Q: Our pediatrician wanted me to introduce our one-year-old to two percent milk instead of whole milk. The doctor says that she doesn't need all of the harmful fat in the whole milk and that they have equal amounts of vitamins. Is this correct, and is this okay for her, developmentally speaking?
A: Your pediatrician is correct. As babies grow into toddler years, most do not need the extra fat of whole milk and do just fine with two percent milk. Yet the question of when to switch from whole to low-fat milk depends upon your toddler's overall nutrition. In my pediatric practice, I usually wait until two years of age to switch a toddler from whole milk to two percent milk. The reason why has more to do with toddlers' temperament rather than developmental needs: Most toddlers are picky eaters and need the extra fat for extra calories.
If your toddler has an overall balanced diet, then switching to two percent milk is fine. As your pediatrician mentioned, low-fat and whole milk have equal amounts of vitamins and minerals. In fact, an 8-ounce glass of low-fat milk contains more protein than an 8-ounce glass of whole milk (10 grams versus 8 grams). Whole milk contains 3.5 to 4 percent fat, and this extra fat is primarily saturated fat, which your toddler can do without. But your growing toddler still needs fat in his diet. That is why I do not advise giving skim milk to infants and toddlers.
Toddlers are picky eaters for two reasons: They have tiny tummies (about the size of their fist), and toddlers don't like to sit still for anything, let alone to eat. Fat provides twice as many calories per gram as do carbohydrates and proteins. Also, healthy fats are a necessary component of the vital tissues—especially the brain and central nervous system—that are growing so fast in your toddler. So, when you switch to two percent milk, you must add other healthy fats to your baby's diet.
As you make changes to your child's diet, I'd like you to remember my guide for toddler feeding: Feed your toddler a right-fat and not a low-fat diet. The best fats for babies are omega-3 fats, found in oily, coldwater fish, primarily salmon. Seafood fats (especially wild salmon) are the healthiest fats for growing children—and for adults for that matter. Other healthy fats are flax oil (2-3 teaspoons a day mixed in oatmeal or a smoothie), olive oil (2-3 teaspoons a day) and nut butters (a tablespoon a day). Best to wait until two before introducing peanut butter, especially if there is a strong family history of food allergies. Almond butter is usually a safer alternative.
Pediatricians and nutritionists agree that one of the most unhealthy trends in the past 20 years is children switching from milk to sweetened beverages. It's important to reverse that trend and encourage your child to drink more water and milk and less sugar-sweetened beverages. The best thing about milk is that it is power-packed nutrition for typically picky eaters. An 8-ounce glass of milk contains 8-10 grams of protein and 300 milligrams of calcium—that's 35 percent of the daily value (DV) for children. It also has half of the DV for vitamin B-2, 30 percent of the DV for B-12, ten percent of the DV for zinc, 25 percent of the DV for vitamin D and ten percent of the DV for vitamin A. By comparison, an 8-ounce can of soda contains none of this.
In order to remember the different types of milk to give your children at different ages, I give my patients the following guide:
- No cow's milk before age one (because of allergies).
- Whole milk until two.
- Nonfat or low-fat after that.