Milk FAQs for Babies & Toddlers

Do babies and toddlers need cow’s milk?

No, though the American Academy of Pediatrics does recommend plain cow’s milk for toddlers 12 months and older as a source of essential fat and nutrients, including calcium, vitamin D, protein, vitamin A, and zinc.1 That said, if your child is 12 months or older, meeting growth chart standards, without health concerns or allergies that may affect diet and eating a wide variety of fresh foods high in the aforementioned essential nutrients, cow’s milk (or any milk, plant-based or otherwise) may not be necessary. If you want to avoid animal milk entirely, it would be wise to work with your pediatrician and/or pediatric dietitian to ensure your child is receiving optimal nutrients. 

When can babies drink cow’s milk? 

Most pediatric organizations have recommended waiting until a baby’s first birthday to introduce cow’s milk (or any other ruminant milk) as the digestive systems of babies may not tolerate cow milk protein in large quantities well.2 Compared to breast milk or formula, cow’s milk is nutritionally incomplete, which means that it does not provide all of the healthy fats and nutrients that your baby needs to thrive.3 4 While cow’s milk forms the base for most infant formulas, it is modified in formula to make it nutritionally similar to human milk.5

Around 11 months of age, it is our opinion that it’s okay to offer small sips of cow’s milk (about 1 ounce) in an open cup to encourage your baby’s drinking skills and to acclimate your child to the new taste. Just avoid replacing breast milk or formula feeds with cow’s milk. Babies who consume cow’s milk prior to their first birthday are more at risk of iron deficiency anemia and intestinal distress, which can also contribute to anemia.6 Why? Cow’s milk is low in iron and babies who drink cow’s milk may reduce their intake of other iron-rich foods.7

Is cow’s milk good or bad for babies?

Compared to breast milk and formula, cow’s milk poses many nutritional disadvantages for babies younger than 12 months of age. 

Cow’s milk is low in a number of nutrients but, most importantly, it is low in iron—an essential nutrient that fuels your baby’s brain development. To complicate matters, the type of iron that is present in cow’s milk is not as well absorbed as the form of iron found in breast milk.8 While cow’s milk has more protein and minerals like calcium and phosphorous, the higher mineral content may increase the risk of dehydration in babies (though evidence is limited).9 Lastly, early consumption of cow’s milk can take the place of other, more nutritious foods that your baby would have otherwise been eating, increasing the risk of nutritional deficiencies as a result.10

Genetics, gut function, and the age at the time of introduction all influence your baby’s response to dairy. Additionally, the quality of dairy matters. Upwards of 90 percent of cows live on a diet of genetically-modified, pro-inflammatory corn, cottonseed, and soy and contain levels of toxins often exceeding government limits.11 12 Unfortunately, the contaminants in conventional dairy can disrupt hormone function and lead to a wide range of adverse health concerns.13

Because we don’t fully understand either the effects of these chemicals on the body, aim to buy organic, pasteurized dairy if possible. We do understand that organic milk isn’t an option for all families and in this case, we encourage that you do the best you can with the resources available to you and your family.

Whenever you decide to introduce dairy, be sure to watch for signs that your baby cannot digest dairy (such as stomach pain, gas, and/or diarrhea) and consult your pediatrician for advice.

Does calcium in cow’s milk inhibit iron absorption?

Yes, calcium can affect how our bodies absorb iron from certain foods. Know, however, that your baby’s ability to absorb iron are affected by many factors. 

At this stage in life, your baby’s iron levels are already at their lowest and lots of iron is needed for healthy growth. Iron doesn’t affect calcium absorption, but calcium does affect the absorption of iron from plants, meat, and seafood.14 15. This is one of the key reasons why cow’s milk is not recommended for babies under 12 months of age. The body is brilliant at self-regulating and studies show that iron status is not necessarily affected by calcium intake because the body will adjust iron absorption when stores are low.16 Studies also show that the effect of calcium on iron absorption is reduced when a diet consists of a wide range of foods.17

What is the best milk for toddlers? Whole milk, low fat, or skim?

