Food | Infants & Toddlers | Whole Milk
No Milk (Except Breast Milk or Formula) if Less Than a Year
All research and your doctor generally state that a baby should not drink milk (other than breast milk or formula) if she is less than a year old. “In infants, the introduction of cow’s milk in the first year of life is the greatest dietary risk factor for the development of iron deficiency and iron deficiency anemia.” Not only does cow’s milk not have a lot of iron but the iron in the milk is poorly absorbed. “In addition, it decreases the absorption of iron from dietary sources. Therefore, the strict avoidance of cow’s milk in the first 12 months of life is essential in preventing iron deficiency anemia” (American Academy of Family Physicians (“AAFP”). In addition, the AAFP recommends starting iron supplements at four to six months for breastfed infants and to use iron-fortified formula (NOT low-iron formula) when not breastfeeding.
Another reason not to introduce cow's milk "until at least one year" is because it "is not wise to introduce a potentially allergenic drink at the same time that your baby's intestines are getting used to a variety of solid foods" (Baby 236). You may wonder why some sources recommend giving the baby yogurt or cheese around the nine month mark, doesn't that have milk in it? According to Sears, "[y]ogurt gives all the nutritional benefits of milk but with fewer problems" since the process of making yogurt "breaks down the milk lactose into simple sugars, which are more easily absorbed" and also "making yogurt less allergenic than milk" (Baby, 236). Overall, it is recommended to continue breastfeeding or bottle feeding with formula since formulas are "much closer to the composition of human milk and contain all of the necessary vitamins" until at lest one year (Baby, 236).
Iron Deficiency for Toddlers
As stated by AAFP, “toddlers deserve the same degree of attention” to prevent iron deficiency anemia. There may be the “risk of developmental effects” if a toddler gets iron deficiency anemia. In addition, it seems that “the prevalence of iron deficiency anemia between one and three years of age may be greater than was formerly thought.”
According to the AAFP, the following are ways to prevent iron deficiency in the second year of life:
- Diversified diet with iron and vitamin C
- Limit cow’s milk consumption to less than 24 ounces per day
- Provide daily iron-fortified vitamin
- Avoid excessive juice intake
- Continue use of cereals fortified with iron
Due to the above issue with iron deficiency, I continued to give my son some formula designed for the 9 – 24 month old until he was almost 17 months old. I also continued to give my son the iron fortified baby cereal; primarily because of his acid reflux we continued to mix the cereal with whole milk. Once my son is no longer eating the iron fortified cereal, I plan to start him on the Enfamil Poly-Vi-Sol (multivitamin) that includes iron; I currently give him the Enfamil Poly-Vi-Sol without iron.
Formula (9 – 24 Months)
I knew that I would need to use part formula for some time after my son turned one so I started introducing the Nestle Good Start 2 for 9 – 24 months when my son was around 11 months old. I had previously asked at his 9 month visit if it was a good idea to use formulas like this for 9 – 24 months once the baby is over one and the doctor said whole milk would be sufficient and a formula is not needed. Although, knowing my son’s past history with changes in formula and still some issues surrounding drinking his bottle I didn’t expect to transition him immediately to drinking whole milk the day he turned one.
The Nestle Good Start 2 for 9 – 24 months formula cost less than the 0 – 12 months formula; probably because this formula is competing against the cost of whole milk which is significantly cheaper than the infant formula. I was happy to read on the Nestle Good Start web site, that the Protect Plus and the Gentle Plus 2 formulas also contain the “easy-to-digest 100% whey COMFORT PROTEINS.”
I gave my son formula for a 9 – 24 month old until he was almost 17 months old. Refer to the next section on how I transitioned him to whole milk. The formula I gave him provided vitamins, minerals, and some additional immune support. According to the Nestle Good Start containers as of July 2009, please refer below for a comparison of formula for 0 – 12 months compared with 9 -24 months per 100 calories (5 fl ox, prepared as directed):
||Nestle Good Start
0 - 12 Months
|Nestle Good Start
9 - 24 Months
Transition to Whole Milk
I didn’t expect my son to transition immediately to whole milk. I started giving it to him in a sippy cup and he would immediately spit it out. Thus, we started mixing whole milk with Nestle Good Start 2 (9 – 24 months) formula.
I used a similar transition schedule when starting a new formula as documented on the Gerber web site to transition my son to whole milk. The schedule per the Gerber web site states to try the following assuming eight feedings a day.
- Day 1, 2, 3 switch out one feeding with formula.
- Day 4 and 5 switch out two feedings with formula.
- Day 6 and 7 switch out three feedings.
