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Ask Dr. Sears: Cows' Milk for Babies?

Q  My baby is ten and a half months old and has been exclusively breastfed since birth. She refuses formula and bottles defiantly. However, she will drink water, but only from a cup. Recently, she has stopped wanting to nurse, except once in the morning and once in the afternoon. I'd like to give her something other than water, especially at bedtime, to help get her through the night. Our doctor said we could give her a bottle of whole milk, which she tried and liked, but I've been reading that whole milk before one year can be dangerous to her. Is it safe to give her whole milk and, if so, how much?

Cow's milk has gotten an unfair rap lately. Realistically, cow's milk is a very rich source of nutrition in a small package. Milk is high in protein, a healthy carbohydrate called lactose, B-vitamins, vitamin A, vitamin D, and zinc. A guide I give patients in my pediatric practice is: no cow's milk before age one, whole milk until age two, low fat or non-fat milk after that. Once baby is weaned from the breast, 24 ounces of cow's milk or goat's milk a day is plenty.

There are two reasons why the Committee on Nutrition of the American Academy of Pediatrics discourages the use of cow's milk under one year of age: allergies and iron- deficiency anemia. The intestinal lining is slower to mature in some babies than others. While lactose intolerance is rare in infants, some toddlers and older children can develop diarrhea, bloating, and abdominal pain, because of their inability to digest the lactose sugar in milk. Also, the allergic proteins may seep through the irritated intestinal lining into the bloodstream and cause an allergic reaction, such as a runny nose, wheezing, or a red, raised, sandpaper-like rash, especially on the cheeks. Some babies who are allergic to cow's milk can even get frequent ear infections.

Iron-deficiency anemia is another problem, as there is very little iron in cow's milk. If baby is allergic to the cow's milk protein, the irritated intestines may consistently lose a tiny bit of blood into baby's stools.

Because of the concerns about getting too much cow's milk too early, try these recommendations:

Give baby more breastmilk. Since your baby is thriving on your milk, it sounds like you just need to figure out ways of nursing her more often. They like to play a lot during the day and forget to nurse. Twice a day, take her into a dark, quiet room, such as a bedroom or bathroom and get down to the business of nursing. At prescheduled times of the day, snuggle down with her and let her breastfeed off to sleep.

Try iron-fortified formula. While most babies will simply increase the frequency and duration of nursing to meet their needs, if your baby doesn't, suggest trying an iron-fortified DHA/AA-enriched formula. Use a brand recommended by your baby's doctor. If she prefers cow's milk to infant formula, it's okay to give her one or two 8-ounce bottles of cow's milk starting around one year of age. However, consider the bottles of cow's milk as an addition to, but not as a substitute for your more nutritious milk.

When giving her cow's milk, it's best to give her small, frequent feedings by breaking up an eight-ounce bottle into two four-ounce feedings. Smaller feedings enables the intestines to get used to and digest a different type of milk.

Try yogurt. Ounce for ounce, yogurt is more nutritious than cow's milk for three reasons:

  1. Yogurt contains slightly more calcium.
  2. Yogurt contains healthful bacteria that promote intestinal health.
  3. The fermentation process of yogurt breaks down the proteins and the lactose for easier digestion.

Buy organic. When you start cow's milk, it's preferable to buy organic. While milk is an extremely nutritious food, the antibiotics, hormones, and other stuff that are given to some dairy cows nowadays may be harmful. "Certified organic" means there were no hormones or antibiotics added to the cow feed. Another option is to give your baby goat's milk. Goat's milk protein forms a softer and more easily-digestible curd and contains less potentially allergenic proteins.

Finally, once you wean from your milk onto cow's milk, it's necessary to give your baby more iron-containing foods, such as prune juice, iron-fortified cereals, beans, organic meats, lentils, and tofu.

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