Giving cow's milk after six months of age

Does my eight-month-old baby need cow’s milk?

Cow’s milk is not recommended for babies under six months and is recommended only in limited quantities for older babies and children. The reason is that it increases the risk of low iron levels and is not designed for human babies. Babies under six months of age should be breastfed or given expressed breast milk or infant formula. For babies 6 to 12 months old, cow’s milk can be given in small amounts with meals. Other options are expressed breast milk, water, and infant formula. At 12 months, breastfed babies can continue to breastfeed. Formula-fed babies generally switch to cow’s milk and it is recommended that they receive no more than 500 ml (2 cups) of cow’s milk a day. Breastfeeding babies who are not drinking cow’s milk, which is usually fortified with vitamin D, may have low levels of vitamin D, but this can be provided through vitamin D preparations.

B) Giving cow’s milk to babies under six months

No cow’s milk should be given to babies up to six months of age.

C) Giving cow’s milk to babies from six months to one year of age

Recommendations regarding whole cow’s milk vary globally. The following are based on European and North American guidelines. 

Until one year of life, a baby’s primary milk should be breast milk, expressed breast milk, or infant formula.

Once babies start solid foods, they may like a small drink of waterexpressed breast milk, cow’s milk, or infant formula in a sippy cup (cup with a lid that has a spout) with meals that have drier foods. More than small amounts of cow’s milk and water will displace appropriate milks and solid foods and may result in the baby not growing well.  

If your baby is breastfeeding but has also needed regular supplementation with milk for medical reasons with more than small amounts of expressed breast milk or infant formula (for example, more than 150 millilitres or 5 U.S. fluid ounces), you will probably need to continue supplementing the baby with these for the first year of the baby’s life. Small amounts of solid foods or milk from a sippy cup may not provide enough nutrition to replace these.

D) Giving cow’s milk to babies after one year of age

After one year of life, breastfeeding children will continue to take in breast milk as their main milk and do not need additional milk but may like small amounts of water, expressed breast milk, or cow’s milk in a cup with meals or snacks. They can be given expressed breast milk or cow’s milk when the mother is not available to breastfeed.

Formula-fed babies generally switch to cow’s milk around 12 months. It is recommended that these children receive no more than 500 ml (2 cups) of cow’s milk a day (Domellöf et al. 2014; Koletzko et al. 2019). They should be given water if they need more liquid. This milk is generally given in a cup as most authorities discourage using a bottle after one year of age.

Cow’s milk is generally fortified with vitamin D. Babies who are breastfeeding and not drinking fortified milk may have low levels of vitamin D. This is easily provided through vitamin D preparations.

E) Other milks

Fortified soy milk is generally not recommended before the age of two. Other plant-based drinks are generally not appropriate for children, because they contain mostly water and sugar.

References

Domellöf M, Braegger C, Campoy C, et al.; ESPGHAN Committee on Nutrition. Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr. 2014 Jan;58(1):119-29
 
Griebler U, Bruckmüller MU, Kien C, et al. Health effects of cow's milk consumption in infants up to 3 years of age: a systematic review and meta-analysis. Public Health Nutr. 2016 Feb;19(2):293-307
 
Koletzko B, Godfrey KM, Poston L, et al. Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations. Ann Nutr Metab. 2019 Jan 23;74(2):93-106