Cow's milk for babies

Why can’t I give my baby cow’s milk instead of infant formula?

Cow’s milk is designed for calves, not human babies. Compared to breast milk, it has low levels of vitamin A, iron, and essential fatty acids, and high levels of sodium, potassium, calcium, and protein. Babies who receive cow’s milk as their main milk source in the first year are at a significant risk of having low iron levels. Cow’s milk also makes the kidneys work harder and can cause bleeding in the gut. Whole cow’s milk can be given in small amounts with meals after six months of age. After one year of age, it can replace infant formula, but children should not drink more than 500 ml (2 cups) a day. Breastfed babies do not need infant formula or cow’s milk.

A) Describing the differences between cow’s milk and infant formula

Cow’s milk is designed for calves, not human babies.

While cow’s milk is the base for most infant formula, it undergoes many changes in the manufacturing process to become infant formula and to make it more appropriate for human babies.

Compared with human milk, cow’s milk has many differences, including:

  • Low levels of:
    • Vitamin A
    • Iron
    • Essential fatty acids
  • High levels of:
    • Sodium
    • Potassium
    • Protein

Cow’s milk-based formula is modified to minimize some of these differences.

B) Risk of feeding cow’s milk to babies

Babies who receive cow’s milk as their main milk in the first year are at a risk of having low iron levels (Thorisdottir 2013; Turck 2013). This is because cow’s milk (Ziegler 2007):

  • Does not have enough iron to support a baby’s healthy development.
  • Can cause the gut to bleed, resulting in even lower levels of iron.
  • Has high levels of calcium and a certain milk protein (casein) that can prevent iron from being absorbed from milk.

Furthermore, cow’s milk has more minerals and protein than a human baby needs. The baby’s kidneys have to work extra hard to get rid of the minerals and the waste products from the protein. Under some circumstances, the kidneys cannot keep up and the baby loses too much fluid and becomes dehydrated.

C) Recommendations for the use of cow’s milk

Recommendations regarding cow’s milk can vary globally. The following are based on European and North American guidelines. Please discuss this with your health-care providers.

Whole cow’s milk can be given in small amounts with meals or snacks after six months of age.

Whole cow’s milk can be used to replace infant formula after one year of age. The amount given should not be more than 500 ml (2 cups) a day. This can be changed to low fat milk at two years of age.

References

Thorisdottir AV, Ramel A, Palsson GI, et al. Iron status of one-year-olds and association with breast milk, cow's milk or formula in late infancy. Eur J Nutr. 2013 Sep;52(6):1661-8
 
Turck D. Cow's milk and goat's milk. World Rev Nutr Diet. 2013;108:56-62
 
Ziegler EE. Adverse effects of cow's milk in infants. Nestle Nutr Workshop Ser Pediatr Program. 2007;60:185-96; discussion 196-9