When to start cow's milk and how to stop the bottle

Plain cow's milk can become your child's main milk drink from the first birthday, not before.¹ Between 1 and 2 years, about 2 cups (roughly 480 ml) of full cream milk a day is plenty.¹ The bottle is best phased out between 12 and 18 months.² More milk is not better; too much can crowd out iron-rich food.

When can my baby drink cow's milk?

From 12 months of age. Before that, your baby's milk should be breast milk or infant formula.¹

The American Academy of Pediatrics (AAP) lists no cow's milk as a drink in the first year.¹ The Indian Academy of Pediatrics (IAP) advises exclusive breastfeeding for 6 months, then good home foods with continued breastfeeding.³ The same applies to buffalo milk, goat milk and packet milk, whether boiled or diluted.

Why is cow's milk not good for babies under one year?

Cow's milk is low in iron, can cause tiny hidden blood losses from a young baby's gut, and makes it harder to absorb iron from food.⁴

Its high protein and salt content also loads immature kidneys. That matters most during diarrhoea, when a baby can dry out faster.⁴ The hidden gut bleeding usually stops after the first birthday, which is one reason 12 months is the cut-off.⁴

How much milk does a toddler need?

From 1 to 2 years, about 2 cups (around 480 ml) a day is enough. From 2 to 5 years, about 2 to 3 cups (roughly 480 to 720 ml) a day.¹

This includes milk in porridge, kheer or dalia. Curd (dahi) and paneer give the same calcium and protein. After the first birthday, milk is a drink alongside meals, not the meal itself. Most of your toddler's nutrition should now come from family food: dal, rice or roti, egg, fish, vegetables and fruit.

Offer water between meals. The AAP suggests about 1 to 4 cups of plain water a day at this age.¹

Should I give my toddler full cream or toned milk?

Give full cream (whole) milk from 1 to 2 years. From 2 years, you can move to toned or double toned (low-fat) milk.¹

Toddlers need fat for energy and brain growth, and their small stomachs cannot take big volumes. After 2 years, most of that fat can come from food, so the AAP suggests low-fat or skimmed milk.¹ If your child is underweight, your paediatrician may suggest staying on full cream milk longer. Always boil loose milk from a local dairy before use.

Is toddler formula or growth milk needed?

No. For most healthy children, toddler milks and "growing-up" formulas are unnecessary and offer no clear advantage over a good diet with breast milk or cow's milk.¹

The European nutrition society ESPGHAN reviewed these products. It found no need for routine use in children aged 1 to 3 years, and noted that some contain high amounts of protein and added sugar.⁵ The AAP adds that they cost more.¹ The iron and vitamins they contain can come from ordinary foods or, if needed, a prescribed supplement.⁵ Advertisements make powerful promises. Spend that money on eggs, fish, dal and fruit instead.

Should I keep breastfeeding after one year?

Yes, if you and your child want to. The IAP recommends continued breastfeeding up to 2 years and beyond, with good family foods.³

If your toddler still breastfeeds often, she may need less cow's milk, or none. Breast milk still gives energy, protein and protection from infections. Many working mothers in Kolkata keep a morning and bedtime feed for years. That is completely fine.

Can too much milk cause anaemia in toddlers?

Yes. Drinking a lot of cow's milk is a well-known cause of iron deficiency in toddlers.⁴

A toddler who fills up on milk eats less iron-rich food. Milk itself contains little iron, and its calcium and casein (a milk protein) block iron absorption from other foods.⁴ Anaemia (low haemoglobin) is very common in India. In the latest national survey, 67.1 percent of children aged 6 to 59 months were anaemic.⁶

A classic picture Dr Dutta sees: a pale, fussy toddler drinking 1 litre of milk a day from a bottle and refusing food. Cutting milk to the recommended amount often brings the appetite back within weeks. Iron-rich foods include egg, meat, fish, ragi, green leafy vegetables, and dal with a squeeze of lemon.

Can cow's milk cause constipation?

It can in some children. Large amounts of milk fill the stomach and leave little room for fibre-rich food, and a few children have true intolerance of cow's milk protein.

