Baby feeding: when to move to milk

Milk is one of the most important foods in children's lives. It's an unparalleled and relatively inexpensive source of protein, calcium and vitamins D and A, which are crucial not only for growth, but to make bones strong for years to come. As with any good thing, however, too much milk can be a problem. In addition, some children are either allergic to milk or can't digest it properly.

Milk matters

Here are some guidelines for keeping milk in the right place on the menu.

• Infants under one year should never be given normal cow's milk.

  If you are not breastfeeding, give your child commercial formula. Formula breaks the large milk molecule into smaller pieces that are easier to digest. Unprocessed milk, on the other hand, can cause a reaction in the lining of the infant's gastrointestinal tract that leads to a constant, slow loss of blood. (After age one, a child can digest milk more easily and safely.) Also, there is some evidence that introducing milk early in life can be responsible for allergic reactions later.

• Too much is not good.

  Some toddlers drink so much milk that they don't have an appetite for other, more nourishing, meals and snacks. They may continue to gain weight and grow but are not getting a balanced diet. Children between the age of one and three need 470 to 700 ml (16 to 24 ounces), or two to three average-size glasses, of milk a day. However, milk is deficient in iron, fibre, zinc and other nutrients that are necessary for your child's development.

• Not all children can tolerate milk.

  True milk allergy, in which the body forms antibodies to fight off milk as though it were an alien threat, can be serious. When a child has this allergy, within minutes even a small amount can cause symptoms such as vomiting, diarrhoea, itching of the face, mouth or whole body, swollen lips and eyes, wheezing and difficulty breathing. Fortunately, reactions of this severity are uncommon, but if your child has them you must avoid giving her anything containing milk. Reading labels becomes a second career for parents of children who have this kind of reaction. Many children outgrow this allergy, but if it begins after age three, it's more likely to be lifelong.

• Lactose intolerance is more common than allergy.

  A form of sugar that's found in milk, lactose, is difficult for many people to digest. The severity of bloating, wind and abdominal pain with lactose intolerance depends on the amount of milk taken. Many lactose-intolerant children tolerate products such as yoghurt and cheese even though they can't cope with straight milk. Changing to a soya-based formula or drink may be necessary for a short time. If your child has an ongoing lactose intolerance, consult your paediatrician for an alternative to drinking milk.

• Not all children like milk.

  If your child refuses milk and has no evidence of digestive or allergic problems, try flavouring it with chocolate, strawberry, vanilla or another favourite. If your child doesn't or can't drink milk, substitute other calcium-containing foods such as calcium-fortified orange juice, cheese, yoghurt, cottage cheese and tofu. A calcium supplement may be necessary, depending on how well your child accepts other sources of calcium.

• Drinks made from soya or rice are not necessarily nutritious.

  If you don't want to give your child milk, make sure that the substitute you choose is fortified with calcium and vitamins A and D. Isolated cases of rickets, a calcium-deficiency disease that had almost disappeared decades ago because of vitamin supplementation of milk, have been reported because children were drinking less-than-adequate drinks in place of milk. Consult your paediatrician to make sure that you're using the right product for your child.

Got milk? What kind?

Until recently, paediatricians recommended that children between one and two drink whole milk, and then a low fat milk after the age of two. This was based on a belief that the fat necessary for brain and nerve growth in the second year of life might not be supplied by lower fat milk.

A recent study from Scandinavia, however, followed children who were given skimmed milk from the age of weaning to five years and compared them with those who drank whole milk during that period. There was no difference in their growth or neurological development.

The choice of which milk to give can depend on other factors, too, such as whether your family has a history of problems with cholesterol and early heart attacks, and whether your child is having problems gaining weight. For guidance on choosing milk, talk to your paediatrician, who will help you to decide what's best for your child.