The verdict is still out. Whole pasteurized milk is recommended for children under two years of age, at which point many parents are guided to switch their toddler to reduced-fat cow’s milk. However, a summary of 14 studies measuring the effects of consumption of whole milk versus reduced-fat milk shows that higher fat intake correlates with lower weight as children age, and that reduced-fat milk consumption correlates with increased weight or obesity.18 Whatever fat content you choose, be sure to look for milk without any added flavors or sugars. 

What about raw milk?

Avoid. Babies’ immune systems are still developing, and raw milk can harbor pathogenic bacteria and other potential contaminants that can increase the risk of foodborne illnesses, which can be fatal to babies. Pasteurization—the process of heating a food to a certain temperature to kill bacteria—is fundamental to reducing the risk of foodborne illness and thus making food safer to eat.19 For these reasons and more, many medical organizations recommend that all milk for human consumption should be pasteurized.20

Can babies be allergic to milk?

Absolutely. Cow’s milk is one of the most common food allergens for babies.21

Can a baby outgrow a milk allergy?

Yes! If your baby is allergic to dairy, be reassured that it is an allergy that often disappears with time. About half of infants at 1 year of age with milk allergies will outgrow the allergy.22  As children grow older, the more likely they are to grow out of their allergy: up to 90% of children grow out of their allergy by age 6.23

What is the best milk alternative for children sensitive to cow’s milk?

It depends on the age: 

0 to 12 months old: Breast milk. Studies show that breast milk is the most tolerated milk for babies.24

If you think your baby has sensitivities to infant formulas with dairy, reach out to your pediatrician for guidance. Cow’s milk protein allergy is thought to occur in 2-3% of infants in the US, and approximately 0.5% of breastfed babies.25 If your baby is formula fed and is having digestive difficulties, they may need to try out hypoallergenic or amino acid-based formulas.26 For breastfed babies, mom may need go on a dairy-free diet (but consult your pediatrician before self-diagnosing) and ensure she is getting adequate nutrition during this time too. As always, be sure to consult a pediatrician or pediatric gastroenterologist and/or pediatric dietitian or nutritionist when selecting an alternative, as some of these options can still pose a risk for allergic reaction.27

12+ months of age: If your baby has a true cow milk protein allergy, they may need to avoid mammalian milks as well (such as buffalo, goat, and sheep milks), in addition to unmodified rice and soy milk as these milks have a risk of also triggering an allergic reaction and may not be nutritionally adequate.28 However, if your child is sensitive to cow’s milk, but not allergic, they could try alternative mammalian milk, or other plant-based milk alternatives listed below.29

What are the best plant-based milks for babies and toddlers?

Not all plant-based milks are created equal when it comes to nutritional value.30 Furthermore, plant-based milks are considered to be a nutritionally incomplete drink for babies and may promote nutrient deficiencies if they take the place of healthier foods for babies, like breast milk or formula.31  That’s why general consensus suggests waiting to serve plant-based milks as a drink until after a baby’s first birthday, though cooking foods with plant-based milks for your baby is perfectly fine.

When shopping for plant-based milks, read the labels. You want to select brands of plant-based milks that are fortified with calcium and vitamin D, free of added sugars, low in preservatives, and offer similar protein and calorie content to cow’s milk. Below are our top choices of plant-based milks ranked according to nutritional similarity to cow’s milk:

  • Soy milk (fortified)
  • Pea protein milk (fortified)
  • Oat milk (fortified)

The chart below shows how popular plant-based milks stack up against mammalian milks, organized by nutritional density across key nutrients babies and toddlers need:

