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Feeding your baby is one of the most important and complex things you will do. It seems like such a simple thing – babies just drink milk don’t they? But that can be where any simplicity ends! There is no one form of ‘milk’. Here is a list of the types and forms of milk that you need to be familiar with:
Whether you breast or bottle feed your baby, there comes a time when the type and amount of milk will need to change to take account of their growing needs. This article should give you the confidence and direction to move from milk only (whether that be breast, bottle or both) to cow’s milk. It will also assist those for whom cow’s milk is not an option due to allergy or intolerance.
All experts agree that breastfeeding is the best and most natural way to feed your baby. Here’s why:
Breast milk contains all the nutrients your baby needs for the first four months of her life. If you can, and you choose to continue breastfeeding past this first four months, it will still be the most important part of her diet throughout the first year, supplying half or more of her nutrients until her first birthday and up to one third to her second birthday. As long as your baby is getting enough nutrients from solid foods when they are introduced, there is no need to supplement with either cow’s milk or formula until you choose to finish breastfeeding.
A baby on formula starts off on step/stage one formula. Some of these are marketed as suitable from birth to twelve months but many others are as described as suitable from birth to six months. After this time the companies market step/stage two or a ‘follow on’ formula for babies aged six to twelve months. I have become aware of problems when babies are introduced to step two formula. I have many clients contact me when their six-and-a-half month old, previously contented baby suddenly starts night waking, early rising, catnapping and/or vomiting. After careful consideration and ruling out many things I have found the one thing that most of these babies have in common is that they have been started on step two formula. After advising parents to move back to the step one formula their babies have returned to their happy, settled and well rested selves again.
Why can there be problems with the introduction of Step/Stage Two formula? One reason is the ratio of casein and whey. The protein in milk can be broken down into curds (casein) and whey. The ratio of casein to whey can vary according to the type of baby formula:
Step/Stage One formula. These milks consist of mostly whey, with a casein:whey ratio of 40:60. This is about the same as breast milk. They are suitable for your baby from birth up to about fourteen months, and are thought to be easier to digest.
Step/Stage Two formula. These milks consist of mostly casein, with a casein:whey ratio of 80:20. They take longer to digest and as a result are often marketed as keeping babies “full” for longer. They can, however, disagree with bubs that have a casein sensitivity.
Step/Stage three formula or toddler milk is the formula suggested for toddlers aged twelve months and older. I also advise clients to avoid these follow-on formulas as some contain a large amount of sugar. This can have the same effect as introducing cow’s milk before fourteen months in that it can make toddlers unsettled.
As long as your toddler is eating a varied and balanced diet which provides her with all the essential vitamins and minerals, there is no need for toddler milk.
Within the three formula steps or stages, there are also three main types of formula.
As I have previously discussed, your baby can most likely have cow’s milk-based formula unless there is an allergy or intolerance to cow’s milk.
The majority of formulas are based on cow’s milk, which is modified to resemble breast milk as closely as possible. This is done by adjusting carbohydrate, protein and fat levels and adding vitamins and minerals of cow’s milk.
If your baby has an allergy to cow’s milk, it is the protein in the milk that will cause and allergic reaction. If your baby has intolerance to cow’s milk, she will have difficulty digesting the lactose (sugar) in the milk.
The hydrolysed protein formulas are based on cow’s milk. They are nutritionally the same as standard formula milk, but the protein in the milk is broken down (hydrolysed). This means your baby is less likely to react to it. Many of these milks are also lactose free, which means that babies with intolerance to cow’s milk can easily digest them.
This formula is made from soya beans, modified with vitamins, minerals and nutrients to make it suitable for babies. It’s important to know that soy formula is not recommended if your baby has a cow’s milk allergy as babies who are allergic to cow’s milk are often allergic to soy too. Your doctor is the best person to consult if you are considering using a soy-based formula for any reason.
