Cow’s Milk During The First Year

February 12th, 2013 posted by Dr. Paul

Babies with a bottle


My daughter is almost one year old and has been on baby formula all of her life. When should I stop giving her formula? I am also feeding her baby food.


My answer to your question today is different from what I would have replied 10 years ago. Currently, the American Academy of Pediatrics recommends that children be given breast milk or iron-fortified formula for the first 12 months of life. (The Canadian Pediatric Society recommends breast milk or fortified formula for the first 9-12 months). There are many reasons for this, but the most important is related to the iron needs of a child. Iron is an essential part of red blood cells. When the body does not have enough iron to make red blood cells “anemia” (or decreased level of red blood cells) will develop. Normally, babies are born with enough iron in their body for the first few months of life. However, when the baby reaches three to four months of age, extra iron is needed. The extra iron should come from the child’s diet and this is why iron-fortified formula is recommended for infants who are not breast-fed. For a variety of reasons, whole cow’s milk is considered to be a very poor source of iron. In addition, the protein in cow’s milk is not easy for babies to digest. By far, breast milk is the best source of iron and other nutrients for a baby. However, when breast-feeding is not an option, a child should be drinking iron-fortified formula that contains enough iron and all other essential vitamins and nutrients to support normal growth and development. In addition, infant formulas contain modified cow’s milk protein that a baby can more easily digest. As a child approaches one year of age, you can switch to whole cow’s milk. Remember, you should switch to whole cow’s milk because skim or 2% milk are not recommended for children less than two years old. If a child is breast fed and is being weaned off the breast before 12 months of age, the baby should be switched to an iron-fortified formula and not to whole cow’s milk Prior to the current recommendation, babies were switched to whole cow’s milk at six months of age. The reason pediatric specialists recommend that the period on formula or breast milk be extended is that several studies have shown a surprising amount of iron deficiency anemia in children less than a year of age. We also now recognize that iron deficiency anemia in the first year has been linked to developmental delays, that in some cases are not reversed by adding iron to the diet later. Therefore, prevention of iron deficiency anemia is our goal. To recap — whole cow’s milk should not be given to babies during the first year of life.

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