Nutritional content of common animal and plant-based milks

Per 8 oz serving

Milk typeCalories Fat (gm)Protein (gm)Calcium (mg)Vitamin D (mcg) Vitamin B12 (mcg)
Cow11497.97.72763.21.1
Goat116810.18.73273.20.2
Sheep12651715473Unavailable1.7
Buffalo1237179412Unavailable0.9
Camel21347.77.4274UnavailableUnavailable
Soy31053.66.33002.72.1
Pea4704.5846562.5
Oat5160933503.61.2
Almond3902.514512.53
Coconut3765.10.54592.41.5
Hemp6808239050.6
Macadamia7505158551.2
1. Assuming whole milk. 2. Assuming dromedary camel.32 3. Assuming unsweetened, will vary greatly depending on brand. 4. Using nutritional information from Ripple, will vary with different brands. 5. Using nutritional information from Oatly, will vary with different brands. 6. Using nutritional information from Tempt, will vary with different brands. 7. Using nutritional information from Milkadamia, will vary with different brands.
Using data from USDA’s FoodData Central unless otherwise specified, accessed May 14, 2020.8,9

What are the best plant-based milks for toddlers with allergies?

Fortified, organic soymilk or pea protein milk are the most nutritious milk alternatives from the standpoint of nutrients that toddlers need. If your child is allergic to soy or legumes, oat milk is a good alternative. In detail:

  • Soy, a legume, was one of the first plants to replace dairy. Compared to cow milk, it’s lower in carbohydrates, fats and proteins, and insufficient amounts of calcium and B-12. However, compared to other plant-based beverages, soymilk is one of the best sources of all of these nutrients, and it’s the only plant-based milk with protein levels similar to cow’s milk. Therefore, if your child can tolerate soymilk, that is the most nutritious option. Note that soy contains high levels of isoflavones (which may alter hormones, though no statistically significant data has surfaced), and still poses risk of allergic reaction.33 For these reasons, soy may not be ideal as the only plant-based beverages offered as a milk alternative.
  • Pea protein milk, another legume, (often sold under the brand name Ripple), offers fewer carbohydrates and fat than cow’s milk, yet is a great source of protein. It also touts higher levels of calcium, iron and vitamin D than cow’s milk, and is fortified with vitamin B12.34
  • Oat, a pseudo-grain, is low in beneficial fats and proteins, yet has a better amino acid profile that other plant-based beverages. While the fiber in oats may benefit the gut, it’s naturally low in calcium (although it is often fortified with calcium, vitamin D, and vitamin B12) and also contains phytic acid, which may inhibit nutrient absorption.35

Also, each of these plant-based beverages has benefits and drawbacks. If using a milk alternative, opt for one that is fortified with key vitamins and minerals (be sure to read labels, as not all are fortified). Some are high on the glycemic index and come in forms that also include added sugars, preservatives, binders and other ingredients that may not benefit health when offered frequently and in large quantities.37 Lastly, most grains, nuts and legumes grown in conventional agriculture are genetically modified and/or are grown with chemicals. Therefore, consider milk alternatives as a “sometimes” beverage and/or considering rotating the types of milk alternatives you offer.

In most cases, milk alternatives are not recommended to replace cow’s milk (except for health reasons). A well-balanced diet consisting of whole plant and animal foods may offer ideal nutrient intake without cow’s milk or fortified milk alternatives. As always, work with your pediatrician, allergist, and/or pediatric dietitian or nutritionist when selecting a cow milk alternative that is best for your child.

Is almond milk good for babies and toddlers?

Unfortunately, almond milk lacks the protein, fat, and calories we like to see in plant-based milks for toddlers. More nutritious options would be fortified soy, pea, or oat milk—all of which have greater amounts of calories, fat, and protein.

How do you properly store breast milk?

The most important thing to keep in mind when storing breast milk is avoiding cross contamination with other foods. All containers for collection and storage of breast milk should be kept clean and sterile. 

It is acceptable to store breast milk for up to 4 days in the refrigerator (preferably in the back of the refrigerator to prevent intermittent warming from the door opening). If you are going to freeze breast milk, try to freeze the fresh or refrigerated breast milk within 24 hours as the beneficial enzymes begin to change at approximately 25 hours. This doesn’t have to be a determining factor in the how quickly you freeze your refrigerated milk, but it’s worth consideration. 

