Sarah Remmer: The Non-Diet Dietitian


Milk For Toddlers: What Kind And When To Transition?

Conflicting messages make for confused Mommas when it comes to feeding their babies and toddlers milk

I’ve had many questions from fellow moms on which milk is best for their babies and toddlers. Some of these moms have toddlers that can’t tolerate homogenized milk due to milk allergy or lactose intolerance, so they are turning to milk alternatives such as rice milk, soy milk, almond milk or coconut milk to fulfill their little one’s milk needs. Unfortunately, most of these alternatives don’t provide enough nutrition for growing babies and toddlers. And to make things even more confusing, there are many misleading theories and opinions out there about cow's milk and its alternatives. 

New infant feeding guidelines were released in early 2014 by Health Canada, Dietitians of Canada, the Breastfeeding Commitee of Canada and the Canadian Pediatric Society stating that homogenized fluid milk should be introduced between the ages of nine and 12 months of age. 

When should you start feeding cow's milk?

It is safe to introduce cow’s milk at between the ages of nine and 12 months of age. The reason why babies should not drink cow's milk before then is because the proteins present in fluid cow's milk are hard for young infants to tolerate and digest. Also, milk contains too much sodium, potassium and chloride which can tax your baby’s kidneys. It also lacks important vitamins and minerals such as iron, Vitamin E and Zinc. Your baby would be at a higher risk for iron deficiency anemia and if he or she consumed too much cow’s milk. 

That being said, once your baby reaches nine to 12 months, his digestive tract is mature enough to handle milk and reap the many nutritional benefits from it. It’s a nutrition powerhouse full of protein, carbohydrates, calcium, Vitamin D, and Vitamin A. Milk is key not only for energy as well as tissue growth, but also for building strong bones and teeth and regulating muscle control.

What about weaning from the breast or bottle?

At around one year of age, I encourage moms to continue breastfeeding if they are already, even with the introduction of cow’s milk. Some moms choose to delay the introduction of cow's milk because they are still breastfeeding two to three times a day and that is fine. If your baby is on formula, you can slowly transition to homogenized cow’s milk (assuming your baby doesn’t have a milk allergy) at around one year. You don’t want rush this transition because your baby’s digestive system needs time to adapt to the new proteins and other nutrients present in fluid milk. Start with one to two tablespoons a day and slowly increase until fully transitioned. Again, you can continue to breastfeed as long as possible. Your baby should be having two to three cups (16-24 oz) of milk per day maximum until the age of two and then should decrease down to two cups max. (16 oz). If your baby is still nursing, he may not need as much of any. Milk should be offered ideally in an open cup or straw cup preferably at meals or just after. This is to make sure that your baby or toddler is not filling up on milk before a meal (ruining their appetite). Offer water freely in between meals. Even though it may be a tough transition, try to encourage cups and not bottles, especially after 14-15 months of age. 

What about other milks?

You don’t want to feed your baby reduced-fat or fat-free milk because your baby needs the dietary fat for proper growth and development until the age of two. You also don’t want to feed your baby soy milk, rice milk, almond milk or any other milk alternative until the age of two. These milks often do not contain enough calories, protein or fat for proper growth and development. 

What if my baby has a milk allergy or lactose intolerance?

If your baby is allergic to milk or lactose intolerant, you may want to consider keeping your baby on formula or a follow-up formula until the age of 2 to ensure proper nutrition. There are soy varieties or hydrolyzed protein/hypoallergenic varieties out there for babies with allergies or intolerances. There is also lactose-free homogenized milk available at most grocery stores which is the best alternative for those babies or toddlers with a lactose intolerance. You should offer the same quantity as you would cow’s milk. If you're unsure, make an appointment with a pediatric dietitian who can offer personalized advice. 

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