Growing-Up Milk Transition: Evidence-Based Recommendations
Primary Recommendation
Follow-up formulas and growing-up milks are not recommended for healthy children; instead, transition directly from breast milk or infant formula to whole cow's milk at 12 months of age, limiting intake to 500 mL (16-17 ounces) per day while ensuring adequate complementary foods. 1, 2
Why Growing-Up Milks Are Not Recommended
The WHO explicitly states that follow-up formulas (for children 12-23 months) are not recommended, as they are unnecessary when children receive adequate complementary foods alongside continued breastfeeding or appropriate cow's milk 1
Growing-up milks and follow-up formulas are widely marketed but considered dispensable by international expert groups, as infant formula can substitute throughout infancy and cow's milk is appropriate after 12 months 3
These products often fail to meet nutritional recommendations, with studies showing they average 3-4 nutrient deficiencies compared to established standards for toddlers 4
Marketing practices for these products frequently cross-promote with infant formula through similar branding, colors, and packaging, creating confusion for parents 5
The Correct Transition Approach
At 12 Months of Age
Transition directly to whole cow's milk (not follow-up formula) for most children, providing essential calcium, protein, magnesium, and vitamin D 2
Limit milk intake to maximum 500 mL (16-17 ounces) daily to prevent displacement of other nutrient-dense foods 2
For children with family history of obesity, heart disease, or high cholesterol, discuss transitioning to reduced-fat milk (2% to fat-free) with your pediatric provider 2, 6
Continued breastfeeding remains nutritionally superior to cow's milk and should continue as long as mutually desired by mother and child 7
Dietary Pattern at 12+ Months
Establish a structured eating pattern with 3-4 meals and 1-2 snacks daily, offered every 90-120 minutes, emphasizing nutrient-dense foods from all food groups 2
Ensure 15-20% of calories from protein and 50-55% from carbohydrates, with remaining 30% from fats 2
Provide iron-rich or iron-fortified foods, as iron bioavailability from cow's milk is poor 2
Target dietary fiber intake of 14 g per 1000 kcal consumed 2
Limit 100% fruit juice to maximum 4-6 ounces daily, served only from a cup 7
Avoid added sugars, high-sodium foods, and caffeine 2
Vitamin D Supplementation
Continue vitamin D supplementation at 400 IU/day for all children, as recommended by the American Academy of Pediatrics, since vitamin D deficiency risk remains high even with adequate milk intake 2
Critical Exception: Underweight Infants
For underweight infants at 12 months (significantly below 9-9.5 kg), consider delaying transition from infant formula, as non-infant formulas and cow's milk may contribute excessive protein and electrolytes relative to their smaller body size 8
Base the transition on weight and nutritional status rather than age alone for these children 8
Ensure the child is not heavily reliant on formula for caloric intake before transitioning, as this increases risk of nutrient imbalances 8
Common Pitfalls to Avoid
Do not use follow-up formulas or growing-up milks as an intermediate step—they are unnecessary and potentially nutritionally inadequate 1, 4
Do not exceed 500 mL daily milk intake, as this displaces other essential nutrients from complementary foods 2
Do not introduce foods without nutritional value simply to provide calories during the transition period 7
Avoid abrupt transitions; make only one feeding change at a time to assess tolerance 7
Do not assume goat milk is appropriate for cow's milk protein allergy, as cross-reactivity is common 6
Environmental Considerations
While breastfeeding has approximately 48% lower carbon footprint than formula feeding, nutritional adequacy for child development must take priority over environmental considerations when making feeding decisions 6