Cow’s milk has nutrients that are important for your child as she grows. Milk provides protein, calcium, magnesium and vitamins B12 and B2 (riboflavin). However, under no circumstances should you feed your baby cow’s milk until they are over fourteen-months of age.
When moving from formula or breast milk, it’s best to give your child full-fat cow’s milk. She’ll need the energy that the fat provides. Fat also carries essential vitamins A and D, so when fat is skimmed off milk, the amount of these vitamins is reduced. Your child should be given full-fat milk until she is at least two as there is no reason for babies and toddlers to be given fat reduced milk. While we adults strive to eat and drink lower-fat versions of our favorite foods, it’s important that you start your child out with whole milk, not lower-fat varieties. ?
Lots of health professional’s recommend moving a toddler to cow’s milk soon after their first birthday. I, however, do not recommend this. I have seen very similar problems when parents try to introduce their twelve-month-old baby to cow’s milk or step three formula. The problems include runny nappies, night waking, early rising and toddler waking up soon after going to bed with tummy cramps. While this problem does not affect all toddlers my advice is to keep your baby on step one formula from birth through toddlerhood until she is ready to drink cow’s milk.
Cow’s milk is not suitable as a baby’s main source of milk until she is over fourteen-months-old (see my advice for introducing cow’s milk below). Your baby needs breast milk or formula, which provides all the correct nutrition until she is eating a variety of foods. You can use small amounts of cow’s milk in cooking from around ten months, but watch out for a reaction which could include waking 40 minutes after settling for the night or night waking, early rising, catnapping or a combination of all these problems.
Many parents find when they first introduce cow’s milk in cooked food or as a feed or milk drink their baby or toddler wakes up during the night or 40 minutes after they first go to sleep. If this happens I suggest you cut out the cow’s milk from your toddler’s diet and try it again in a couple of months. Start with small amounts in food and build up the amount of cow’s milk until your toddler can tolerate it.
Adam was thirteen-months-old when his mummy Inga gave him cow’s milk for the first time. She decided to introduce it slowly and first added it to his kids Weetbix in the morning, then in his morning bottle and last of all at night time in his 6.20 pm bottle. The first night on all cow’s milk Adam woke up unsettled 40 minutes after he had gone to bed. However, Adam had had his twelve-month injections two days before so Inga attributed this unsettled waking down to the injections. It wasn’t until three weeks later when Adam was waking three times a night and starting his days at 5 am that Inga contacted me for advice.
After a brief chat with Inga about Adam’s behaviour which included night waking, early rising and fussy eating I asked if anything had changed in his diet. Inga explained she had recently introduced cow’s milk. We changed Adam back to infant formula and within 48 hours he was happy contented and sleeping again. I have since heard from Inga that Adam continued to react like this to cow’s milk until he was two-years-old.
The following plan is based on a toddler who currently drinks two breastfeeds or 410 ml of formula daily:
7 am: 12-minute breastfeed or 210 ml
6.20 pm: 10-minute breastfeed or 200 ml
| Feed | Day One | Day Two | Day three | Day Four |
| 7am | 30 ml cow’s milk followed by 180 ml formula in a different bottle or a breastfeed | 60 ml cow’s milk followed by 150 ml formula in a different bottle or a breastfeed | 90 ml cow’s milk followed by 120 ml formula in a different bottle or a breastfeed | 210 ml cow’s milk |
| 6.20 pm | 200 ml formula or breastfeed | 200 ml formula or breastfeed | 200 ml formula or breastfeed | 200 ml formula or breastfeed |
If you are breastfeeding and your toddler refuses the cow’s milk offered, I would not offer the breastfeed. I would only suggest offering the breastfeed after your toddler drinks the cow’s milk. If your toddler drinks the cow’s milk, they will take less and less from the breast as you offer more of the cow’s milk by following the guide above.
