC (RR 1.33; 95% CI: 0.79–2.25) or the number of teeth affected by caries (p = 0.273). Conclusion: The intervention to prevent and reduce sugar intake in the first year of life was not effective at reducing the occurrence of ECC or the number of teeth with carious lesions. Teeth with cavities, known as dental caries, are widespread, affecting more than half of children in most countries. These cavities can cause significant discomfort, disrupting the routine of children and their parents’ lives, leading to sleep problems and work absences. The primary cause of these cavities is the frequent consumption of foods and drinks with added sugar, a practice that is not recommended before the child reaches 2 years of age. To address this issue, our study investigated the effect of advising mothers about healthy feeding practices during the first year of the child’s life on preventing caries and reducing sugar consumption at 6 and 12 months. Our findings showed that the nutritional guidance reduced sugar consumption significantly after comparing groups of mothers who received nutritional advice with those who did not. Still, it was ineffective in preventing the occurrence of caries in the child’s first year of life. [ABSTRACT FROM AUTHOR]