Parents often have many questions about introducing babies to homogenized cow's milk. Starting your child on complementary foods is an exciting milestone, with the goal of nurturing a healthy relationship with foods from all food groups. The introduction of cow’s milk dairy foods can be a contentious topic for parents, as it is a food group that is commonly singled out as the culprit for many health woes, from lactose intolerance or dairy allergy, to skin, respiratory, and digestive concerns. Let’s explore some of the most common issues in order to clarify and ease you through the milk transition.
When can babies drink cow's milk?
It is recommended that the introduction of homogenized cow's milk as a beverage into your child’s diet should happen no earlier than 9-12 months. Adding it sooner than this is associated with iron-deficiency, which can lead to anemia. A child’s risk of iron deficiency is increased after 6 months of age, when a healthy infant’s iron stores begin to wane (for premature infants, low birth weight babies, and those with other health challenges, this could occur sooner). This is why recommended first foods usually include iron-rich foods like dark chicken, beef, beans, sweet potatoes and cooked spinach. Note that adding milk earlier than 6 months of age is associated with gastrointestinal bleeding, which further increases anemia risk. If you will be introducing cow’s milk to your baby around 9-12 months, delaying until the end of this age range may be beneficial if they aren’t consuming adequate amounts of iron rich foods.
In North America, 12 months of age is often the point at which milk usually becomes a larger part of a child’s diet. In Canada, this is partially due to the fact that maternity leave ends and breastfeeding may be substantially reduced or eliminated, requiring nutritional substitution. If a child was formula-fed, it is assumed that their solid food intake will provide a greater portion of their nutritional needs so they no longer need the more costly supplementation that formula provides (this may not be the case for all children, and some are encouraged to continue Stage 2 formula until their solid food intake improves). It is also the age at which a child’s calcium needs almost triple.
There may be benefit to introducing cheese and yogurt earlier than the recommendation for liquid cow’s milk. These fermented foods are good for baby's gut health and emerging evidence suggests that introducing cheese and yogurt, just as you would any other solid food after 6 months of age, may be associated with reduced risk for allergy development when compared to delaying until after 1 year of age (Fleischer 2013). If you have a family history of food allergies, talk to your healthcare practitioner to develop an introduction plan before adding common food allergens like dairy foods to your child’s diet.
How much milk should my baby have?
By 12 months of age, Health Canada guidelines suggest that 1/3 of a child’s energy intake should come from their “milk source” and the remaining 2/3 should be provided by complementary foods. This translates into 2 cups (500 ml) of homogenized milk per day if a child is not breastfed. It is recommended not to exceed 750 ml of milk per day, as too much milk displaces other nutrient sources, increases the risk of constipation and iron-deficiency anemia.
If your child is breastfed, it is recommended by the World Health Organization (WHO) to continue until 2 years of age and beyond. Provided that you are nursing 2-3 times per day and your child is taking in a variety of solid foods, breast milk will be the “milk source” that provides 1/3 of their caloric needs and there is no need to make cow’s milk a regular beverage for your child. Other dairy-based foods can be introduced for nutritional variety, rather than as staples of your child’s diet. For babies who have previously established dairy allergies or sensitivities and who have been consuming soy-based formula, it is recommended to continue this until 2 years of age, or to talk to your healthcare team to discuss other options for providing the required nutrients.
Does my child really need dairy?
Dairy foods are recommended due to their relatively high calcium content. Cow’s milk is also considered a good source of protein, vitamin D, magnesium, vitamin B2, and B12, all of which are needed for a child’s rapid growth, for bone and tooth development, and to support nerve, muscle, and immune function. Whole or homogenized cow’s milk (3.25% milk fat) in particular contains a significant amount of fat, which is necessary for providing the building blocks for rapid brain development and for carrying and aiding absorption of fat soluble vitamins A and D. The higher fat content in whole milk means it is a calorie-dense food, providing a substantial amount per serving (160 kcal per 250 mL) that is needed to fuel active little bodies. For these reasons, it is only considered prudent to switch from whole milk to lower fat (e.g. 2%) milk after age 2.
As long as your child tolerates it well (has no allergy to milk protein, and does not have other systemic symptoms that are arise due to dairy intake), dairy foods including unsweetened yogurt, cheese, and milk can form a part of a varied and healthy diet. Lactose intolerance can be managed with the use of lactose-free products, and aged cheeses like cheddar, parmesan, Swiss, and plain, full-fat European-style yogurts (like Greek yogurt).
The nutrients found in cow’s milk dairy can also be acquired from other foods. The reality is that milk and dairy foods are simply convenient, palatable nutrient sources that are easily accessible and are often less costly than milk alternatives. If you choose other foods to fulfill your child’s nutrient needs, be informed of the nutrient content of these alternatives, as well as vigilant in ensuring your child’s intake.
*Originally published November 3, 2016