After four days you can swap any other drinks to cow’s milk – such as the morning or afternoon tea you might give in a cup, or the formula you add to meals, excluding the last milk feed of the day. The last feed of the day should remain a breastfeed or formula-feed for now. If your toddler remains settled and is sleeping well after a further two weeks you can then follow the process above to wean the last milk feed to cow’s milk as well. If your toddler becomes unsettled or begins rising early, please go back to full formula or breastfeed and try the above approach again after two months.
In summary, if your toddler was previously settling and sleeping well but is starting to wake at night or rise early, please look at her diet and food intake first as the possible cause of her sleep problems.
A2 milk is becoming more common in our shops. Toddlers seem to transition to A2 milk more easily than regular cow’s milk. A2 refers to the type of a protein (beta-casein) found in cow’s milk. A2 is the original form of beta-casein which was produced by cows thousands of years ago. Over time a second form of beta-casein known as A1 began to appear in dairy cattle and eventually became the most the common form of beta-casein in many breeds of cows. But some dairy cows still only produce the A2 type of beta-casein and their milk is used to produce A2 milk, which seems to be kinder on little ones tummies.
If children under six years are offered a cup of milk or water at the start of their meal they have a habit of drinking it all and, because their body does not know the difference between water and solid food, they fill up on liquid and have no room left for their meal. As adults we sip drinks while we eat our food. This is a learned skill. To teach your toddler these skills only offer her a drink after she has eaten three-quarters of her meal and then only a sip of milk or water. I recommend the Amadeus 360° cup and the Anyway up cup because children can only take small sips from them. Explain to your child why it is necessary that she only take small sips. When she has finished her main meal and a second course you can offer her a cup of milk or water and allow her to have a big drink.
When toddlers are over thirteen months and their diet is mainly milk-based, they are known as ‘milkoholics’. This can often happen if a baby has been introduced to solids late. If a baby has had only milk until the age of six months or later, parents often find it hard to introduce solids into their child’s diet. This can result in a toddler who still has one to six night feeds every night and four or five milk feeds during the day.
Over time I have found it easier to abruptly change a milkaholic’s diet than to slowly wean them off these extra milk feeds. If your child is over fourteen months I advise you to move her to two feeds, one in the early morning and the other in the evening as part of her bedtime ritual. For the first few days your toddler will be very tired, grumpy and hungry but after this time she will start to devour her meals. If your child is under fourteen months, slowly decrease her milk feeds over a couple of weeks. Reduce the amount of the middle of the day feed by 40 ml a day.
Cow’s milk is a common cause of food allergy in infants. InAustraliaandNew Zealandaround 2 per cent (1 in 50) babies are allergic to cow’s milk and dairy products. Although most children out grow cow’s milk allergy by the age of 4 years, persistent cow’s milk allergy may sometimes occur. However, ongoing symptoms in adults are very rare.
If your child drank cow’s-milk-based formula as a baby without any problems, you can rest easy that she’ll have no problems tolerating regular cow’s milk. Even babies who were breastfed for the first year can usually handle regular cow’s milk because they’ve been exposed to cow’s milk protein in their mother’s milk (unless their mothers avoided all dairy).
The main symptoms of milk allergy are blood in the stool, diarrhoea, and vomiting. If your child also develops eczema, hives, a rash around the mouth and chin, severe nasal stuffiness, a runny nose, cough, wheezing, or breathing difficulties, it could be a sign that the respiratory system is being affected by a milk allergy. If your toddler develops any of these symptoms, talk with her doctor.
Although rare, some children have an immediate, life threatening allergic reaction called anaphylaxis after ingesting milk protein. If your child appears to have sudden and severe problems with breathing or swallowing, urgent medical attention is required.
If it turns out that your toddler is allergic to cow’s milk, you will want to be careful to avoid foods such as cottage cheese, condensed and evaporated milks, ice cream, yogurt, margarine that contains milk, butter, milk chocolate, and powdered milk. Always read labels for sources of cow’s milk protein, like casein and whey.
