La leche de vaca y los bebés de 6 a 12 meses de edad

When to Introduce Cow’s Milk to Babies

Wait until around the first birthday to offer milk as a drink. Cow’s milk and milk alternatives like soy milk and nut milk may be introduced in food (such as porridge or yogurt) as soon as baby is ready to start solids, which is generally around 6 months of age, but avoid milk as a drink at this age. A small sip is fine, but drinking cow’s milk and milk alternatives takes away room in the belly from breast milk and formula, which are baby’s main sources of nutrition through the first year. 

Before Age One

While drinking cow’s milk and milk alternatives is not recommended until around the first birthday, it’s important to introduce food containing milk (such as yogurt and cheese) when starting solids. Regularly serving food containing milk helps prevent allergies from developing. You can introduce food containing cow’s milk and milk alternatives from around 6 months of age, unless your doctor advises you to start earlier. Check out Tips for Introducing Allergens Before Baby Is Ready to Start Solids for more information. 

Around the First Birthday

Around the first birthday, you can offer small sips of cow’s milk and milk alternatives as a drink, but it is not necessary. At this age, milk should be treated like a beverage for cup drinking practice (not a meal replacement) and baby can just as easily practice cup drinking with water. Use an open cup and start small: 1 to 2 fl oz (~30 to 60 mL) is plenty for cup drinking practice. Do not serve cow’s milk or milk alternatives in a bottle, as it can compromise dental health and displace nutrition from other food. Milk may be mixed into porridge and other foods, but when you want to offer a bottle, stick with breast milk or formula. 

After the First Birthday

You can offer milk as a drink, but it is not necessary. Calcium can come from food, too. If you want to offer cow’s milk or milk alternatives as a drink, we recommend offering no more than 16 fluid ounces (480 mL) over the course of a day. This limit does not count foods containing cow’s milk or milk alternatives, like butter, cheese, and yogurt. 

If they are thirsty for more, offer water as a drink to quench their thirst. Offering more milk on some days is fine, but regularly offering excessive amounts of milk can lead to a toddler filling up on milk, which decreases their motivation to eat solid foods and increases their risk of iron deficiency, poor appetite, constipation, and challenges with growth. Setting gentle boundaries on what food is and is not available guides toddlers away from filling up on one food in excess, and toward trying other foods offered.

Daily Cow’s Milk Limits for Babies & Toddlers

Guidelines vary by country. Our guidelines do not apply to solid foods containing milk. Toddlers do not need to drink milk, but it is okay if you want to offer it. 

These limits apply to plant-based milks like almond milk, oat milk, and soy milk. 

It is worth noting that sometimes the American Academy of Pediatrics suggests offering up to 24 fluid ounces (720 mL) of milk per day after 12 months of age, but we encourage you to offer less. This helps ensure their belly doesn’t fill up on milk and take away space from solid food that toddlers need for their health. In our experience as pediatric professionals and moms, young toddlers who drink more than 16 fl oz (480 mL) per day usually have less hunger for food, consume less variety of foods, and refuse food more often when it’s time to eat. 

When to Transition to Cow’s Milk 

It’s a common myth that cow’s milk needs to eventually replace breast milk and formula. In fact, breast milk and formula do not need to be swapped out for cow’s milk at any time, even when you’re ready to wean your child. Toddlers can transition to cow’s milk or another calcium-fortified milk alternative as a beverage, if needed, or you may choose not to serve milk at all. As long as a toddler has plenty of sources of protein, fat, and calcium (which is high in cheese, tofu, and yogurt), cow’s milk is not a requirement.  

If you want to offer cow’s milk as a drink to a toddler, there are few ways to make this transition go smoothly. 

How to Transition Toddlers to Drinking Cow’s Milk

Babies with CMPA (Cow’s Milk Protein Allergy)

Cow's milk protein allergy (also called CMPA) can involve not only classic allergy symptoms (like rashes, swelling, and trouble breathing), but also gastrointestinal issues (such as blood in stool, delayed vomiting and diarrhea, and poor growth).

