By Jasmine Capitano, clinical dietitian at CHOC
The transition from infant to toddler nutrition can be a challenging time for families. It is important to follow up with your pediatrician routinely to help monitor growth during this transition. To help answer some common questions, below are recommendations for how to introduce cow’s milk to toddlers.
Breastmilk or formula should act as a baby’s primary nutrition source until 1 year of age
The sole source of nutrition from birth to around 6 months of age is breastmilk or infant formula. For exclusively breastfed infants, the American Academy of Pediatrics (AAP) recommends exclusively breastfeeding for the first six months and continuing breastfeeding up to 2 years of age, as desired by mother and infant.
For infants fed infant formula, the recommendation is to continue infant formula alongside age-appropriate foods through the first year of life. The AAP recommends that whole cow’s milk not be used during the first year of life.
When should I introduce my baby to cow’s milk?
The Centers for Disease Control and Prevention (CDC) states that at 12 months old, children can be introduced to cow’s milk. Introducing cow’s milk before this age is not recommended because infants (under 12 months) have digestive systems that may not tolerate the cow’s milk protein in large quantities.
What do I do if I am worried about introducing cow’s milk to my baby because of an allergy?
Most infants have already been introduced to cow’s milk protein before the age of one. Infants breastfed by mothers who included cow’s milk or cow’s milk protein in their diet or infants who have consumed a standard infant formula have already been exposed to cow’s milk protein.
If your baby has been diagnosed with allergic colitis, which is caused by cow’s milk protein allergy, speak with your pediatrician before introducing cow’s milk. If necessary, your pediatrician can help choose an appropriate milk substitute.
How much milk does my baby need?
The Dietary Guidelines for Americans 2020-2025 recommend 1 2/3 cups to 2 cups of dairy daily for toddlers ages 12 through 23 months. This is equivalent to 13 to 16 ounces of cow’s milk daily. Many toddlers receive dairy through other foods such as yogurt and cheese, which count towards the recommended daily intake of dairy.
What if my toddler wants more than 16 ounces of cow’s milk?
Toddlers who are used to taking multiple bottles of formula daily often transition to taking multiple bottles of milk per day. Consuming too much milk can be harmful and can raise the risk for iron deficiency anemia.
Iron remains the most prevalent nutrient deficiency among children. While cow’s milk does contain small amounts of iron, the other nutrients in the milk make it harder for the body to absorb iron from other foods your toddler eats. Therefore, too much cow’s milk can lead to inadequate iron intake and large volumes of milk intake should be avoided.
Toddlers should consume 13 ounces to no more than 24 ounces of cow’s milk daily. For toddlers who love milk and demand multiple bottles daily, try offering less in each bottle or diluting the milk with water to avoid exceeding 24 ounces per day.
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At CHOC, we specialize in providing a full continuum of pediatric nutrition services, including inpatient and outpatient services, depending on our patients’ needs.