Why is it recommended that cows milk should not be given to infants under the age of 12 months?

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

At what age can my child start drinking cow’s milk?

A: Avoid feeding cow’s milk to any child younger than 12 months old.

Fresh cow’s milk has been associated with small micro-bleeds in the digestive tracts of infants younger than 1 year old. It’s also low in iron, vitamin E and essential fatty acids, and it doesn’t have the ideal proportions of proteins and fats found in breast milk or formula. 

Are there other kinds of milk should I shouldn’t give my baby?

Besides cow’s milk you should avoid giving goat’s milk, soy milk or almond milk to infants under 12 months. They are not good for your child’s development and growth. Also avoid flavored milks like chocolate, vanilla or strawberry. 

What should babies drink?

Stick with feeding your baby breast milk and/or properly prepared iron-fortified infant formula.

You can typically introduce cheese and plain yogurt to infants younger than 1 year of age, but seek advice from your pediatrician if your child has a milk protein intolerance or milk allergy.

It’s also generally acceptable to use small amounts of milk for cooking or for the preparation of other infant-appropriate foods, but avoid cow’s milk to drink until after your baby’s first birthday.

If your child has a milk allergy or other issues with cow’s milk your pediatrician or registered dietitian can suggest the healthiest, safest nutrition plan.

— Pediatrician Kimberly Churbock, MD

Related Articles

Your growing child needs vitamins and minerals like vitamin D and calcium to build strong bones. Pasteurized, whole cow’s milk and soy beverages that have been fortifiedalert icon with vitamin D are good sources of vitamin D and calcium. Most cow’s milk sold in the United States is fortified with vitamin D.

Choose milk or milk alternatives that are unflavored and unsweetened. Flavored cow’s milk and fortified soy beverages can have added sugars. Your child does not need added sugars.

When Should I Introduce My Child to Cow’s Milk?

At 12 months old (but not before), your child can be introduced to cow’s milk. Before your child is 12 months old, cow’s milk may put him or her at risk for intestinal bleeding. It also has too many proteins and minerals for your baby’s kidneys to handle and does not have the right amount of nutrients your baby needs.

How Much, and How Often?

Cow’s milk or fortified soy beverages can be a part of a child’s balanced and diverse diet but not the only thing. The Dietary Guidelines for Americans recommend children aged 12 through 23 months get 1⅔ to 2 cup equivalents of dairy a day, including cow’s milk, yogurt, cheese, fortified soy beverages, and soy-based yogurt. If your child drinks too much cow’s milk, he or she may not be hungry for other foods with important nutrients. Some experts say that consuming too much cow’s milk can make it harder for your child’s body to absorb the iron he or she needs from foods.

Continue to follow your child’s cues to decide when he or she is hungry or full. Talk with your child’s doctor or nurse for more questions about adding cow’s milk or fortified soy beverages in his or her diet.

Whole Cow’s Milk or Lower Fat Cow’s Milk?

Children can drink unflavored, unsweetened whole cow’s milk. Whole cow’s milk is the same as lower fat cow’s milk except that it is higher in fat. It is important for young children to get fat in their diet for healthy growth and development. If your child has excessive weight gain or a family history of obesity, high cholesterol or triglycerides, or cardiovascular disease, talk to your child’s doctor or nurse about the type of cow’s milk to give.

Raw Milk

Raw milk and raw milk products from cows, goats, and sheep can carry harmful bacteria and other germs that can make your child very sick and can be life-threatening. Raw milk can also be called unpasteurized milk. Do not give your child raw or unpasteurized milk.

Milk Alternatives

Milk alternatives can include beverages made from plants, such as soy, oat, rice, coconut, cashew, and almond.