When a baby has CMPA, proteins in milk trigger their immune system to over-react, causing symptoms that can range from mild to severe. The most common symptoms in babies involve the skin and digestive systems, including vomiting, diarrhea, but other symptoms of an allergic reaction are possible. Symptoms of classic (IgE-mediated) milk allergy typically occur within minutes (but can happen up to 2 hours) after exposure to cow’s milk, while symptoms of delayed (non-IgE) milk allergy can take up to several hours to appear.

If your baby is diagnosed with cow's milk allergy, the first approach to treatment will be removal of milk from the diet. Your doctor may also prescribe emergency medications (adrenaline/epinephrine for IgE-mediated allergy or anti-nausea medication for FPIES). They can also point you toward formula and breast milk that won’t cause an allergic reaction, such as non-dairy or hypoallergenic infant formulas (extensively hydrolyzed, or amino acid-based formulas) and breast milk from a parent or donor on a milk-free (and sometimes soy-free) diet. 

Babies with CMPA are also frequently advised to avoid solid foods containing cow’s milk at first, but many are able to eventually introduce foods containing extensively heated milk (such as a muffin that contains milk in the batter). 

Work closely with your health care team to determine when to reintroduce cow’s milk to a baby with CMPA. Most babies will outgrow cow's milk allergy on their own by the first birthday, and many will be able to consume baked milk. For those children with persistent milk allergy, treatments are now available. 

Types of Cow’s Milk Protein Allergy in Babies

* Allergy testing is only helpful for IgE-mediated allergy. Delayed milk allergy (FPIAP and FPIES) is not diagnosed with skin prick tests or bloodwork, but rather based on symptoms and baby's response to removal of milk from the diet.

Milk Alternatives for Babies with CMPA 

There are plenty of safe milk alternatives to use in food for babies with CMPA, although there are some that should be avoided, at least at first. Babies with CMPA frequently cannot tolerate goat’s milk and milk from other ruminants (buffalo,  sheep, yak). They should also avoid lactose-free cow’s milk, which contains the same proteins in cow’s milk that trigger allergic reactions in individuals with CMPA. Between 9 to 14% of babies with CMPA also react to soy protein, so doctors may recommend holding off on introducing formula containing soy milk for the first 6 months of life.

Cow's Milk Alternatives to Use in Food for Babies with CMPA

* Tree nuts are a common allergen. Only use in food after the tree nut in the milk has been safely introduced and food allergy has been ruled out.

Reintroducing Dairy to Babies with CMPA

Good news for families with cow’s milk allergy: CMPA usually resolves with time. Half of all babies with CMPA outgrow the allergy by their first birthday, and most outgrow it by age 6. Even among toddlers and older children with cow’s milk allergy, many are able to tolerate milk that has been fully baked into a cake or muffin. 

If your baby has CMPA, talk to your doctor about your options, because the best strategy for safely reintroducing dairy depends on your individual circumstances. Families of babies with CMPA are typically able to reintroduce cow’s milk around the first birthday under the guidance of their healthcare team. However, some babies with FPIES and other delayed food allergies may be advised to wait or hold on reintroducing dairy (and possibly soy-based foods) until after the first birthday or later. 

Ways to Reintroduce Dairy to Babies with Milk Allergy or Intolerance

A dairy ladder is one way to slowly reintroduce dairy products to a baby who has been avoiding milk due to allergy or intolerance, beginning from extensively heated milk baked into muffins or other food, and then progressing through partially baked milk in pancakes or waffles, baked cheese, boiled milk, unbaked dairy, and finally liquid milk. Talk to your doctor before trying a dairy ladder. Reintroduction needs to be carefully planned with a pediatric medical provider as each baby is different and this method may not be safe for some babies with severe milk allergy.