How to introduce cow's milk to your baby

Around the time Sara Chow’s daughter, Serena, turned one, she noticed many of the parents she’d met in her moms’ groups were transitioning their babies to cow’s milk, especially those on formula. It was something Chow was hoping to do, too. “Milk is so much cheaper and easier than formula,” she says. But Serena was underweight, so she wasn’t sure if it was the right move.

Official guidelines recommend parents hold off until babies are between nine and 12 months old before introducing cow’s milk. Prior to that, it’s not an appropriate substitute for breastmilk or formula. That’s because younger babies aren’t ready to digest it, and can develop an iron deficiency if they’re drinking too much milk and not eating enough iron-rich foods, such as meat, eggs and fortified cereals. Once infants start consuming a variety of solids, cow’s milk can be introduced as a nutritious supplement. Choosing the right type of milk is important: Pasteurized, homogenized 3.25 percent milk (a.k.a. whole milk) is recommended until two years of age. “This is a period of rapid growth and brain development for your baby, and they require higher calories and fat content,” says Jeff Critch, a paediatrician in St. John’s, Nfld., and the chair of the nutrition and gastroenterology committee at the Canadian Paediatric Society.

While whole pasteurized goat’s milk can be used as an alternative to the cow’s variety, look for one that has added vitamin D and folic acid. Rice, nut and even fortified soy beverages aren’t recommended as a main source of milk, because they don’t have the same nutritional content as cow’s milk. But, Critch says, after two years of age, switching to lower-fat cow’s milk is fine.

And those “toddler drinks” you may have seen marketed as transitional milks and formulas for picky eaters? They aren’t recommended, because they’re mostly made of powdered milk, and contain corn syrup or other added sweeteners. They also have more sodium and less protein than milk.

If you’re starting cow’s milk between nine and 12 months, it’s OK to use a bottle or sippy cup. But if your child is over a year, doctors recommend offering milk in a regular cup alongside meals and snacks. Using a cup will help them learn to drink and encourage healthy cheek, bone and jaw development—not to mention healthier teeth.

Toddlers who are attached to their bottles and sippy cups may drink more milk than they need. Experts stress it’s important to limit the amount of milk you’re giving your child each day. Critch recommends that tots this age get a maximum of 750 millilitres each day so it doesn’t reduce their intake of other nutritious foods.

But not every baby or toddler likes to drink milk. Breastfed babies can be slower to take a liking to it, and that’s OK—breastfeeding is still encouraged until two years of age or as long as mom and baby want to continue. Aven Poynter, a Langley, BC, paediatrician and the president of the BC Pediatric Society, recommends starting the transition by offering cow’s milk gradually. “Like any other food, it may not be accepted right away,” she says. She suggests mixing it with a more familiar milk, such as formula or expressed breastmilk, slowly increasing the proportion of cow’s milk over time.

If your baby experiences breathing trouble, vomiting or hives a few minutes to a couple of hours after drinking milk or consuming dairy products, they may have an allergy. In severe cases, such as when your child can’t breathe properly or when more than one system in the body is involved (such as hives and vomiting combined), call 911 or go to the hospital right away. Delayed allergic reactions can be milder but also include vomiting, as well as diarrhea, constipation and a rash. Either way, see a doctor. A milk allergy doesn’t usually develop in children over the age of one, so most babies would have shown signs of an allergy in response to certain formulas or mom’s dairy consumption during breastfeeding—but it’s possible for children to develop the issue later.

In these cases, instead of switching to milk, formula-fed babies could try a soy-based formula as an alternative, while breastfed babies would probably be advised to continue to breastfeed. However, some children who are allergic to milk also have a problem with soy. In this situation, you’ll likely need to switch to a hydrolyzed formula, which means the milk protein has been thoroughly broken down so your baby’s system doesn’t recognize it as a threat. It’s also worth seeing a dietitian.

Chow ended up waiting until Serena was at a healthy weight, at about 14 months, before transitioning her to cow’s milk, on the advice of her dietitian. To start, she was told to give the toddler a cup with meals and make sure it wasn’t her main source of nutrition. It was surprisingly easy. “There was no fighting from her!” Chow says. “We’re lucky she’s not picky about flavour.”

Read more: Are milk alternatives actually unhealthy for kids? 10 things your doctor told you about kids' nutrition that are wrong