Introducing Your Baby to Dairy - Part 1
Introducing your child to complementary foods is an exciting milestone, with the goal of nurturing a healthy relationship with foods from all food groups. The introduction of cow’s milk dairy foods can be a contentious topic for parents, as it is a food group that is commonly singled out as the culprit for many health woes, from lactose intolerance/dairy allergy, to skin, respiratory, and digestive concerns. Parents often have many questions about adding dairy to their child’s diet. Let’s explore some of the most common issues in order to clarify and ease you through the milk transition.
When can cow’s milk be introduced to my child’s diet?
It is recommended that the addition of cow’s milk as a beverage to your child’s diet should be no earlier than 9-12 months. Adding it sooner than this is associated with iron-deficiency, which can lead to anemia. A child’s risk of iron deficiency is increased after 6 months of age, when a healthy infant’s iron stores begin to wane (for premature infants, low birth weight babies, and those with other health challenges, this could occur sooner). This is why recommended first foods usually include iron rich foods like dark chicken, beef, beans, sweet potatoes and cooked spinach. Note that adding milk earlier than 6 months of age is associated with gastrointestinal bleeding, which further increases anemia risk. If you will be introducing cow’s milk to your child around 9-12 months, delaying until the end of this age range may be beneficial if they aren’t consuming adequate amounts of iron rich foods.
In Canada, 12 months of age is the point at which milk usually becomes a larger part of a child’s diet. This is partially due to the fact that subsidized maternity leave ends and breastfeeding may be substantially reduced or eliminated, requiring nutritional substitution. If a child is formula-fed, it is assumed that their solid food intake provides a greater portion of their nutritional needs so they no longer need the more costly supplementation that formula provides (this may not be the case for all children, some are encouraged to continue Stage 2 formula until their solid food intake improves). It is also the age at which a child’s calcium needs almost triple (see table in Part 2).
There may be benefit to introducing cheese and yoghurt earlier than the recommendation for liquid cow’s milk. Emerging evidence suggests that introducing cheese and yoghurt just as you would any other solid food after 6 months of age may be associated with reduced risk for allergy development when compared to delaying until after 1 year of age (Fleischer 2013). If you have a family history of food allergies, talk to your healthcare practitioner to develop an introduction plan before adding common food allergens like dairy foods to your child’s diet.
If I’m going to introduce cow’s milk, how much is too much?
By 12 months of age, Health Canada guidelines suggest that 1/3 of a child’s energy intake should come from their “milk source” and the remaining 2/3 should be provided by complementary foods. This translates into 2 cups (500mL) of whole milk per day if a child is not breastfed. It is recommended not to exceed 750 mL of milk per day, as too much milk displaces other nutrient sources, increases the risk of constipation and iron-deficiency anemia.
If your child is breastfed, it is recommended by the World Health Organization (WHO) to continue until 2 years of age and beyond. Provided that you are nursing 2-3 times per day and your child is taking in a variety of solid foods, breastmilk will be the “milk source” that provides 1/3 of their caloric needs and there is no need to make cow’s milk a regular beverage for your child. Other dairy-based foods can be introduced for nutritional variety, rather than as staples of your child’s diet. For babies who have previously established dairy allergies or sensitivities and who have been consuming soy-based formula, it is recommended to continue this until 2 years of age, or to talk to your healthcare team to discuss other options for providing the required nutrients.
What role does dairy, particularly cow’s milk, play in a child’s diet?
Dairy foods are recommended due to their relatively high calcium content. Cow’s milk is also considered a good source of protein, vitamin D, magnesium, vitamin B2, and B12, all of which are needed for a child’s rapid growth, for bone and tooth development, and to support nerve, muscle, and immune function. Whole or homogenized cow’s milk (3.25% milk fat) in particular contains a significant amount of fat, which is necessary for providing the building blocks for rapid brain development and for carrying and aiding absorption of fat soluble vitamins A and D. The higher fat content in whole milk means it is a calorie dense food, providing a substantial amount of calories per serving (160 kcal per 250 mL) that is needed to fuel active little bodies. For these reasons, it is only considered prudent to switch from whole milk to lower fat (e.g. 2%) milk after age 2.
As long as your child tolerates it well (has no allergy to milk protein, and does not have other systemic symptoms that are arise due to dairy intake), dairy foods including unsweetened yoghurt, cheese, and milk can form a part of a varied and healthy diet. Lactose intolerance can be bypassed with the use of lactose-free products, aged cheeses like cheddar, parmesan, Swiss, and plain, full-fat European style yoghurts (like Greek yoghurt).
The nutrients found in cow’s milk dairy, however, can be taken in from other foods. The reality is that milk and dairy foods are simply convenient, palatable nutrient sources that are easily accessible and are often less costly than milk alternatives. If you choose to substitute foods to fulfill your child’s nutrient needs, you may need to be more aware of the nutrient content of these alternatives, as well as more vigilant in ensuring your child’s intake.
*Originally published November 3, 2016
Read Part 2 where we talk about the nutrient needs of your child as they age and how milk and milk alternatives can support their development!