Duration of infant formula use

When do I stop using infant formula and start using cow’s milk?

Breastfeeding will meet all of the baby’s need for milk for the entire duration of breastfeeding, even after one year of age.  Vitamin D supplements can be continued after the first year. Babies who are not breastfed and less than one year of age should be given infant formula. Cow’s milk is missing certain nutrients such as iron, making it unsuitable as the main milk for babies. After the first year, when more nutrients are provided by increasing amounts of solid foods, infant formula is replaced with whole cow’s milk. Their intake should be limited to 500 millilitres (2 cups) a day as drinking larger amounts may increase the risk of low iron levels and obesity. There is no need to use toddler milk instead of whole cow’s milk and plant-based milk drinks do not provide enough nutrients.

A) When to stop using infant formula

Recommendations regarding the use of infant formula and whole cow’s milk can vary globally. The following are based on European and North American guidelines for healthy babies and children (Domellöf 2014). Please see your health-care providers for information specific to your situation.

Breastfeeding provides babies with appropriate milk, even after the first year of life. Vitamin D supplements can be continued after the first year. Once solid foods are started, babies should be offered iron-rich foods.  

1) Less than one year of age

If breastfeeding is stopped before one year of age, babies should be offered infant formula. They can be offered small amounts of cow's milk or water with meals or snacks. 

Cow’s milk is unsuitable as the main milk for babies less than one year of age. For example, it is missing certain nutrients such as iron and has high levels of salt.

2) After the first year 

If breastfeeding is stopped after one year of age, babies should be offered whole cow’s milk. Commercially produced cow’s milk contains added vitamin D. It can also be a good source of calcium and protein (Nachshon 2014).  

It is recommended that older children receive no more than 500 ml (2 cups) of cow’s milk a day as larger amounts increase the risk of low iron levels (anemia). To compensate for this, they should be offered iron-rich foods. They can be given water to meet any additional need for liquid.

Larger amounts of cow’s milk have also been associated with obesity (DeBoer et al. 2015). If obesity is a concern, children can be given reduced-fat milk (2%) after one year of age instead of waiting until two years.

B) Other milks

Toddler milk is not recommended. 

Fortified soy drinks are not recommended before the age of two. Other  plant-based drinks are mostly water and sugar, making them inappropriate for children.

References

DeBoer MD, Agard HE, Scharf RJ. Milk intake, height and body mass index in preschool children. Arch Dis Child. 2015 May;100(5):460-5
 
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
 
Nachshon L, Goldberg MR, Schwartz N, et al. Decreased bone mineral density in young adult IgE-mediated cow's milk-allergic patients. J Allergy Clin Immunol. 2014 Nov;134(5):1108-1113.e3