Toddlers have transitioned away from breast milk and formula, so you may give them cow's milk for some extra nutrients and calcium. It's safe to give cow's milk to children over1 year old, according to the American Academy of Pediatrics (AAP), but you probably want to be aware of a potential side effect, called milk anemia.
Milk anemia is very rare, but it can happen, and it raises questions about how much milk 1- and 2-year-olds should drink. Here's what parents need to know about milk anemia and how much milk is safe for a toddler to drink.
When Can Babies Drink Milk?
What Is Milk Anemia?
Milk anemia, also referred to as iron-deficiency anemia (IDA), happens when the body does not have enough iron to make hemoglobin, which is an important component of red blood cells. Without enough red blood cells, the body does not get enough oxygen and other nutrients.
C.S. Mott Children's Hospital explains that cow's milk can interfere with the body's ability to absorb iron. As a result, too much cow's milk coupled with low levels of iron in the diet can lead to anemia. Large amounts of cow's milk without iron supplementation can also cause intestinal bleeding in infants and older babies, which is what happened in the case of Gencarelli’s daughter and led to her severe blood loss.
Symptoms of iron-deficiency anemia might include:
- Excessive cow's milk consumption (over 24 ounces per day)
- Pale skin
- Poor appetite
- Fatigue
- Swollen eyelids
- Rapid breathing
- Frequent infections
- Slowed development
- Behavioral problems
- Cravings for dirt, paint, or ice
How Common Is Milk Anemia?
According to Sahira Long, M.D., of Children’s National in Washington D.C., full-blown milk anemia is rare. Only 2% to 3% of toddlers have IDA, but 7% to 9% of toddlers have an iron deficiency that could be caused by milk, along with other factors like the amount of iron in their diet.
The AAP recommends that all babies have their iron and hemoglobin levels checked between 9 and 12 months old. This test is usually performed at the 1-year well-check. If your baby's iron levels are too low, the doctor may recommend an iron supplement and diet changes to help raise the levels to a healthy range.
“Though the amount of iron in breast milk is low, it is known to be much more bioavailable and that influences how much is absorbed," explains Dr. Long. "Full-term babies who are breastfed typically have adequate iron stores to meet their needs until around 6 months of age at which time they need to have a complementary source of dietary iron introduced,” she adds.
Most infant formulas, on the other hand, are fortified with iron. For babies who are exclusively formula-fed, formula alone can meet their iron needs for the first 12 months, according to the Centers for Disease Control and Prevention.
According to Dr. Long, babies who drink cow’s milk are also at an increased risk of developing blood loss in their intestines due to a reaction with certain milk proteins. She explains that drinking cow's milk before 12 months increases the risk of the baby developing iron-deficiency anemia, so whenever possible, save the cow's milk for after your baby's first birthday. (While you'll want to avoid offering cow's milk as a beverage before the 1-year mark, you can introduce milk products like yogurt and cheese as soon as your baby begins solids, usually around 6 months.)
While milk anemia is rare, a more common concern with excessive milk intake is how it impacts a child's overall diet. Milk can be filling, and in cases where toddlers are drinking more milk than is recommended, the risk is that the milk may displace other foods and the array of nutrients those foods offer. In other words, a toddler who regularly drinks a lot of milk may fill up on cow's milk and not be hungry enough to eat other nutritious foods.
When and How to Introduce Cow's Milk to Your Baby
How Much Milk Is Safe for Toddlers?
Cow's milk can be a healthy part of a toddler's diet, and many pediatricians recommend it as a good source of protein, fat, calcium, and vitamin D (as long as the child doesn't have a sensitivity, intolerance, or allergy). The key to getting the benefits of milk without risking adverse effects like milk anemia is ensuring that your toddler isn't getting too much.
The AAP provides guidelines for how much cow's milk babies and toddlers can safely drink a day.
Recommended Milk Intake Limits for Kids
According to the AAP, the healthiest beverages for kids are plain water and milk. The AAP suggests the following daily limits for cow's milk by age:
- Under 12 months: Breast milk or formula only (no cow's milk)
- 12 to 24 months: No more than 16 to 24 ounces of whole cow's milk per day
- 2 years and up: No more than 16 to 20 ounces of low-fat cow's milk per day
While you can feel good about offering your toddler cow's milk within these limits, drinking milk isn't the only way for toddlers to benefit from what milk has to offer. In fact, the Dietary Guidelines for Americans recommends that toddlers between 12 and 23 months get between 1 2/3 to 2 cups of dairy a day, which can be from cow's milk or dairy products like yogurt, cheese, and even fortified soy beverages and soy-based yogurt.
What Experts Say About Toddler Formula vs. Cow's Milk
What About Cow's Milk Alternatives?
If you're considering cow's milk alternatives for your child, Portland, Oregon pediatrician and author Whitney Casares, M.D. explains that it’s not just cow’s milk that can cause problems.
“Other mammalian milks like goat milk can also cause gut irritation and anemia," Dr. Casares notes. "Alternative [non-dairy] milks, like soy milk and nut milks, also do not meet the nutritional needs of children under 1 year old."
After a child's first year, cow's milk alternatives can be an option, particularly for children who have a cow's milk allergy, but not all options are created equal from a nutritional standpoint, says the AAP.
If you opt to offer your child non-dairy milk after their first birthday, Dr. Casares recommends that you check labels carefully as these beverages can have less protein and fewer calories compared to cow’s milk. You'll also want to ensure that any non-dairy options you choose are fortified with calcium and vitamin D and that they don't include added sugar or sweeteners.
Whether the choice to skip cow's milk in favor of alternatives is a preference or a requirement, be sure to chat with your child's pediatrician to ensure that they are getting the nutrition they need.
7 Things Parents Should Know About Non-Dairy Milks
Key Takeaways
Consistently giving a toddler more than the recommended limit of cow's milk per day could put them at risk for milk anemia and other deficiencies. To avoid anemia and other nutritional concerns, be sure to only offer your toddler cow's milk as a beverage after they turn 1, stick to the recommended limits, and provide them with plenty of iron-rich foods in their diet.
