The Transition from Breast Milk and Infant Formula


When should moms breastfeeding transition from breast milk to other forms of milk? The American Academy of Pediatrics suggests that whole cow milk may be introduced at 1 year of age as a healthy option for many children. Just ensure not to exceed 32 ounces daily—it’s important that children have an appetite to experiment with grains, vegetables, fruits, and meats, all in a variety of textures and colors, rather than get all of their calories from milk.

Cow milk may not be the right choice for all toddlers, however; clinical and parental observation suggests that more than half of all children experience signs and symptoms related to cow-milk consumption, such as bloating, gas, constipation, diarrhea, congestion, and eczema.

While lactose is often thought to be the culprit, we’re genetically programmed to digest and assimilate the lactose in breast milk, so that’s rarely the case in children. In most populations, lactase (the enzyme that breaks down lactose) doesn’t begin to decrease until 3 to 5 years of age. It’s more likely that these children suffer from the far more common phenomenon of cow milk sensitivity (CMS), in which the protein in cow milk is the likely offender.

Choices for Children with CMS

Children younger than age 2 require nutrient-dense, calorie-rich foods. For that reason, rice, almond, coconut, and soy milk (which are all delicious, healthy options for older kids and adults) may not provide the nutrition toddlers need. This is especially true for pickier eaters. For example, toddlers require 16 grams of protein per day, and nut milk contains just 1 gram of protein (or less) per cup. Almond milk also lacks vitamin K, B vitamins, folic acid, phosphorous, zinc, manganese, copper, and selenium. For families who avoid dairy entirely, I encourage using whole nuts and seeds to meet some of their toddler’s protein and micronutrient requirements.

I recommend goat milk for many children because it is nutritionally rich and more similar in composition to human milk compared with cow milk, making it naturally easy to digest. Like breast milk, goat milk contains trace alpha S1 casein, the more difficult-to-digest milk micro-protein. This results in a smaller and softer curd being formed in the tummy. The fat globules in goat milk are also smaller than those in cow milk. For all of these reasons, goat milk tends to be well-tolerated by children with CMS. Goat milk is also a nutritional powerhouse: It contains more than 8 grams of protein per cup, as well as certain minerals—including iron, calcium, and zinc—which are more bioavailable (meaning easier for the body to absorb) than they are in cow milk.

Like cow milk, goat milk contains whey and casein protein fractions in a ratio of 4-to-1. Because the natural ratio of whey to casein in breast milk is 3-to-2, a toddler formula with an adapted whey-to-casein ratio may be a gentler transition food from breast milk or infant formula. Toddler formula is also often enriched with a range of important nutrients, including DHA, an essential omega-3 fatty acid for your little one’s developing vision and nervous system. More good news to ease any picky eating worries, whichever option parents choose!

There is no one ideal transition food from breast milk or infant formula. Cow milk is the most common choice, but it may not be right for your toddler if you suspect cow milk sensitivity. Goat milk is gentler on the gut and more similar to breast milk, making it a good solution for young children, especially if CMS is a concern. Be sure to talk to your healthcare provider about any feeding changes and foods that will best meet your toddler’s daily nutrition needs.

By Kate Morrison

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