If you choose a milk alternative, here are things to remember:

• Milk alternatives should not be given before 12 months.
• Fortified soy beverages are the only milk alternative that help meet a child’s recommended dairy needs.
• Choose one that is unflavored and unsweetened. Your child does not need added sugars.
• Choose one that is fortified with vitamin D and calcium. Check labels, since nutrient content can vary between brands.
• Talk with your child’s doctor or nurse about the milk alternative you are using, because the vitamins and minerals in these types of milks are different than in cow’s milk.

Visit Vitamins & Minerals to learn more about the vitamins and minerals your child needs.

There are differences between at what age industrialized countries recommend that cow's milk can be introduced to infants. Most countries recommend waiting until 12 months of age, but according to recommendations from some countries (e.g. Canada, Sweden and Denmark) cow's milk can be introduced from 9 or 10 months. The main reason for delaying introduction is to prevent iron deficiency as cow's milk is a poor iron source. In one study mainly milk intake above 500 ml/day caused iron deficiency. Cow's milk has a very low content of linoleic acid (LA), but a more favorable LA/alpha-linolenic ratio, which is likely to be the reason why red blood cell docosahexaenoic acid (DHA) levels seem to be more favorable in infants drinking cow's milk compared to infants drinking infant formula that is not supplemented with DHA. It has been suggested that cow's milk intake can affect the later risk of obesity, blood pressure and linear growth, but the evidence is not convincing. There are also considerable differences in recommendations on at what age cow's milk with reduced fat intake can be introduced. The main consideration is that low-fat milk might limit energy intake and thereby growth, but the potential effects on development of early obesity should also be considered. Recommendations about the age for introduction of cow's milk should take into consideration traditions and feeding patterns in the population, especially the intake of iron and long-chain polyunsaturated fatty acids and should also give recommendations on the volume of milk.

1. Fomon SJ. Infant feeding in the 20th Century: Formula and beikost. J Nutr. 2001;131:S409–20. [PubMed] [Google Scholar]

2. Committee on Nutrition, American Academy of Pediatrics The use of whole cow’s milk in infancy. Pediatrics. 1992;89:1105–9. [PubMed] [Google Scholar]

3. Department of Health . London: Her Majesty’s Stationery Office; 1994. Report on Health and Social Subjects No.45. Weaning and the Weaning Diet; pp. 1–15. [Google Scholar]

4. The National Board of Health (Denmark) Copenhagen: The National Board of Health (Denmark); 1998. Recommendations for the Nutrition of Infants: Recommendations for Health Personnel (in Danish) pp. 1–78. [Google Scholar]

5. Axelsson I, Gebre-Medhin M, Hernell O, et al. Vänta med Komjölk som dryck tills barnet är 10–12 månader! Läkartidningen. 1999;96:2206–8. [PubMed] [Google Scholar]

6. Canadian Paediatric Society, Dietitians of Canada, and Health Canada . Ottawa: Ministry of Public Works and Government Services; 1998. Nutrition for Healthy Term Infants; pp. 1–50. [Google Scholar]

7. Ziegler EE, Fomon SJ, Nelson SE, et al. Cow milk feeding in infancy: Further observations on blood loss from the gastrointestinal tract. J Pediatr. 1990;116:11–8. [PubMed] [Google Scholar]

8. Wilson JF, Lahey ME, Heiner DC. Studies on iron metabolism. V. Further observations on cow’s milk-induced gastrointestinal bleeding in infants with iron-deficiency anemia. J Pediatr. 1974;84:335–44. [PubMed] [Google Scholar]

9. Leung AK, Chan KW.Iron deficiency anemia Adv Pediatr(In press). [PubMed]

10. Oski FA. Iron deficiency in infancy and childhood. N Engl J Med. 1993;329:190–3. [PubMed] [Google Scholar]

11. Tunnessen WW, Jr, Oski FA. Consequences of starting whole cow’s milk at 6 months of age. J Pediatr. 1987;111:813–6. [PubMed] [Google Scholar]

12. Penrod JC, Anderson K, Acosta PB. Impact of iron status of introducing cow’s milk in the second six months of life. J Pediatr Gastroenterol Nutr. 1990;10:462–7. [PubMed] [Google Scholar]

