Cow’s Milk & Babies 6 to 12 Months of Age

Cow’s milk (plus soy milk, almond milk, and other milk alternatives) are not recommended as drinks before the first birthday. Our licensed pediatric doctors explain why—and how to navigate dairy before age one.  

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At a Glance

Frequently Asked Questions

When can baby drink cow’s milk?

Around 11 to 12 months, a baby may begin to have small sips of cow’s milk (and cow’s milk alternatives) as a drink. Start small: 1 to 2 fl oz (~30 to 60 mL) in an open cup. At this time, cow’s milk and cow’s milk alternatives are not meant to replace the volume of breast milk or formula that baby is consuming. Offering a small amount in an open cup helps baby become familiar with the taste while practicing cup drinking. 

Why can't babies drink cow's milk?

When served as a drink, cow’s milk and cow’s milk alternatives can displace baby’s consumption of breast milk and formula, which provide the main source of nourishment until baby has the skills to eat a variety of solid food. While a sip here and there is fine, wait until around the first birthday to offer cow’s milk and cow’s milk alternatives as a drink, if you can. Milk may be mixed into porridge and other foods, but when you want to offer a drink, stick with breast milk, formula, and water.

Can baby drink formula with cow’s milk? 

Yes. Cow’s milk forms the base for most infant formulas. Rest assured that formula is a safe and excellent source of nutrition for baby as it is modified to be a complete source of nutrition for baby.

Why does the WHO advise giving cow’s milk as a drink to baby?

The suggestion is mainly intended for those who are not able to access breast milk or formula. If families are facing barriers with access to breast milk or formula, cow’s milk may be a temporary alternative recommended by your medical provider. Your doctor may also offer a referral to a pediatric dietitian, lactation consultant, and/or program that provides infant formula for free or at a reduced rate. See Infant Formula Shortage for more information.

Can babies have dairy before age one?

Yes—as a solid food, not as a regular drink. Dairy products like butter, ghee, and yogurt made with cow’s milk and cow’s milk alternatives may be introduced as soon as baby is ready to start solids, which is generally around 6 months of age. Wait until after the first birthday to regularly offer cow’s milk or milk alternatives as a drink so the milk does not displace breast milk or formula, which offer important nutrition that baby needs to grow and thrive.

Can I mix cow’s milk into baby’s food? 

Yes. It is fine to mix cow’s milk or milk alternatives into porridge, pancake batter, and other food for baby. When introducing food with cow’s milk and cow’s milk alternatives, start small. Cow’s milk is a common food allergen, and many cow’s milk alternatives contain soy and tree nuts, which are also common food allergens. Check out Solid Starts Compass℠, our guided app experience for step-by-step guidance.

Does calcium in cow’s milk inhibit iron absorption?

Not in the long-term when a variety of food is consumed. In the very short term, calcium can block some of the absorption of iron, but this is expected and okay as long as baby consumes a variety of food over time. However, regularly consuming excessive amounts of cow’s milk and other dairy products may result in lower consumption of food containing iron, thereby reducing iron absorption and increasing the risk of iron deficiency anemia. 

Can cow's milk cause constipation?

When consumed in excess, yes. Consuming excessive amounts of cow’s milk and dairy products takes up space in the belly, which can result in lower consumption of foods that help promote regular digestion, such as fiber-rich beans, fruits, grains, and vegetables. Constipation can also be a symptom of cow’s milk protein allergy, although it is more common for babies with cow’s milk allergy to experience diarrhea. Check out Solid Starts Compass℠, our guided app experience for more tips, and know that ultimately, constipation is influenced by many variables. Your pediatric medical provider can help you develop a plan that meets baby’s needs.

How to safely give cow’s milk to baby

Start with a small amount of cow’s milk or a cow’s milk alternative mixed into a food that baby has already tried, such as beans, mashed vegetables, or porridge. 

Cow’s milk is a common food allergen, and many cow’s milk alternatives are made with common food allergens like soy and tree nuts. Babies with severe eczema or another pre-existing food allergy have a greater risk of food allergy than unaffected infants. If one of these risk factors is present in baby, consult a pediatric healthcare professional for guidance before introducing cow’s milk and cow’s milk alternatives. If your doctor advises the risk of food allergy is low, they may advise introduction at home. If the risk is high, they may refer you to an allergist for allergy testing or introduction of cow’s milk under medical supervision in the office. 

When you are ready to introduce cow’s milk, offer a pre-loaded spoon of the food containing a small amount of cow’s milk, then watch for any symptoms of an allergic reaction. If baby shows no signs of a reaction after 10 minutes, offer more and gradually increase the quantity of cow’s milk in baby’s food over future meals. For an introduction schedule, specific quantities, and step-by-step guidance, check out Solid Starts Compass℠, our guided app experience.

Can babies be allergic to cow’s milk? 

Yes. Cow’s milk is a common food allergen in babies and young children, and dairy products from other ruminants (such as buffalo, goat, and sheep) may provoke similar allergic reactions to cow’s milk. See Milk (Cow) for more allergen information. 

Can a baby outgrow a cow’s milk allergy?

