Many of my private practice clients ask me about cow's milk and alternatives to transition their baby off of breastmilk or formula. Although it's common practice and many parents will choose to switch from breastmilk/formula to cow's milk it is not necessary.
First, the benefits of breastmilk do not disappear after your child reaches one. It is perfectly fine and beneficial to continue to breastfeed for as long as you (and your child) like. Weaning generally starts when your child is six months old, when solid foods are being introduced. As your child eats more solids, they will start to consume less breastmilk. This is a gradual process – breastmilk or formula should still provide the majority of calories until the child reaches one year. Interestingly, the World Health Organization (WHO) recommends breastfeeding for two years and beyond. After 12 months, formula is no longer necessary and bottles are typically discouraged. However, the transition away from breastmilk or formula does not mean that the child suddenly needs to be transitioned onto cow’s milk.
There is nothing special about cow’s milk. It is but one source of calcium and vitamin D and it is no more necessary than any other individual food. In fact, multiple studies suggest that cow’s milk may prevent iron absorption (and cause iron deficiency anemia) if your toddler drinks too much without eating enough iron-rich foods. In the United States, iron is the most deficient nutrient among children because of the volume of cow’s milk that so many young children consume. Beyond the issues with iron absorption, many children are allergic to cow’s milk or have intolerances to dairy. So, what is the path forward?
Harvard nutrition researchers have designed their own version of the USDA “MyPlate” with a note about milk. Harvard Nutrition also points to substantial evidence that shows consuming milk and dairy foods can be harmful, noting that there is little evidence that dairy actually protects against osteoporosis or bone fracture. They state that milk and other dairy products are a convenient source of calcium and vitamin D, both important nutrients for children, but that research does not show that milk reduces the risk of bone loss or fractures. In fact, research shows that in addition to the immediate risk of iron deficiency, those who consume dairy are at a higher risk of developing prostate, endometrial, colorectal and breast cancer.
In other words, times (and science) have changed and milk or dairy are no longer considered must-have foods. The nutrients in milk can be found in other foods and therefore cow's milk is not an essential food for growth and development in children. If consumed, milk or dairy products should be limited to 1-2 servings per day.
So what can you do instead?
I recommend limiting, if not eliminating dairy and milk products. Instead, parents should focus on meeting children’s calcium requirements from non-dairy foods. Beans and leafy greens are great sources of calcium. Try kale, cooked spinach, arugula, turnip greens, broccoli, kidney beans, pinto beans, white beans, garbanzo beans, and lentils. Edamame and tofu are excellent sources (also great sources of protein). Even some fruit has calcium like raisins, oranges and dried figs. Another added benefit to choosing non-dairy calcium foods, your child gets to try and (hopefully) enjoy a variety of foods, making healthy eating in the years ahead much easier. The American Academy of Pediatrics recommends all infants and children receive supplemental vitamin D. Cow’s milk is fortified with vitamin D and so are many non-dairy milk options as well as many orange juice and cereal brands. Your doctor can recommend a supplement to fulfill this recommendation if intake is limited.
The fat content in whole milk is often listed as a reason for toddlers to consume milk. Your child can get plenty of fat by eating foods like nut/seed butters, avocado, ground flax and hemp seeds. Even if you don’t completely avoid milk or dairy, including other options for calcium, vitamin D and fat not only leads to healthier eating habits but is also consistent with current nutrition recommendations.
NIH. How much calcium do children & teens need? 2016 https://www.nichd.nih.gov/health/topics/bonehealth/conditioninfo/children
Parkin PC, DeGroot J, Maguire JL, Birken CS, Zlotkin S. Severe iron-deficiency anaemia and feeding practices in young children. Public Health Nutr. 2016 Mar;19(4):716-22. doi: 10.1017/S1368980015001639. Epub 2015 Jun 1. PMID: 26027426.
Skerrett P. Harvard to USDA: Check out the Healthy Eating Plate. 2016 https://www.health.harvard.edu/blog/harvard-to-usda-check-out-the-healthy-eating-plate-201109143344
World Health Organization. Breastfeeding. 2018. http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/
Ziegler EE. Consumption of cow's milk as a cause of iron deficiency in infants and toddlers. Nutr Rev. 2011 Nov;69 Suppl 1:S37-42. doi: 10.1111/j.1753-4887.2011.00431.x. PMID: 22043881.