How much cow’s milk should my baby be having?
As discussed in recent blogs, feeding, growth and nutrition are central to our role as parents, but can be quite challenging in children, especially during the first two years of life. As babies get older, one very important thing to consider is the balance between milk and solid foods and exactly how much and what milk they should be drinking.
Although cow’s milk is a nutritious drink for children, many parents might not be aware that drinking too much cow’s milk, which is very low in iron, can actually be damaging to their child’s health. After 12 months of age, cow’s milk should be limited to around 500ml per day. I see kids every week who are drinking up to five or six bottles of cow’s milk a day and who are very low in iron and are usually anaemic. Their parents are often not aware just how much milk they’re having and that they are giving in to demands for more and more!
What are the risks of drinking too much cow’s milk?
Children who drink too much cow’s milk may:
- be pale
- have low energy and be tired all the time
- have low blood pressure and be falling over or fainting
- have slowed development and difficulty concentrating and/or learning as iron is needed for brain development
- have a lowered immune system and be regularly unwell
- have a condition called Pica where children eat strange objects such as sand, crayons, leaves etc
- have a poor appetite and are often not hungry
- be constipated and pass hard poos infrequently
- have blood flecked in their poos due to delayed cow’s milk allergy
Most of the above symptoms are due to anaemia, which means that the number or quality of red blood cells in the blood is lower than normal. That is, the red blood cells have a lower level of haemoglobin than normal, which is the protein that carries oxygen around the body. Iron from the diet is needed to make haemoglobin. This means kids won’t be function at their very best and can get sick.
How does cow’s milk affect iron levels?
Cow’s milk reduces the amount of iron in our kids’ diet in three key ways:
- Cow’s milk reduces the amount of iron that is absorbed from the gut due to its high protein and calcium content compared to human milk. The iron in breast milk is very easily absorbed (with 50-70% being absorbed from the gut) compared to only about 10% from formula (which is why extra iron is added to formula).
- Cow’s milk is very low in iron compared to breast milk and formula. Drinking large amounts of cow’s milk also means that other foods that may be higher in iron are not eaten.
- Cow’s milk can cause microscopic bleeding in the gut if the child has a delayed cow’s milk allergy which causes a small amount of blood loss in the poo (I will talk about this in a separate blog).
What are the recommended amounts of cow’s milk that my child should be having?
Most parents know that cow’s milk should not be the main drink given to infants under the age of 12 months due to the increased risk of iron deficiency. Small amounts can still be given as yoghurt, cheese or on cereal. Babies under 12 months should either be breast-fed or have an iron-fortified infant formula. After 12 months of age, cow’s milk should be limited to around 500ml per day because of the factors mentioned above.
What should my baby’s diet look like when they’re between six and 24 months?
- Continue to breastfeed if you and your baby want to and you are able to. In the first 12 months in particular, breastfeeding helps to maximise nutrients and the immunological benefits that your baby receives
- Increase solid foods slowly from around six months and aim for a variety of such as fruits, vegetables, meat, fish, poultry, cooked plain tofu and eggs
- Give iron-fortified infant cereals and meat as they are good sources of iron. The iron from meat is more easily absorbed from the gut and is a good source of zinc and vitamin B
- The best source of calcium for infants is breast milk or infant formula
- Dietary fat is an important source of energy and essential fatty acids and also helps with the absorption of essential fat-soluble vitamins, such as vitamins A and D. Therefore, fat-free or low fat milk should be avoided. (See the link below for more detailed information on infant feeding guidelines).
What should I do if my child is anaemic?
If you are worried that your child has the above symptoms and may be anaemic, it is essential to see your doctor to have your child examined and to have their blood count and iron levels tested. Your child will need treatment with iron for at least three months if they are anaemic and have low iron stores. Occasionally children need an iron infusion or a blood transfusion. You should also encourage your child to eat foods that are high in iron such as meat (especially liver), poultry and fish; lentils and dried beans; eggs; fruits (such as prunes, apricots, and raisins), green leafy vegetables such as spinach, kale and broccoli and iron-fortified breads and cereals. Also remember that vitamin C increases iron absorption so, for example, a glass of orange juice with their meal will help their body to absorb more iron.
If your baby has a good balanced diet they should not need any nutritional supplements, unless they have an underlying medical problem, were born premature or low birth weight or have any risk factors for iron or vitamin D deficiency. Please discuss with your doctor if you are not sure if your child may need some nutritional supplements or you would like some dietary advice. A referral to a dietitian may be extremely helpful if you would like to review your child’s diet.
Please remember that kids don’t need more than about half a litre of milk a day after they turn one and try not to fall into the trap of giving in to requests for excessive requests for bottles of cow’s milk, especially at night to get them back to sleep. Remember you’re the parent and be strong!
Please note: Dr Margie is no longer monitoring questions on this blog. If you are concerned about your child, please speak with your maternal and child health nurse or GP for further advice.