From the Guidelines
Cow's milk can cause anemia in toddlers due to its low iron content and potential to cause occult gastrointestinal bleeding, as well as interfere with iron absorption from other foods. This is supported by studies such as 1, which highlights the risks of early introduction and excessive consumption of whole cow's milk in infants and toddlers. The Centers for Disease Control and Prevention recommends avoiding cow's milk in infants under 12 months of age and limiting consumption to no more than 24 oz daily after the first year of life, as stated in 1 and reinforced by 1.
Some key points to consider:
- Breast milk has the highest percentage of bioavailable iron, making it an ideal source of nutrition for infants under one year, as noted in 1.
- Iron-fortified formulas are a suitable alternative to breast milk and can provide sufficient iron to meet an infant's needs, with few proven side effects, as mentioned in 1.
- Toddlers should receive iron-rich foods like meat, beans, fortified cereals, and green leafy vegetables alongside appropriate amounts of milk to prevent anemia.
- If anemia has developed, a healthcare provider may recommend iron supplements, such as ferrous sulfate drops or syrup, to replenish iron stores, as part of a comprehensive treatment plan.
From the Research
Causes of Anemia in Toddlers due to Cow's Milk Consumption
- Excessive cow's milk consumption can lead to iron-deficiency anemia in toddlers, as it can cause occult intestinal blood loss, inhibit non-heme iron absorption, and provide low iron content 2.
- The high calcium and casein content in cow's milk can also inhibit iron absorption from other foods, increasing the risk of anemia 2.
- Toddlers who consume more than 24 ounces of cow's milk per day are at a higher risk of developing severe iron-deficiency anemia 3, 4.
Mechanisms of Anemia Development
- The low iron content of cow's milk makes it difficult for infants to obtain the necessary amounts of iron for growth, leading to iron deficiency anemia 2.
- The high protein intake from cow's milk can also place infants at increased risk of obesity in later childhood, which may be associated with an increased risk of anemia 2.
- Gastrointestinal and allergic problems caused by early introduction of cow's milk or its substitution for breast milk can also contribute to the development of anemia 5.
Clinical Presentations and Consequences
- Severe iron-deficiency anemia can cause fatigue, poor appetite, and pica in toddlers, and can also lead to more severe complications such as cerebral sinovenous thrombosis 3, 4.
- Anasarca edema can also occur in severe cases of iron deficiency anemia due to excessive cow's milk intake 6.
- Iron-deficiency anemia can have long-term consequences on cognitive, affective, and motor development in toddlers if left untreated 3.