At what age can infants be introduced to milk?

From the Guidelines

Babies should not have cow's milk as a main drink until they are 12 months old. Before their first birthday, babies should drink breast milk or infant formula as their primary source of nutrition. This recommendation is based on the study by the Centers for Disease Control and Prevention 1, which advises against the use of low-iron milks, such as cow's milk, until age 12 months.

Key Considerations

• Introducing cow's milk too early can cause problems because it doesn't contain the right balance of nutrients for infants, is difficult for babies to digest, and may cause intestinal bleeding.
• Cow's milk doesn't provide enough iron, vitamin E, and essential fatty acids that babies need for proper development.
• The American Academy of Pediatrics and other organizations recommend exclusive breastfeeding for the first 6 months, and continued breastfeeding as complementary foods are introduced 1.
• Small amounts of dairy products like yogurt and cheese can be introduced around 6 months as complementary foods, but milk itself should wait until the one-year mark.

Introduction of Cow's Milk

When you do introduce cow's milk at 12 months, start with whole milk (not reduced-fat) because babies need the fat for brain development, and transition gradually by mixing it with formula or breast milk if needed. It's also important to note that iron-fortified infant formula should be used as a substitute for breast milk for infants aged less than 12 months who are not breastfed or are partially breastfed 1.

From the Research

Introduction to Milk Consumption in Babies

• The introduction of cow's milk to infants varies by country, with most recommending waiting until 12 months of age, while some suggest it can be introduced from 9 or 10 months 2.
• The main reason for delaying introduction is to prevent iron deficiency, as cow's milk is a poor iron source 2.

Age Recommendations for Cow's Milk Introduction

• Some countries, such as Canada, Sweden, and Denmark, recommend introducing cow's milk from 9 or 10 months of age 2.
• Most countries recommend waiting until 12 months of age to introduce cow's milk 2.
• Introducing whole cow milk at 6 months of age may lead to lower serum ferritin levels and a greater incidence of hemoglobin values less than 11 g/dl 3.

Considerations for Cow's Milk Introduction

• The volume of milk intake is important, as mainly milk intake above 500 ml/day can cause iron deficiency 2.
• Cow's milk has a low content of linoleic acid (LA), but a more favorable LA/alpha-linolenic ratio, which may be beneficial for red blood cell docosahexaenoic acid (DHA) levels 2.
• There is no convincing evidence that cow's milk intake affects the later risk of obesity, blood pressure, and linear growth 2.

Alternatives to Cow's Milk

• Hypoallergenic infant formulas based on hydrolyzed cow's milk proteins are available for the management of cow's milk allergy (CMA) 4, 5, 6.
• Milk from other mammalian sources, such as goat, sheep, camel, donkey, and horse, has received attention due to its different protein composition profile and potentially low cross-reactivity with cow's milk proteins 4.
• Proteins from plant sources, such as potato, lentil, chickpeas, quinoa, soy, and rice, have gained interest due to their climate-friendly and vegan status, as well as potential lower allergenicity 4.