Questions about milk and dairy alternatives come up all the time with my clients. When to start, how much to offer etc. I recently had Ilona Burkot, Paediatric Registered Dietitian, meet with us to make sure that my kids were eating enough variety and getting the nutrients they needed. When I asked her “how much milk should my child be drinking”, she explained that a lot of kids are having too much dairy. This surprised me and I asked her if I could share some of her thoughts on the subject with you. Here’s how our conversation went.
At what age can you introduce cow’s milk?
According to Health Canada’s Nutrition for Healthy Term Infants, the appropriate time to introduce whole cow’s milk is at 9-12 months of age. Before this age, babies’ tummies are not mature enough to digest cow’s milk. Also, cow’s milk does not provide adequate nutrition for the young infant – it is lower in calories and protein and does not contain iron. By 9 months of age babies are ideally eating a variety of solids, including iron rich foods, and so parents can introduce fluid cow’s milk as a beverage. Yogurt and cheese can be given after 6 months of age, after a variety of iron-rich foods have been introduced.
Can you give us a guideline of how much milk/dairy kids should be having? Does it change by age?
Once cow’s milk is introduced I advise parents to limit it to 2 cups (500ml) per day – this doesn’t sound like a lot, especially if a baby is weaning from formula. However, I encourage parents to consider that by 12 months of age their child should be eating a variety of family foods and so milk or formula can take a back seat in terms of importance in the diet. Milk is a valuable source of calories, fat, protein, calcium and other nutrients, but a variety of other foods is important too. For breastfed babies, parents can decide to hold off on introducing cow’s milk, or add it to their child’s diet as a beverage with eating times.
Continue offering 2 cups (500ml) of cow’s milk per day throughout your child’s growing up years; it’s not until the preteen and teen years that they require more in response to increased calcium needs, at which point up to 3-4 servings of milk and alternatives can be offered.
Why do we have to be careful about not giving too much dairy?
Excessive cow’s milk intake is something I see frequently as a paediatric dietitian, with the most common consequence being iron deficiency and iron deficiency anemia. It’s kind of a three pronged issue: cow’s milk is devoid of iron; excessive calcium from too much milk binds dietary iron and prevents your body from absorbing it; and too much milk contributes to poor appetite and picky eating (therefore kids are eating less iron-rich foods in the first place). Do consider how much yogurt, yogurt drinks, cheese and milk-based puddings, custards etc. your child is eating as well.
If your child is drinking 2 cups of milk per day, limit other milk alternatives to 1-2 servings per day to ensure there is room for a variety of other foods!
What is the best time of the day to offer milk?
Offer cow’s milk from a cup with your child’s meal and snack times – yes, even at 9 months of age! I often suggest that parents and caregivers start offering whole cow’s milk in a cup rather than a bottle so you can transition those two things together. The newest guidelines recommend introducing open cups to babies at 6 months of age to help them learn and master this new skill early on – at that point you can offer expressed breast milk, formula or small amounts of water in an open cup (it will get messy!); after 9 months of age you can also offer whole cow’s milk by cup. Sippy cups are commonly used but are not necessary. Introducing early cup drinking is important, especially when you consider that it is recommended to stop bottle use by 12 months of age, and no later than 18 months of age.
Avoid letting your child sip on milk throughout the day as this will affect the health of their teeth, create not so great eating habits and diminish their appetite for food at mealtimes (often resulting in the dreaded mealtime battles!)
Formula fed babies often transition to cow’s milk around one year of age. If they are used to having 4+ bottles of formula per day (6-8ozs), how do you make the transition to milk? If a baby is used to 8ozs of formula before bed, do parents offer 8ozs of milk?
As mentioned above, once you are ready to introduce whole cow’s milk (between 9-12 months of age), start by offering it in a cup – so at this point your child might take some cow’s milk by cup and some formula by bottle. Babies are likely to drink less with a cup than a bottle – this may be a good thing for babies who drink a lot of formula. By 12 months of age, formula intake should be decreasing to make room for a variety of nutrient-dense table foods. I generally counsel families to decrease formula intake to a maximum of 16-20oz (500-600ml) by 12 months of age and beyond. This may be divided up into 4oz (125ml) portions, four times per day (for example with meals and a snack, or before bedtime).
For babies who continue to nurse after one year of age, do they need less milk?
Generally speaking, breastfed babies don’t need additional whole cow’s milk in their diet. However, a family may choose to offer whole cow’s milk by cup after 9 months of age to introduce a new skill and a new food, while continuing to breastfeed.
Remember to continue providing a vitamin D supplement while you are breastfeeding.
We know that a lot of babies & kids have an intolerance to dairy. For families who decide not to give their little one cow’s milk, what is a good alternative?
Families may choose to avoid dairy for a variety of reasons – cultural preferences, dietary choices, milk allergies or intolerances. Cow’s milk protein allergies, as diagnosed by specific criteria, affect about 2-3% of children under 3 years of age; most children tend to outgrow this allergy overtime. Cow’s milk intolerances may be a little trickier to pinpoint so do talk to your child’s doctor to see if you actually need to be avoiding milk.
For families who are breastfeeding their child, continue to breastfeed for up to 2 years and beyond. For formula-fed children (or for families who are choosing to wean breastfeeding), Health Canada’s Nutrition for Healthy Term Infants recommends to offer soy formula until 2 years of age to ensure adequate provision of calories, protein and nutrients. Plant-based milk alternatives (like soy, almond, coconut, rice, pea protein and hemp beverages) do not provide sufficient calories or protein. If your child does not accept soy formula or you would prefer not to offer it, I would definitely advise that you speak with your child’s doctor or seek guidance from a dietitian with experience in paediatrics. This is a critical time in your child’s growth and development and nutrition plays an important role in supporting that.
Ilona Burkot, RD, is a paediatric and family dietitian working in the Milton, Oakville and Burlington area (although she will travel!). She received her BASc in Food and Nutrition at Ryerson University, followed by an internship at SickKids Hospital in order to become a Registered Dietitian (RD). She has over 10 years of experience working as a dietitian with families, children and infants.