Cow's Milk and Milk Alternatives for Toddlers: When, How Much and Which Kind

A growing child needs vitamins and minerals such as vitamin D and calcium to build strong bones. From 12 months on, pasteurized, unsweetened whole cow's milk and fortified dairy alternatives are good sources of both. Most cow's milk sold in the United States already has vitamin D added; with alternatives, look for ones fortified with vitamin D and calcium.

Not before 12 months

Start whole cow's milk at 12 months — not earlier. Before then, cow's milk:

• may put a baby at risk of intestinal bleeding;
• has more protein and minerals than a baby's kidneys can handle;
• does not have the right balance of the nutrients a baby needs.

The same goes for dairy alternatives: none should be given before 12 months.

How much

From 12 months, whole cow's milk or a fortified alternative can be part of a varied, balanced diet — but it does not replace food. The Dietary Guidelines for Americans recommend a mix of food groups, dairy among them, in amounts that depend on a child's age and activity. Children aged 12 through 23 months need about 2 servings of dairy a day, which can include:

• cow's milk — pasteurized, whole, fortified with vitamin D, unflavored and unsweetened;
• full-fat yogurt;
• cheese;
• dairy alternatives fortified with calcium and vitamin D, unflavored and unsweetened.

Too much milk can leave a child too full to eat other foods with important nutrients, and some experts say a lot of cow's milk can make it harder for the body to absorb iron from food. Let your child's cues tell you when they are hungry or full, and ask their doctor or nurse if you have questions.

What to choose

• Unflavored and unsweetened. Flavored milks and alternatives can contain added sugars, which a child does not need.
• Whole, not lower-fat. Whole milk is the same as lower-fat milk apart from its fat, and young children need fat to grow and develop. If your child is gaining weight too fast, or the family has a history of obesity, high cholesterol or heart disease, ask their doctor which milk to use.
• Never raw. Raw (unpasteurized) milk and milk products from cows, goats and sheep can carry harmful germs that can make a child very sick and can be life-threatening. Do not give your child raw or unpasteurized milk.

Dairy alternatives

Plant-based drinks can be made from soy, oat, rice, coconut, cashew or almond. Only fortified dairy alternatives count toward a child's dairy needs. If you use one:

• pick one that is unflavored and unsweetened;
• check that it is fortified with vitamin D and calcium, and read the label, because nutrients vary by brand;
• tell your child's doctor or nurse which one you use, since its vitamins and minerals differ from cow's milk.

Sources

• Centers for Disease Control and Prevention, Infant and Toddler Nutrition: "Cow's Milk and Milk Alternatives."