In an Italian trial of children with long-standing constipation that had not responded to laxatives, 68 percent improved when cow's milk was swapped for soy milk. Their constipation came back when cow's milk was given again.⁷ These were children seen at a specialist clinic, so this does not mean every constipated child needs to stop milk. If your child has hard, painful stools, first keep milk to the recommended amount and add fruit, vegetables and water. Talk to your doctor before cutting out milk completely.

Can I give soy, almond or oat milk instead of cow's milk?

Fortified soy milk is an acceptable alternative for children who cannot have cow's milk. Most other plant milks, such as almond, rice or oat, are not nutritionally equal.¹

Many plant milks are low in protein and calories, which toddlers need. If your child has a cow's milk allergy or your family is vegan, ask your paediatrician or a dietitian to plan the diet with you.

When should my baby stop using a bottle?

Aim to finish the move from bottle to cup between 12 and 18 months.²

Start offering a cup around 6 months, when your baby begins solid foods.² An open cup, a small steel glass, or a paladai all work. Spills are part of learning. Sippy cups are a step, but aim for an open cup by about 2 years.²

Why is using a bottle after age one a problem?

Long bottle use is linked with too much milk, poor appetite for food, tooth decay and a higher risk of obesity.

In a large US study, children still using a bottle at 2 years had a higher chance of obesity at 5.5 years, even after accounting for other factors.⁸ Bottles also let milk pool around the teeth, especially during sleep, which feeds decay.⁹ A toddler sipping from a bottle all day rarely feels hungry for meals.

How do I wean my toddler off the bottle?

Go step by step: allow a bottle at mealtimes for a while, and gradually remove the others, especially the nap and bedtime bottles.²

• Offer milk in a cup with meals, and water in a cup between meals.²
• Remove one bottle every few days, starting with the one your child cares least about.
• Let your toddler pick a special cup. Praise her when she uses it.
• Make sure every carer, including grandparents and the maid or creche, follows the same plan.²
• Put bottles away out of sight once they are no longer used.

Some families choose a "bye-bye bottle" day and give the bottles away together. Expect a few grumpy days. It passes faster than most parents fear.

How do I stop the night-time bottle?

Replace the bedtime bottle with a new calming routine, such as a bath, a story and a cuddle, and do not give the bottle back once you have stopped.²

Giving in when your child protests can turn a short phase into a long fight.² If you need a gentler path, offer the milk earlier, in a cup, before brushing teeth, and then go to bed. Some parents dilute the night bottle a little more each night until it is just water. Never let your child fall asleep with milk in a bottle; if she must have a bottle in bed, it should contain only water.⁹

A toddler over 1 year who is eating well does not need milk during the night.

When can my baby eat peanuts, eggs and other common allergy foods?

Once your baby has started solids, there is usually no reason to hold back. For peanut, giving it early in a safe form actually lowered peanut allergy in a major trial of high-risk babies.¹⁰

In the LEAP trial, babies aged 4 to 11 months with severe eczema or egg allergy were given peanut regularly or avoided it. At 5 years, peanut allergy was 1.9 percent in the eating group versus 13.7 percent in the avoiding group, among babies who were not already sensitised.¹⁰ Never give whole nuts to small children, as they can choke. Mix smooth peanut butter or finely ground peanuts into food. If your baby has severe eczema or a known food allergy, talk to your doctor first, as testing may be needed.

When should I see a doctor about milk or bottle problems?

See your doctor if your child shows signs of anaemia, poor growth, or milk intolerance.

• Pale skin, tiredness, poor appetite, or eating mud, chalk or ice.
• Drinking much more milk than the amounts above and refusing food.¹
• Hard, painful stools, bleeding from the bottom, or straining for weeks.
• Rash, vomiting, lip swelling or wheeze after milk or a new food.
• Poor weight gain or dropping centiles on the growth chart.
• Brown or white patches on the front teeth.

Go to hospital straight away if your child has swelling of the face or tongue, trouble breathing, or collapses after eating any food.