If not used within 72 hours, fresh breast milk should be transferred to the freezer in a clean, freezer-safe container and dated. While it is acceptable to store breast milk in a deep freezer with an attached refrigerator (0°F or −18°C) for up to 6 months and in a deep freezer (−4°F or −20°C) for up to 9-12 months, the sooner you use it, the better. Frozen breast milk lasts safely in the freezer for one month while preserving most of the nutrients, but after 3 months in the freezer, there is a noteworthy decline in concentrations of fats, calories and other macronutrients.

To thaw, plan ahead and defrost overnight in the refrigerator, and never on the counter. And because heating to excessive temperatures can greatly alter the nutrient quality, refrain from defrosting breast milk in the microwave or on the stove. Once breast milk is completely thawed, you have 24 hours to use it. And remember: breast milk does not have to be heated at all! Many babies will happily drink room temperature—or even cold—breast milk. 

Can you cook with breast milk?

Yes, though heat does alter the structure of breast milk. Some studies have suggested that when breast milk is heated to just 100.4°F (38°C)—slightly above body temperature—its proteins begin to break down. This means that even when we heat stored breast milk it can lose important immunologically “active” and digestive components that benefit babies. 

While you lose some nutrients in the heating process, cooked breast milk still offers nutritional value, so if you want to cook with your breast milk, go for it. Just know it would be better just to add some fresh breast milk stirred into food after it has been cooked.

Note: If you intend to freeze the food you cook with breast milk, remember to only use fresh breast milk as it is not safe to refreeze breast milk.

Can you store formula in the refrigerator?

Yes. Similarly to breast milk, it is important to: avoid cross contamination with other foods, maintain clean surfaces, use sterile containers, keep the refrigerator at less than 41°F or 5°C, and preferably place the formula at the back of the refrigerator to avoid intermittent warming with door openings.38 If formula is prepared from powder for later use, it should be covered and stored in the refrigerator immediately and is recommended to be used within 24 hours to avoid risk of foodborne illness. If using a ready-to-feed formula, once opened, it can be stored covered in the refrigerator for up to 48 hours. Formula that is left over from feeding your baby should not be stored in the refrigerator and should be thrown away as your baby’s saliva can contribute to the growth of bacteria.39

Can you cook with formula?

Yes, though similarly to breast milk, heating formula can also degrade certain nutrients and decrease the bioavailability (the usability) of certain vitamins and minerals.40 41 42

This can be avoided by adding prepared or powdered formula into foods after cooking. Up to 1 teaspoon of powdered infant formula can be sprinkled onto 4 ounces of soft or puree textured foods.43 Prepared formula can be used to thin out certain thicker consistency foods and stirred into other foods. That being said, we recognize that feeding your baby can feel overwhelming at times and we want to reassure you that it is completely fine to cook with prepared infant formula as it still provides calories, fat, protein, and other vital nutrients to help your baby thrive. 

When can babies drink water?

In small amounts, water may be introduced after 6 months of age. When babies consume water, it puts them at risk of inadequate intake of calories, protein, and essential nutrients. However, per the American Academy of Pediatrics, starting around 6 months of age—and as long as baby is growing and gaining appropriately—small amounts of water can be offered, although not usually required. 

While the American Academy of Pediatrics suggests you can offer up to 8 ounces of water per day starting at 6 months old, it is our strong opinion that water should be limited to less than 2 to 4 ounces a day so it doesn’t displace valuable nutrition from breast milk or formula.44 If you’re concerned about your baby’s hydration status, you can monitor the number of wet diapers and energy levels and contact your pediatrician.  


Reviewed by: 

Jamie Truppi, MSN, CNS

Venus Kalami, MNSP, RD

Rachel Ruiz, MD

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