How to transition your baby to cow’s milk

Switching from breast milk or formula to cow’s milk is a common milestone for many babies in the U.S., but parents often have questions about when and how to make the change.

Rachel Mills, RD, LD, CNSC, Clinical Dietitian at Children’s Health℠, explains that while cow’s milk is a good source of protein, calcium, carbohydrates, fat and vitamin D, it’s important to wait until the right age to introduce it – and to ensure little ones aren’t drinking so much that they miss out on other key nutrients.

When can an infant drink cow’s milk?

Babies can start drinking cow’s milk around their first birthday.

By that time, their digestive systems have developed to the point where they can digest cow’s milk. Before age 1, cow’s milk can be too high in protein, sodium and other minerals leading to stomach and kidney problems.

When switching from breast milk or formula to cow’s milk, it's important to understand that they do not have the same nutritional value.

• Breast milk and formula are considered full meals for an infant. They’re complete sources of nutrition, meant to be the only thing an infant consumes and provide all their necessary nutrients.

• Cow’s milk is a beverage, not a full meal or complete source of nutrition. Once they start drinking cow’s milk and water, they’ll need other foods to provide important nutrients.

Can I continue breastfeeding while introducing cow’s milk?

Yes. The World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend exclusive breastfeeding for the first six months of life. Then, after six months of only breast milk, they recommend introducing solid foods and continuing to breastfeed for as long as it's beneficial – for both parents and baby.

What type of milk should I give my 1-year-old?

Whole cow’s milk is the best milk option for babies and toddlers.

“At that age, their brains are growing rapidly and the fatty acids they get from whole fat milk and full-fat dairy products provide one of the main building blocks of the brain,” Mills says. “So whole milk and full-fat dairy sources are really important for brain development and overall growth.”

The AAP recommends avoiding plant milks for children under 5, unless a child cannot have dairy for medical, religious or lifestyle reasons. They also recommend avoiding flavored milk, sugary beverages and sugar-free alternatives.

How to transition from breastmilk or formula to cow’s milk

There’s no single right way to transition from formula or breastmilk to cow’s milk, as long as you wait until age 1. The process looks a little different for every child.

How to transition if your infant immediately loves cow’s milk

If your child is happy to drink cow’s milk, you can simply give it to them in their sippy cup. Just make sure they don’t drink too much, because they can fill up on it – and not get important nutrients milk doesn’t have, like fiber and iron.

If your child loves cow’s milk, you can use these guidelines to make sure they don’t have too much:

• Babies and toddlers: Limit milk to 12 to 16 ounces per day. Standard sippy cups and large bottles are typically 8 ounces, while small bottles are 4 ounces (So two sippy cups or three small bottles of milk per day is plenty.)

• Kids ages 5 and up: For these kids, 24 ounces of milk (or three standard cups) per day is plenty.

If your child wants more milk than recommended:

• Try offering them food first and then milk at the end of the meal.

• Offer milk at snack times but not mealtimes.

How to gradually transition to cow’s milk (if your child resists the change)

Because cow’s milk has a different taste and temperature, it often works best to make a gradual transition from formula or breast milk to cow’s milk.

• Start by mixing formula or breast milk with cow’s milk using a one-to-one ratio (for example, 2 ounces of breast milk mixed with 2 ounces of cow’s milk).

• Slowly increase the ratio of cow’s milk over the next few weeks until they’re drinking entirely cow’s milk.

If your child won’t drink the combination of cow’s milk and breast milk or formula, you can try:

• An even more gradual transition of two parts breast milk or formula and one part cow’s milk or maybe just a few drops of cow’s milk mixed with breast milk or formula.

• Another week or two on breast milk or formula, then try cow’s milk again.

• Slightly warming the cow’s milk on a stovetop.

Are there signs I might need to slow or stop the transition to cow’s milk?

Some families, especially those with a history of lactose intolerance or milk allergies, worry about introducing cow’s milk to their child’s diet. In most cases, if your child has a true milk protein allergy, you’ll know before their first birthday. Many infant formulas are made with cow’s milk, and milk proteins can also pass through breast milk when a breastfeeding parent consumes dairy. Because of this, most families discover a milk allergy well before their child tries cow’s milk directly.

Signs of a milk allergy in infants

A true milk protein allergy is rare. This type of allergy happens when the immune system mistakes milk proteins for dangerous germs and starts attacking them. Milk sensitivity or intolerance is much more common than a true milk allergy.

Signs of a true milk allergy include:

• Anaphylaxis

• Blood in your child’s poop

• Persistent vomiting with signs of dehydration, such as decreased urination, dry mouth or lack of energy

• Hives (raised, puffy welts on the skin)

If your child has these symptoms, call your doctor right away. If they have trouble breathing or are unconscious, call 911.

Signs that an infant has a milk sensitivity or intolerance

If a child has trouble digesting milk, it's more often a sensitivity or intolerance. This happens when the digestive system has trouble breaking down a food or beverage. These symptoms include:

• Diarrhea

• Constipation

• Increases in spitting up or reflux

• Seeming more fussy than usual

Call your pediatrician if your child has these symptoms. For some children, a lactose and urea breath test can be used to diagnose lactose intolerance.

“If you have significant concerns about your child’s nutrition or growth, reach out to their primary care provider,” Mills says. “If your child is not accepting cow’s milk or is having trouble digesting it, a dietitian may be able to help. Your pediatrician can make a referral to a dietitian as needed.”

Find more health and wellness tips on newborns, infants and toddlers at childrens.com/newborn.

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