Tuesday, September 8, 2009

Cow's milk: When and how to introduce it

Why do experts recommend waiting to introduce cow's milk until a baby is 12 months old?

There are several reasons to delay the introduction of cow's milk until your baby reaches his first birthday. Most important, a baby's digestive system can't digest cow's milk proteins. Cow's milk also has too much sodium, potassium, and chloride, which can tax your baby's kidneys.

Even if his system could handle it, cow's milk doesn't have all the vitamins and minerals (especially vitamin E, zinc, and iron) that he needs for growth and development in his first year. Giving a baby cow's milk could even cause iron deficiency and internal bleeding. And it can increase his risk of an allergic reaction.

Once your baby's digestive system is ready to digest it, though, milk becomes a powerful ally. A great source of calcium, phosphorus, vitamin A, and magnesium, milk will build your toddler's bones and teeth and help his body regulate his blood coagulation and muscle control. Almost all milk is fortified with vitamin D, which helps the body absorb the calcium it needs.

Milk also provides protein for growth, as well as carbohydrates, which will give your child the energy he needs to toddle all day! And if your child gets enough calcium from the get-go, there's evidence that he'll have a lower risk of high blood pressure, stroke, colon cancer, and hip fractures later in life.

My toddler doesn't seem to want cow's milk. Any tricks I can try?

Some toddlers greedily gulp whole cow's milk right off the bat. But because milk has a different texture, taste, and even temperature than breast milk or formula, some kids are hesitant to make the switch. If that's the case for your toddler, try mixing whole milk with some breast milk or formula at first (say, one part whole milk and three parts of his usual stuff). Then slowly shift the ratio until he's drinking 100 percent whole milk.

You might also try giving him just a little bit of whole milk at a time — a few tablespoons as a treat — until he asks for more. Or mix it with some cereal. And remember, just because your toddler is drinking his own milk from a cup now doesn't mean that you need to stop nursing him. Just make sure that breast milk isn't his primary source of nourishment. He's grown to where he needs more.

How much milk should my toddler drink?

Your 1- to 2-year-old child should drink 16 to 24 ounces of whole milk a day. While you'll most likely have to work to make sure he meets the requirement, keep in mind that it is possible for him to drink too much milk.

If your child drinks more than two to three glasses of milk during the day, he may not have room at dinner for the other foods that he needs to round out his diet. (He needs plenty of iron-rich foods like leafy green vegetables and meat, for example, because milk does not contain iron.) So if your toddler's thirsty, get him in the habit of drinking water throughout the day, too.

Can I give my toddler fat-free or reduced-fat milk?

In most cases, not yet. While we adults strive to eat and drink lower-fat versions of our favorite foods, it's important that you start your child out with whole milk, not lower-fat varieties.

That's because he needs the higher fat and caloric content for his growth and development right now. In fact, for children under 2 years old, fats should make up about half of the total caloric intake for the day. Once your child has another birthday — and doesn't have any growth problems — you may decide to switch to reduced-fat or nonfat milk.

Possible exceptions: If you’re overweight or obese, or have a family history of obesity, high cholesterol, or cardiovascular disease, your child’s doctor may recommend starting now with reduced-fat milk.

What if he's made the transition but just doesn't like milk?

Meeting the minimum requirement of 16 oz. can be a challenge if your child doesn't care for milk. While chocolate milk does add sugar to your child's diet, it has the same amount of calcium and other important vitamins and minerals as plain milk. Better yet, try a powdered flavoring — just a small amount will provide less sugar than preflavored milks. Some varieties (like Ovaltine) contain added vitamins and minerals, too.

Keep in mind that there are many ways to sneak milk into your child's diet. Serve him puddings, custards, and shakes for snacks. Make his soup with milk rather than water, and add a milk-based sauce or gravy to casseroles.

What if he absolutely refuses? Or if we're vegans?

If your child won't let a drop of milk cross his lips or he can't tolerate it because of an allergy or your family is vegan, you'll want to be very conscientious about making sure he gets all the calories, protein, calcium, vitamin D, and other vitamins and minerals he needs. Your child's doctor or a nutritionist can help. So might these tips:

Some plant foods, like dark green leafy vegetables, broccoli, blackstrap molasses, and brussels sprouts, contain calcium. So do pinto beans, figs, tofu made with calcium, and calcium-fortified fruit juice. These foods don't provide all of the vitamins found in milk, though. They contain no vitamin D, for example, so if your child doesn't drink milk, you'll want to make sure he takes a vitamin or multivitamin that contains 100 percent of the vitamin D he needs. Also keep in mind that these are not easy substitutions — it takes 4 cups of broccoli to provide the same amount of calcium as 1 cup of milk, for instance.

Some cereals are fortified with vitamin D. Check the labels.

Soy milk can substitute for cow's milk, but check the labels because not all varieties have the same nutritional value. Some are fortified with vitamin D, vitamin A, and calcium, while others aren't. The amount of calcium and other nutrients can also vary, so look for those that have the greatest nutritional value.

Yogurt is a great food for those who shun milk or are lactose intolerant. It has the same amount of protein and calcium as milk, but contains much less lactose, so most people who are lactose intolerant can tolerate yogurt. (Note that being lactose intolerant and allergic to milk protein are not the same thing.) Yogurt also contains bacteria that's healthy for the intestines.

Should I buy organic or hormone-free milk for my child?

While there's no conclusive evidence that these kinds of milk are better for children, if you have access to organic or hormone-free milk, you may want to consider the option. Some parents are willing to pay the significantly higher price for milk that's as pure as possible. Read up on growth hormones in milk and organic foods to help you make a decision.

Could my child have a milk allergy?

True allergies to cow's milk are relatively uncommon — only 2 to 3 percent of children are allergic to milk, according to the American Academy of Pediatrics (AAP), and 95 percent of them outgrow it by age 3. (Learn the difference between a milk allergy and lactose intolerance.)

If your child drank cow's-milk-based formula as a baby without any problems, you can rest easy that he'll have no problems tolerating regular cow's milk. Even babies who were exclusively breastfed for the first year can usually handle regular cow's milk because they've been exposed to cow's milk protein in their mother's milk (unless their mothers avoided all dairy).

If your child drank soy formula because your doctor recommended it, though, check with your doctor before starting him on cow's milk. She may recommend that you start with a soy beverage that's been fortified with vitamin D and calcium. A follow-up formula, made for toddlers, can also be a good choice. Rice milk, on the other hand, is not a good choice for toddlers because it's usually low in protein, calcium, and B vitamins.

Still, it never hurts to arm yourself with information. The main symptoms of milk allergy are blood in the stool, diarrhea, and vomiting. If your child also develops eczema, hives, a rash around the mouth and chin, chronic nasal stuffiness, a runny nose, cough, wheezing, or breathing difficulties, it could be a sign that the respiratory system is being affected by a milk allergy. If your toddler develops any of these symptoms, talk with his doctor.

If it turns out that your toddler is allergic to cow's milk, you'll want to be careful to avoid foods such as cottage cheese, condensed and evaporated milks, ice cream, yogurt, margarine that contains milk, butter, milk chocolate, and powdered milk. And read labels for sources of cow's milk protein, like casein and whey.

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