Cow's Milk: When and How to Introduce It

Cow’s Milk: When and How to Introduce It

Why do experts recommend waiting to introduce cow’s milk until a baby is 12 months old?

There are several reasons to delay the introduction of cow’s milk until your baby reaches his first birthday.

Babies can’t digest cow’s milk as completely or easily as breast milk or formula. Cow’s milk contains high concentrations of protein and minerals, which can tax your baby’s immature kidneys. In addition, cow’s milk doesn’t have the right amounts of iron, vitamin C, and other nutrients for infants. It may even cause iron-deficiency anemia in some babies, since cow’s milk protein can irritate the lining of the digestive system, leading to blood in the stools. Finally, cow’s milk doesn’t provide the healthiest types of fat for growing babies.

Once your child’s ready to digest it, though, milk becomes an important part of his diet. It’s a rich source of calcium, which builds strong bones and teeth and helps regulate blood clotting and muscle control. And it’s one of the few sources of vitamin D, which helps the body absorb calcium and is crucial for bone growth. Almost all milk in the U.S. is fortified with vitamin D. (Ultraviolet rays are another source, but they’re blocked by sunscreen.)

Milk also provides protein for growth, as well as carbohydrates, which will give your child the energy he needs to toddle all day. And if your child gets enough calcium from the get-go, there’s evidence that he’ll have a lower risk of high blood pressure, stroke, colon cancer, and hip fractures later in life.

How much milk should my toddler drink?

According to the American Academy of Pediatrics (AAP), most kids will get enough calcium and vitamin D if they drink 16 to 20 ounces (2 to 2 1/2 cups) of cow’s milk a day. Offer 1-year-olds whole milk (unless they’re at high risk for obesity).

Don’t offer more than 3 cups of milk a day or your child may not have room for the other foods she needs to round out her diet. If your toddler’s still thirsty, offer water.

Can I give my toddler fat-free or reduced-fat milk?

In most cases, not yet. The AAP recommends whole milk for 1-year-olds. Children this age need the higher fat content of whole milk to maintain normal weight gain and to help the body absorb vitamins A and D. And nonfat milk provides too high a concentration of protein and minerals for children this age. Once your child turns 2, you may decide to switch him to reduced-fat or nonfat milk as long as he’s growing well.

Possible exceptions: If you’re overweight or obese, or have a family history of obesity, high cholesterol, or cardiovascular disease, your child’s doctor may recommend giving him reduced-fat milk (2 percent) after age 1.

My toddler doesn’t seem to want cow’s milk. Any tricks I can try?

Some toddlers greedily gulp cow’s milk right off the bat. But because milk has a different texture, taste, and even temperature than breast milk, some kids are hesitant to make the switch.

If that’s the case for your toddler, try mixing milk with some breast milk or formula at first (say, one part milk and three parts of her usual stuff). Then slowly shift the ratio until she’s drinking 100 percent milk. It may also help to serve the milk at room temperature.

Meeting the minimum requirement of 2 cups can be a challenge if your child doesn’t care for milk. But there are many ways to get milk into your child’s diet: Add it to her cereal. Serve yogurt, cottage cheese, pudding, custard, or shakes for snacks. Make soup with milk rather than water. Add a milk-based sauce or gravy to casseroles.

What if my child doesn’t like any dairy products? What if he has an allergy or if we’re vegans?

If your child isn’t getting enough calcium and vitamin D from milk and other dairy products, perhaps because he can’t tolerate them or your family is vegan, your pediatrician will probably recommend calcium and vitamin D supplements.

Should I buy organic or hormone-free milk for my child?

There’s no conclusive evidence that these kinds of milk are better for children, but there’s no harm in them. (Organic milk does tend to be more expensive.) Read up on growth hormones in milk and organic foods to help you make a decision.

The AAP warns against giving your child “raw” or unpasteurized milk, though. Without pasteurization, milk may contain harmful bacteria or parasites that can cause serious illness or even death.

Could my child have a milk allergy?

True allergies to cow’s milk are relatively uncommon. Only 2 to 3 percent of children are allergic to milk, according to the AAP, and almost all of them outgrow it by age 3. (Learn the difference between a milk allergy and lactose intolerance.)

If your child drank cow’s-milk-based formula as a baby without any problems, you can rest assured that she’ll have no problems tolerating regular cow’s milk. Even babies who were exclusively breastfed for the first year can usually handle regular cow’s milk because they’ve been exposed to cow’s milk protein in their mother’s milk (unless their mother avoided all dairy).

If your child drank soy formula because your doctor recommended it, though, check with your doctor before starting her on cow’s milk. Your doctor may recommend that you start with a soy beverage that’s been fortified with vitamin D and calcium. (See what our experts say about giving soy milk or rice milk to a child who won’t drink cow’s milk.)

The main symptoms of milk allergy are blood in the stool, diarrhea, and vomiting. If your child also develops eczema, hives, a rash around the mouth and chin, chronic nasal stuffiness, a runny nose, cough, wheezing, or breathing difficulties, it could be a sign that the respiratory system is being affected by a milk allergy. If your toddler develops any of these symptoms, talk with her doctor.

If your child appears to have sudden and severe problems with breathing or swallowing, take her to the nearest emergency room. She may be having a life-threatening allergic reaction.

If it turns out that your toddler is allergic to cow’s milk, you’ll want to be careful to avoid foods such as cottage cheese, condensed or evaporated milk, ice cream, yogurt, margarine that contains milk, butter, milk chocolate, and powdered milk. Thanks to a law passed in 2004, all allergens must be clearly marked on food products – in this case, the label will say “milk.”