- Day 8 and 9 switch out four feedings.
- Day 10 and 11 switch out five feedings.
- Day 12 switch out six feedings.
- Day 13 switch out seven feedings.
- Day 14 switch out all feedings.
My Son’s Transition
Around 12 months my son had four feedings a day: one morning, mid-morning, afternoon, and bedtime, so our transition schedule went as follows:
- Week 1: One feeding - 4 ounces water/formula mix with 3 ounces organic whole milk, other three feedings all formula
- Week 2: Two feedings - 4 ounces water/formula mix with 3 ounces organic whole milk, other two feedings all formula
- Week 3 and Week 4: All four feedings - 4 ounces water/formula mix with 3 ounces organic whole milk
- Week 5: All four feedings – 2 ounces water/formula mix with 5 ounces organic whole milk
- Since I preferred to delay my transition to whole milk, I continued to give my son formula until 17 months.
I think the slow transition was good for my son and helped him not develop iron deficiency. At 14 months my son had about 30% the Good Start 2 Formula and 70% whole milk and by 17 months I transitioned my son completely to whole milk. By 17 months my son was eating extremely well during the day, including food from all the major food groups: grains, vegetables, fruits, fats and oils, milk and dairy products, meat and fish and so I felt confident that he was obtaining enough vitamins and minerals from the food he ate along with the multivitamin I gave him.
I continued to give my son the iron fortified baby cereal; primarily because of his acid reflux we continued to mix the cereal with whole milk. Once my son is no longer eating the iron fortified cereal, I plan to start him on the Enfamil Poly-Vi-Sol (multivitamin) that includes iron; I currently give him the Enfamil Poly-Vi-Sol without iron. If my son was not eating well then I may have continued to supplement with formula for a longer period of time. According to Dr. Greene, using a toddler formula is a way to provide “DHA, an important omega-3 fatty acid” but “[t]oddlers don’t necessarily need formula, even if they don’t nurse.”
Whole Milk NOT Low Fat Milk
Once you do transition to whole milk from breast milk or formula, it is best to give the baby whole milk not low fat milk. “Toddlers need the high fat content of whole milk (or full-fat soymilk) to build their brains. After age two, it’s sensible to switch to 1 percent or skim milk to lower the risk of heart disease as an adult” (Spock 147).
Organic Whole Milk
I prefer to give my son organic whole milk to avoid giving my son pesticides, hormones, and antibiotics that could be found in standard milk. “Whether or not these substances show up in standard milk (which is supposed to be tested for detectable residues) is uncertain” (Sears, Milk). Most doctors recommend buying organic milk. It is definitely more expensive to buy organic milk than standard milk.
Bottle or Sippy Cup
Many people when they transition the child to whole milk give the whole milk in a sippy cup and thus transition not only from breast milk or formula but also transition from breastfeeding or bottle feeding. We continued to give my son milk in a bottle. It took him awhile to drink well out of a sippy cup and even once he was drinking very well out of a cup he wouldn’t drink milk out of one.
If he liked to drink milk then it would have been easier to one day just tell him if he wants to drink milk he’ll have to drink it out of a sippy cup and not a bottle. Since he didn’t seem to like milk much, I was happy he would drink it anyway I could get him to drink it and thus, I continued to give it to him in his bottle. I continued to give him milk in his sippy cup as well and he would take a few sips but not drink very much. For more information, please refer to the “Weaning” section for notes on weaning from breast, bottle, and nighttime feedings.
American Academy of Family Physicians (“AAFP”). “Prevention of Iron Deficiency in Infants and
American Family Physician. 8 Dec. 2009. <http://www.aafp.org/afp/20021001/1217.html>.
Gerber. “Transitioning from Breast Milk to Formula. ” 8 Nov. 2009
Greene, Alan M.D. , and Cheryl Greene. "Infant vs. Toddler Formulas. " drgreene.com. 8 Dec. 2009.
Nestle Good Start. "Nestle Good Start Gentle Plus 2 Formula." 8 Dec. 2009.
Sears, William M.D. , Martha Sears, R.N. , Robert Sears, M.D. and James Sears, M.D. The Baby Book:
Everything You Need to Know About Your Baby - From Birth to Age Two. New York: Little, 2003.
Sears, William M.D. , Martha Sears, R.N. , James Sears, M.D. , and Robert Sears, M.D. "Milk. ”
AskDrSears.com. 8 Dec. 2009. <http://www.askdrsears.com/html/3/t032100.asp>.
Spock, Benjamin M.D. and Robert Needleman, M.D. Dr. Spock’s Baby and Child Care. New York:
Last Updated: December 2009