13. de Andraca I, Castillo M, Walter T. Psychomotor development and behavior in iron-deficiency anemic infants. Nutr Rev. 1997;55:125–32. [PubMed] [Google Scholar]

14. Pipes PL. Infant feeding and nutrition. In: Trahms CM, Pipes PL, editors. Nutrition in Infancy and Childhood. New York: McGraw Hill; 1997. pp. 98–129. [Google Scholar]

15. Anderson GH, Morson-Pasut LA, Bryan H, et al. Age of introduction of cow’s milk to infants. J Pediatr Gastroenterol Nutr. 1985;4:692–8. [PubMed] [Google Scholar]

16. Ziegler EE. Milk and formulas for older infants. J Pediatr. 1990;117:S76–9. [PubMed] [Google Scholar]

17. Fuchs GJ, Gastanaduy AS, Suskind RM. Comparative metabolic study of older infants fed infant formula, transition formula, or whole cow’s milk. Nutr Res. 1992;12:1467–78. [Google Scholar]

18. Hide DW. Cow’s milk allergy. Clin Exp Allergy. 1993;23:79–80. [PubMed] [Google Scholar]

19. Jacobsson I, Lindberg T, Benedictsson B, et al. Dietary bovine beta-lactoglobulin is transferred to human milk. Acta Paediatr Scand. 1985;74:342–5. [PubMed] [Google Scholar]

20. Paganelli R, Cavangni G, Pallone F. The role of antigenic absorption and circulating immune complexes in food allergy. Ann allergy. 1986;57:330–6. [PubMed] [Google Scholar]

21. Host A, Husby S, Osterballe O. A prospective study of cow’s milk allergy in exclusively breast-fed infants. Acta Paediatr Scand. 1988;77:663–70. [PubMed] [Google Scholar]

22. Hattevig G, Kjellman B, Sigurs N, et al. Effect of maternal avoidance of eggs, cow’s milk and fish during lactation upon allergic manifestations in infants. Clin Exp Allergy. 1989;19:27–32. [PubMed] [Google Scholar]

23. Sigurs N, Hattevig G, Kjellman B. Maternal avoidance of eggs, cow’s milk and fish during lactation: Effect on allergic manifestations, skin-prick tests, and specific IgE antibodies in children at age 4 years. Pediatrics. 1992;89:735–9. [PubMed] [Google Scholar]

24. Lilja G, Dannaeus A, Foucard T, et al. Effect of maternal diet during late pregnancy and lactation on the development of atopic diseases in infants up to 18 months of age – in-vivo results. Clin Exp Allergy. 1989;19:473–9. [PubMed] [Google Scholar]

25. Gerstein HC, VanderMeulen J. The relationship between cow’s milk exposure and type I diabetes. Diabetic Med. 1996;13:230–9. [PubMed] [Google Scholar]

26. Sheard NF. Cow’s milk, diabetes, and infant feeding. Nutr Rev. 1993;51:79–89. [PubMed] [Google Scholar]

27. Dahl-Jørgensen K, Joner G, Hanssen KF. Relationship between cow’s milk consumption and incidence of IDDM in childhood. Diabetes Care. 1991;14:1081–3. [PubMed] [Google Scholar]

28. Varrala O, Knip M, Paronen J, et al. Cow’s milk formula feeding induces primary immunization to insulin in infants at genetic risk for type 1 diabetes. Diabetes. 1999;48:1389–94. [PubMed] [Google Scholar]

29. Couper JJ, Steele C, Beresford S, et al. Lack of association between duration of breast-feeding or introduction of cow’s milk and development of islet autoimmunity. Diabetes. 1999;48:2145–9. [PubMed] [Google Scholar]

30. American Academy of Pediatrics Infant feeding practices and their possible relationship to the etiology of diabetes mellitus. Pediatrics. 1994;94:752–4. [PubMed] [Google Scholar]