Yes. Cow’s milk allergy often disappears with time. The majority of children outgrow it by 6 years of age, while many babies with milder symptoms of cow’s milk protein allergy (CMPA) are able to successfully reintroduce cow's milk as early as their first birthday with guidance from their pediatric health professionals. Even among toddler and other children who are not yet able to drink cow’s milk, many are able to tolerate milk that has been fully baked into a cake or muffin. check out Solid Starts Compass℠, our guided app experience, for more information and guidance. 

My baby drinks formula. Does that mean they don’t have a milk allergy?

If baby is consuming a standard formula containing cow’s milk, baby is likely not allergic to cow’s milk. On the other hand, specialized formulas such as those that are extensively hydrolyzed or amino acid-based (elemental) are processed in a way that the dairy proteins do not provoke an immune response in most children and wouldn’t generally be considered as a dairy exposure. If baby takes one of these specialized formulas, it would not be possible to rule out a milk allergy from exposure to the formula alone. If this is the case for your baby, talk with your pediatric healthcare provider before attempting to introduce cow’s milk and other dairy products.

Can babies be lactose intolerant?

Yes, however it is extremely uncommon. While lactose intolerance tends to emerge around 4 years of age and beyond, onset can vary based on a baby’s diet, health, and ethnic background. Temporary lactose intolerance can also develop after gastrointestinal illness. Lactose intolerance is relatively common in older children and adults and may affect up to 70% of the world’s population. Sometimes lactose intolerance is mistaken for food allergy when an individual with lactose intolerance experiences digestive issues, such as gas, bloating, or diarrhea. If you’re concerned that baby is lactose intolerant, connect with your pediatric health care professional and know that there are many lactose-free dairy foods available. 

How do I reintroduce dairy products to baby with CMPA?

Talk to your medical provider as needs vary:

Fortunately, 50% of babies outgrow cow’s milk protein allergy (CMPA) by their first birthday, and about 90% outgrow it by their 6th birthday. Your pediatric medical provider can help you develop a plan that meets baby’s needs.

When can I reintroduce dairy products to baby with CMPI?

Usually after 6 months or until 9 to 12 months of age, but each baby is different. Work with your pediatric healthcare provider to develop an individualized plan for baby. Until then, avoid dairy products, as well as soy products (if advised by your health care professional), until your doctor suggests reintroducing them.

My baby has CMPA or CMPI. Should I use a dairy ladder to reintroduce cow’s milk?

It depends on your baby’s individual history. 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. 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. Ask your medical team if a dairy ladder is an option for your baby.

What is the best cow’s milk substitute for a baby with CMPA?

There are a variety of options, including specialized hypoallergenic (hydrolyzed) formula or breast milk from a lactating parent on a milk-free (and possibly soy-free) diet. When baking and cooking, fortified plant-based milks like oat milk and pea milk are great choices; just hold off on serving them as a drink before the first birthday.

Avoid lactose-free cow’s milk if baby has CMPA. While free of lactose, it still contains the same proteins in cow’s milk that trigger reactions in individuals with CMPA.

Can baby have FPIES to cow’s milk and other dairy products?

Yes, milk is a known trigger of FPIES, which stands for food protein-induced enterocolitis syndrome. FPIES is a delayed allergy to food proteins which can cause the sudden onset of repetitive vomiting and diarrhea a few hours after ingestion. This is termed acute FPIES. Left untreated, the reaction can result in significant dehydration. When milk is in the diet regularly, FPIES can present as reflux, weight loss, and failure to thrive; this is termed chronic FPIES. Symptoms generally improve with elimination of milk from the baby’s diet. Thankfully, like other forms of milk allergy, FPIES which presents early in life is generally outgrown when the child has reached 3 to 5 years of age.

How to transition to cow’s milk from breast milk or formula

Breast milk and formula do not need to be swapped out for cow’s milk (or cow’s milk alternatives) at any time. That said, you can begin to offer small amounts of cow’s milk and cow’s milk alternatives as a drink around the first birthday if you like. Start with a small amount in an open cup for a few reasons:

If you are interested in transitioning from formula to cow's milk in a bottle, especially as part of a nighttime routine, practices that provide comfort can help wean a toddler from a bottle. Ideas include cuddling, rocking in a chair, singing or humming, patting a toddler’s back, and reading a story. See our guide, How to Wean from Breast to Bottle for more information. 

Can I offer raw milk to babies and toddlers?

No. There is no age at which consuming raw milk is without risk. Raw milk poses a high risk of foodborne illness, especially campylobacter, E. coli, and salmonella, which are harmful bacterial infections for babies, children, and adults alike, with more risk of severe symptoms in 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.

Written By

V. Kalami, MNSP, RD, CSP. Board-Certified Pediatric Dietitian and Nutritionist

M. Suarez, MS, OTR/L, SWC, CLEC. Pediatric Feeding Occupational Therapist

R. Ruiz, MD, FAAP, CLC. Board-Certified General Pediatrician and Pediatric Gastroenterologist

S. Bajowala, MD, FAAAAI. Board-Certified Allergist & Immunologist

K. Rappaport, OTR/L, MS, SCFES, IBCLC. Feeding & Swallowing Specialist

K. Grenawitzke, OTD, OTR/L, SCFES, IBCLC, CNT. Feeding & Swallowing Specialist