How to Transition to Milk (at 12 months or after)
Disclosure: This post is sponsored by Horizon®. As always, all opinions are my own.
With my oldest child, I had to wean her at nine months due to a medical complication preventing me from breastfeeding any longer. Since I had exclusively pumped the entire time, she was already used to the bottle and having expressed milk. Thankfully, I had a freezer full that lasted her up until the 11- month mark. But then I wondered, do I introduce formula for a month, and then transition her to cow’s milk at a year old? Or, should I transition her from pumped breastmilk to cow’s milk early (before one year old)? Formula was obviously more expensive and for such a short period of time, I wondered even as a dietitian mom if I could transition her to milk early.
With my second child, I again needed to wean before she was a year old. While breast milk was my preference for her through the first year of life, other reasons again prevented me from doing so. I had to reconsider the transition from breastmilk to formula and then formula to milk.
With my third child, I was finally able to breastfeed (and not exclusively pump). I was able to nurse him past 12 months old, but then we began to learn more about his eczema and dietary restrictions which meant his transition to milk needed to include a milk alternative.
So why do I share these examples?
Because they show that even within my own family, each child and situation is different when it comes to discussing how we transition to milk. For some children, they will transition from bottle-feeding formula to consuming cow’s milk and other infants will go from exclusive nursing to a milk alternative.
And although the discussion of which milk choices for children are best has several facets for families to consider, this post highlights what the research says, recommendations are, and timeline to follow is when it comes to safely and successfully transitioning your baby to milk.
When and How to Introduce Cow’s Milk
Up until one year of age (before 12 months old)
During the first year of life, breastmilk and/or formula provide 35 to 100% of a child’s total caloric needs. However, because these options differ considerably in their composition to whole cow’s milk, it is important to understand the main nutritional concerns for why cow’s milk should not be offered before one year of age.
The main nutritional concerns to consider before 12 months
The first and most common concern relates to iron. Most healthy, full-term infants have sufficient iron stores early in life. However, as iron needs increase between 7-12 months of age (to 11 mg per day), infants require considerably more iron in their diets to replace iron stores depleted in the first 6 months of life. To account for these increased iron needs, breastmilk or an iron-fortified infant formula are preferred during an infant’s first year. Whole cow’s milk contains little iron and may increase enteric blood loss, further reducing iron stores.
There are other reasons why breastmilk or iron-fortified infant formula are preferred over cow’s milk during the first year of life. Cow’s milk contains a higher amount of casein than breastmilk or infant formula, and casein is difficult for young children to digest. Cow’s milk also contains less vitamins and minerals like zinc, niacin, vitamin C, and vitamin E, and also fatty acids like linoleic acid.
Lastly, the increased amounts of sodium, potassium, chloride, and phosphorus associated with use of whole cow’s milk is another reason to avoid it before one year. Raising the renal solute load may not supply infants with enough margin of free water particularly when water intake is reduced (i.e. vomiting) or lost (i.e. diarrhea or heat).
For these reasons, cow’s milk should not be introduced before one year of age.
At one year of age (between 12-24 months old)
At one year of age, children can be safely introduced to cow’s milk (assuming it is medically indicated to do so). When offered in appropriate amounts and in a manner that supports healthy dietary habits, whole cow’s milk can be a nourishing staple to a young child’s diet.
What to offer
As discussed in The Best Milk Choices for Children, whole milk (sometimes referred to as 4% fat milk) can help meet some of your child’s top nutritional requirements including calories, fat, protein, vitamin D, and calcium. Fortified milk options, like Horizon® Growing Years™ Organic Whole Milk, offer additional nutritional benefits over other cow’s milk or plant-based milk alternatives. This makes Horizon® Growing Years™ Organic Whole Milk an excellent type of whole milk for toddlers to transition to when they reach one year of age.
Children can benefit from fortified milk products that include nutrients like Docosahexaenoic acid (DHA) and choline, as seen in Horizon® Growing Years™ Whole Milk. Developed by pediatricians, one cup of Horizon® Growing Years™ Whole Milk is specially designed with important nutrients for children. Each 8-oz (1 cup) serving provides:
50mg of DHA omega-3 to help support brain health
55 mg of choline to help transport DHA throughout the body
1g of prebiotics that’s good for little bellies, as part of a balanced diet
An excellent source of calcium and vitamin D to support strong bones
High-quality, complete protein
DHA is important to support brain health and is present in fatty fish like salmon (1240 mg per 3-oz filet), tuna (970 mg per 3-oz filet), mackerel (800 mg per 3-oz filet), some meats like chicken (70 mg per cup diced), and eggs (30 mg per large egg). However, young children often reject such foods or do not regularly consume them in the amounts some experts recommend. For this reason, Horizon® Growing Years™, which is supplemented with DHA (50 mg of DHA per 8-oz serving), can help to provide children ages 1-5 with some DHA while they learn to like other foods high in DHA.