Lactose intolerance is different to an allergy to milk. It is caused by the lack of the enzyme lactase, which helps to digest the milk sugar lactose. The symptoms are diarrhoea, vomiting, stomach pain and gas, which are similar to some of the symptoms of milk allergy. This condition is uncomfortable but not dangerous, and does not cause rashes or anaphylaxis. Small amounts of cow’s milk are usually tolerated, and yogurts and hard cheeses are usually tolerated better than milk, as they contain less or easier to digest lactose than cow’s milk. You may need to reduce or avoid giving your little one dairy products containing lactose. You can substitute lactose free formula or milk.
Babies can often develop a temporary lactose intolerance after suffering a bout of gastroenteritis. If you baby becomes unsettled after milk feeds after having gastroenteritis you may need to swap to a lactose free formula or if breastfeeding remove dairy from your diet for 4 weeks to allow your baby’s intestines to recover. You should have no problems after this recovery time going back to normal formula and re introducing dairy back into your diet if breastfeeding. I would recommend you consult with your doctor if you suspect this.
How much milk should my baby drink? A newborn baby drinks approximately 600 ml of milk daily; a four to six month old approximately 1000 ml daily; a six to twelve month old approximately 600 to 700 ml daily; and a child of one to three years should still drink about 600 ml of milk a day.
How will I know my baby is still getting enough milk when I introduce solids? Up until six months, milk is the most important food for your baby. Your baby will still be getting enough if you are following my routines as the milk feeds are given first. This means your baby will fill his tummy with milk before food.
My maternal health nurse has advised me to move my baby’s milk and solid feeds around so I am giving solids first. What do you think? I come across this time and time again and am still not sure why some advisers recommend this change. With my routines, the solids are already at proper meal times so if they were swapped with milk feeds, you would be giving lunch at 11 am and dinner at 4 pm. Some of my clients have made this change only to find their babies start to wake again in the night. By giving the milk an hour beforehand, the milk is nearly digested by mealtimes. This leaves baby’s tummy with more room for solids! But when you turn it around and give the milk second, the solids are not yet digested so the baby does not take as much milk.
My toddler doesn’t seem to want cow’s milk. What is the best way to introduce it? Cows milk has a different texture, taste, and even temperature than breast milk, which can make it a difficult transition for some children. One trick is to mix a little whole milk with some breast milk or formula at first. Slowly increase the amount of whole milk until he is drinking 100% whole milk.
Soy or milk-based formula: Which is better for my baby? Soy formula has no nutritional advantage over milk-based formula and vice versa. Both are fortified with the same vitamins and minerals. ??Usually parents choose soy formula when their baby is sensitive or allergic (or potentially so) to cows’ milk protein, or when a baby is having trouble digesting lactose or milk sugar. However there is little evidence that this is successful. In fact, most babies who are allergic to cows’ milk protein are also allergic to soy protein. If this happens, your child’s doctor may ask you to try other brands of formula that don’t contain cows’ milk protein. Sometimes, you might need to change brands a few times to find what’s best for your baby.
Are all formulas the same? Most formulas are basically the same. When it comes to the most important nutrients, all formulas are created equal. The price of infant formula is not necessarily a guide its quality as all infant formulas sold are required by law to conform to quality control standards (inAustralia andNew Zealand they are regulated by the Australia New Zealand Food Standards Code; inIreland by the Food Safety Authority of Ireland). Prices can vary from shop to shop, and between brands, so it is a good idea to shop around.
There are, however, many specialised formulas for specific situations. Formulas designed for premature and low-birth-weight babies, for example, contain more calories than other types. Formulas for babies with reflux have rice or other thickeners added to it. Soy or hydrolysed formulas are used for infants with possible allergies or an intolerance to milk protein.
To read more information of my advice regarding food and feeding please see my new book – PRE – ORDER Tizzie Hall – Save Our Sleep ® – Feeding
La gach dea-ghui, Tizzie
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