When Can My Baby Drink Cow’s Milk?

Dietitians New Zealand believes it is important to
clarify the current guidelines in New Zealand with regards
to cow’s milk vs. formula for infants from 6 months of
age. This is in response to updates reported in the World
Health Organisation (WHO) Global Feeding Guidelines for
Children Under Two, as reported across various media outlets
in the last week. The New Zealand infant feeding guidelines
were reviewed and updated in 2021 in line with the latest
scientific evidence. The recommendation from these
guidelines is that exclusive breastfeeding is considered the
best nutrition for babies for the first six months and
breastfeeding is continued up to two years or beyond, in
addition to appropriately textured nutritious diet. If an
infant is not breastfed, a commercial infant formula from
ages 0-6 months and follow-on formula from 6 – 12 months,
are the only suitable alternatives to breast milk under 1
year of age.

Dietitians New Zealand recognise the
challenges faced by many parents in a cost-of-living crisis,
particularly when making decisions about household expenses,
such as food. However, before considering switching from
infant formula to standard cow’s milk, we encourage
parents and caregivers to think about the
following:

• The main aim of the review was to
  evaluate the effect of cow’s milk from 6 months on infant
  growth and development. Here, the WHO reported no difference
  in infants receiving cow’s milk. However, researchers
  found an increase in iron deficiency anaemia in infants fed
  cow’s milk.
• The study did not look at the impact
  of the high protein content of cow’s milk on infant growth
  and development.
• The studies included in the WHO
  review were limited (9 studies), making it difficult to
  recommend any changes to the New Zealand infant feeding
  guidelines without further research.
• It’s important
  to recognise that the WHO recommendations consider a global
  perspective, encompassing regions where access to safe
  drinking water, used to reconstitute formula, may be
  limited.
• The WHO recommendation is for using cow’s
  milk only. Other animal and plant-based milks have different
  nutrition profiles. These milks are not included in the
  recommendation and are not suitable for infants from 6 –
  12 months.
• Our current New Zealand infant feeding
  guidelines recommend introducing cow’s milk added to
  solids (such as pureed or mashed vegetables), or yoghurt and
  cheese from 6 months of age.
• The differences in the
  protein and nutrient composition of cow’s milk compared to
  breastmilk or formula can make babies’ kidneys work
  harder.

How to reduce the risk of iron
deficiency anaemia

Many babies are born with low iron
stores and are at risk of developing anaemia in their first
year of life. This risk is increased if their māmā
experienced iron deficiency in pregnancy or if infant was
born prematurely. Commercial infant formulas are iron
fortified, whereas cow’s milk is not. By 6 months of age
babies have used up most of their stored iron. This is why
The Ministry of Health encourages families to start
introducing their infant to iron-rich foods such as pureed
red meat, or chicken, iron fortified rice or cereal, and
egg. Legumes and vegetables have some iron but are less
available for absorption than animal foods rich in iron.
These kinds of foods are encouraged daily, as babies become
more established on solids.

Cow’s milk and
Kidneys

Babies’ kidneys are immature when they are
born and mature over the first year of life. Cow’s milk
contains high levels of protein and minerals which can
increase stress on the kidneys during this time. Evidence is
currently lacking to determine, when in the first year of
life, the kidneys are mature enough to manage cow’s
milk.

Babies are individuals

Dietitians New
Zealand encourage parents and caregivers to talk with their
Well Child Provider or GP before making any changes to
cow’s milk from infant formula from 6 months of age. Each
infant is unique, and they need individual care to keep them
healthy and growing well. For individualised nutrition
advice, specific to the needs of the infant, Dietitians New
Zealand recommends consulting with a Registered
Dietitian.

For those seeking further information about
dietitians or wishing to know where to find a local
dietitian, please go to the Dietitians New Zealand website
at www.dietitians.org.nz.

References:

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