Choline is an essential nutrient that helps transport DHA throughout the body including the child’s brain. Since our bodies do not naturally produce enough choline to meet a child’s needs, it is recommended that children (ages 1-3 years old) consume 200 mg choline per day from dietary sources like beef liver (356 mg per 3-oz), eggs (147 mg per large egg), soybeans (107 mg per ½ cup), chicken or ground beef (72 mg per 3-oz), cod (71 mg per 3-oz), wheat germ (51 mg per ounce), kidney beans (45 mg per ½ cup) , quinoa (43 mg per 1 cup), Brussels sprouts (32 mg per ½ cup cooked), and broccoli (31 mg per ½ cup cooked). For children who are still learning to like such foods or not yet consuming them in large enough quantities to meet such levels, Horizon® Growing Years™ can be a complimentary, food-first approach to supplementation. Horizon® Growing Years™ Organic Whole Milk contains 55 mg of VitaCholine® choline per 8-ounce serving.
How much to offer
The Healthy Beverage Consumption in Early Childhood consensus statement developed by the Academy of Nutrition and Dietetics (AND), the American Academy of Pediatric Dentistry (AAPD), the American Academy of Pediatrics (AAP), and the American Heart Association (AHA), recommends children ages 12 to 24 months consume 2 cups (16 oz) of whole milk per day but no more than 3 cups (24 oz) per day to avoid displacing other nutrient-rich foods including iron-rich foods. Be sure to also factor into this daily total any other dairy-based foods a child is eating, such as yogurt or cheese.
How to transition to milk
To begin the transition to whole milk, you may substitute a child’s midday bottle with an open cup of milk. Although this may take time for a child to adjust to and accept, continue to offer small amounts of milk in an open cup or to use a straw cup, as needed, until the child is successful with larger volumes in the open cup. As whole milk in an open cup is tolerated, eliminate one bottle feed at a time in the order most likely to be tolerated (often with the bedtime bottle as the last to be weaned). A child’s nutrient intake from other foods will help determine how much milk to offer at a given meal or snack, but the total amount consumed per day should align with the recommended ranges for each age group.
If a child struggles to consume adequate milk, whole milk may be titrated with breastmilk or infant formula until the child develops a taste preference for it. Whole milk may also be added to cold or hot cereal, sauces/gravies, and smoothies until a greater volume is consumed. What we do not want, however, is to delay weaning the bottle in attempts to increase the child’s intake of whole milk
How to transition to a cup
The American Academy of Pediatrics recommends that infants be introduced to an open cup around 6 months of age and be fully weaned from the bottle no later than 18 months. These recommendations are intended to optimize appropriate feeding patterns and to decrease the health concerns associated with prolonged bottle feeding.
Drinking from a bottle beyond infancy is associated with childhood obesity as it encourages a child to consume excess calories, particularly when a bottle is used to comfort the child rather than to address the child’s hunger or nutritional needs. This increased availability to milk by way of the bottle can also cause tooth decay and encourage a child to consume more milk than they need. When excessive amounts of milk are regularly consumed, children may become iron-deficient as milk could displace intake of adequate iron-rich foods.
It is tempting to first transition from bottle to sippy cup because of the convenience and fewer spills that sippy cups afford us as parents. However, it is best to switch to an open cup as soon as possible after 12 months (if not sooner). This is because prolonged sippy cup use is associated with the same risks as prolonged bottle use, including relationship to weight gain, tooth decay, and iron deficiency.
To help reduce the concerns that come from prolonged bottle and sippy cup use and increase a child’s intake of milk from an open cup, families should be prepared to wean from a bottle to a cup by 15 months. If you have questions or concerns about how to do this with your child, be sure to speak with your child’s pediatrician at their 15-month well-child check-up.
At two years of age (after 24 months old)
Children need the higher fat content of whole milk to help them meet their increased energy needs until around age two, when they are able to consume a greater proportion of their nutrient intake from table foods. Then, at two years of age, families may decide to transition from whole milk to low-fat milk to adhere with current recommendations.
Should Kids Drink Low-Fat or Whole Milk?
The nutritional composition of whole milk is the same as low fat except that whole is higher in fat.
If a child has excessive weight gain or a family history of obesity, the family as a whole may benefit from transitioning to low fat milk after the child’s second birthday. If a family is interested in transitioning from whole milk to a low- or no-fat option, they may gradually transition from whole to 2% to 1% to skim (if desired) to help promote a preference for it.
Conversely, children who have increased energy needs, unmet nutrient and/or energy intake during seasons of pickiness, and/or a preference for the taste and/or texture of whole milk may opt for the higher fat content in whole milk, like that in Horizon® Growing Years™.
Several publications, however, suggest that whole milk can be consumed as part of a healthy and balanced diet in childhood and is not associated with increased measures of weight gain or adiposity. In fact, several pieces of observational research suggest that consumption of whole milk compared to reduced-fat milk does not adversely affect body weight or body composition among children and adolescents. Instead, children who consume higher milk fat may have lower odds of childhood overweight or obesity than those who consume lower milk fat options. Reverse causation could be a possible explanation for parents of children with lower adiposity choosing whole milk and parents of children with higher adiposity choosing low-fat milk. With this, parents of a child who is overweight might prefer to provide reduced-fat dairy rather than whole-fat dairy, with the intention of reducing overall caloric intake.
In Conclusion
If you are preparing to transition your child to milk, be sure that they are at least one year of age. Around this time, be sure you are also offering them plenty of opportunities to practice with an open cup. Then, focus on emphasizing key nutrients in the diet like calories, fat, protein, vitamin D, calcium, omega fatty acids, and choline by choosing a milk like Horizon® Growing Years™ Whole Milk. This offers complimentary source of nutrition as your child’s intake of table foods continues to increase and expand.