Cow's Milk Introduction for Premature Infants Born at 30 Weeks
A baby born at 30 weeks gestation should be started on whole cow's milk at 12 months of chronological age (not corrected age), which is the same recommendation as for term infants. 1, 2
Timing Based on Chronological Age
- Use chronological age (age from birth), not corrected gestational age, when determining when to introduce cow's milk. 1
- Most guidelines recommend waiting until 12 months of chronological age before introducing whole cow's milk as a primary beverage. 2, 3
- Some countries (Canada, Sweden, Denmark) permit introduction at 9-10 months, but 12 months remains the most conservative and widely accepted recommendation. 3
Why Delay Until 12 Months
- Early introduction of whole cow's milk leads to iron deficiency anemia, which is the primary reason for delaying introduction. 2, 3
- Cow's milk is a poor source of iron, and intake above 500 mL/day particularly increases risk of iron deficiency. 3
- Premature infants are already at higher risk for iron deficiency, making this consideration even more critical. 1
- Early exposure to cow's milk proteins increases the risk of developing milk protein allergy. 2
- Cow's milk has a high renal solute load that narrows the margin of safety during dehydration, though this is less concerning in healthy infants. 2
Feeding Strategy Before 12 Months
- For premature infants, breast milk remains the preferred feed, with fortified breast milk recommended for infants born before 32 weeks gestation. 4
- If breast milk is unavailable or insufficient, use iron-fortified infant formula rather than whole cow's milk during the first year. 2, 4
- Preterm formula is an appropriate option when there is inadequate supply of mother's milk. 4
Introduction of Solid Foods Containing Dairy
- Solid foods, including those containing cow's milk proteins (yogurt, cheese), can be introduced around 6 months of chronological age, but not before 4 months. 1, 5
- This early introduction of cow's milk proteins in solid food form (not as a beverage) may actually be protective against cow's milk adverse reactions. 6
- The distinction is critical: small amounts of dairy in solid foods at 4-6 months is acceptable and potentially beneficial, but whole cow's milk as a primary beverage should wait until 12 months. 5, 2
Common Pitfalls to Avoid
- Do not use corrected gestational age for determining when to introduce cow's milk - use chronological age from birth. 1
- Do not introduce whole cow's milk before 12 months even if the infant appears developmentally ready or is consuming other dairy products in solid foods. 2
- Avoid high volumes of cow's milk (>500 mL/day) even after 12 months to prevent iron deficiency. 3
- Do not use goat's milk or sheep's milk as alternatives, as they have high protein homology with cow's milk. 7
Special Considerations for This Population
- Premature infants born at 30 weeks have increased nutritional needs, particularly for iron and zinc. 1
- Monitor iron status closely, especially if introducing cow's milk at the earlier end of acceptable ranges. 3
- If the infant has developed cow's milk protein allergy through formula exposure or maternal diet during breastfeeding, consult with an allergist before introducing cow's milk as a beverage. 7