Moving to cow's milk at 12 months: how much, which milk and how

Cow's milk can be used in food from around 6 months, but it shouldn't become your baby's main drink until 12 months. From 12 months, most children can drink pasteurised full-fat cow's milk from a cup. Australia's Royal Children's Hospital suggests keeping it to no more than 500 mL (about two cups) a day so there's room for iron-rich food. Toddler and growing-up milks aren't needed, and if you're breastfeeding you can carry on for as long as you both want.

When can my baby have cow's milk?

There are two different answers, depending on how the milk is used.

The NHS guide to drinks and cups says cow's milk can be used in cooking or mixed with food from around 6 months, but shouldn't be a main drink before 12 months because it doesn't contain the right balance of nutrients for babies. The Royal Children's Hospital iron fact sheet adds that cow's milk contains very little iron, and that it can be used in foods once solids start. Pregnancy, Birth and Baby lists cow's, goat's and sheep's milk, and plant-based milks, among the drinks not recommended for babies under 12 months.

So for a 10-month-old, a little cow's milk in porridge or a sauce is fine, but their drinks should still be breast milk, formula and small sips of water. From 12 months, the CDC says you can offer pasteurised, plain whole cow's milk without added sugars, or a fortified, unsweetened dairy alternative.

How much milk should a toddler drink?

Less than many parents expect. The Royal Children's Hospital notes that children grow more slowly in their second year and need a variety of family foods, so milk becomes one part of the diet rather than the main event.

The Royal Children's Hospital toddler guide warns that more than 2–3 cups of milk and dairy products a day can displace foods such as meat and vegetables. It suggests giving food first, then drinks, at meals and snacks.

Why too much milk can cause low iron

The Royal Children's Hospital lists children who drink large amounts of cow's milk among those at higher risk of low iron. It gives three reasons: cow's milk contains very little iron, drinking a lot of it fills children up so they eat fewer iron-rich foods, and large amounts can also reduce iron absorption. Low iron can cause tiredness, headaches and poor appetite, and over time can lead to iron deficiency anaemia.

Offer iron-rich foods such as meat, chicken, fish, eggs, legumes and iron-fortified cereals, and see first foods and iron. Don't start an iron supplement on your own — the Royal Children's Hospital says too much iron can be harmful and supplements should only be given on a doctor's or dietitian's advice.

Should my toddler have full-fat or reduced-fat milk?

This is one of the places where guidance differs by country.

The AAP's drinks guide advises whole milk from 12 to 24 months. The NHS says skimmed and 1% milks don't contain enough calories to be a main drink for children under 5, although lower-fat milk is fine in cooking from 1 year. Avoid flavoured milk — the AAP advises against added sugars for children under 2.

How do I switch from formula to cow's milk?

The CDC's formula guide suggests making the move around 12 months, gradually, by replacing one formula feed at a time. A simple way to do it:

1. Start with one daytime feed — often the one your toddler is least interested in — and offer cow's milk in a cup instead.
2. Keep the other feeds as they are for a few days to a week.
3. Replace the next feed the same way, until all formula feeds have become cow's milk with meals or snacks, water, or nothing at all.
4. Offer milk in an open or free-flow cup. The NHS says bottles should be discouraged once your baby is 1, and the Royal Children's Hospital suggests offering all drinks in a cup.
5. Keep the total within the amounts above, and offer water at other times.

Many families leave the bedtime bottle until last, because it's often the hardest to change. See cups and dropping bottles for ideas.

Toddler and growing-up milks

You don't need them. The NHS says formula milks, including toddler and growing-up milks, aren't needed once your baby is 12 months old. The AAP says toddler milks offer no nutritional advantage for most children, cost more, and contain added sugars that can reduce appetite for healthier foods. If your child has a medical condition or allergy, their doctor or dietitian may advise a specific formula.

If you're breastfeeding

There's no need to switch from breastfeeding to formula or cow's milk at 12 months. The NHS says breastfeeding continues to benefit you and your baby for as long as you carry on, and the WHO recommends breastfeeding up to 2 years or beyond alongside family foods. You can offer cow's milk in a cup with meals as well. If you're ready to wean, see weaning from the breast.

Can my toddler have soy, oat or other plant milks?

From 12 months, some plant milks can be used, but they aren't all equal, and sources differ.

• Royal Children's Hospital (AU): calcium-enriched soy and other plant milks (such as rice or oat) can be used after 12 months if they're full-fat and your toddler eats other foods such as meat, lentils and eggs.
• NHS (UK): unsweetened, calcium-fortified soya, oat or almond drinks can be given from age 1 as part of a balanced diet, but children under 5 shouldn't have rice drinks because of their arsenic levels.
• AAP (US): soy milk is nutritionally equivalent to cow's milk and an acceptable alternative; other plant milks may lack protein, vitamin D and calcium.
• ASCIA (AU): check that an alternative milk has enough protein and fat for growth, and is enriched with calcium at around 120 mg per 100 mL.

Note the disagreement on rice milk: Australian hospital guidance allows it after 12 months if full-fat and calcium-enriched, while the NHS advises against rice drinks for children under 5. If a plant milk will be your child's main milk, talk to your GP, child-health nurse or a dietitian.

What if my child has a cow's milk allergy or intolerance?

The ASCIA cow's milk allergy page says more than 2% (1 in 50) of infants in Australia and New Zealand are allergic to cow's milk protein, and around 80% outgrow it by 3 to 5 years.

If your child has a diagnosed cow's milk allergy:

• don't introduce cow's milk without advice — ASCIA says exclusion and reintroduction should be guided by a medical specialist, often with a dietitian
• other animal milks aren't a safe swap — most children allergic to cow's milk are also allergic to goat's and sheep's milk, and ASCIA lists lactose-free, goat's, sheep's, A2 and partially hydrolysed (HA) milks and formulas as unsuitable
• ASCIA suggests a dietitian review at around 12 months to decide whether a specialised formula is still needed

Lactose intolerance is different. ASCIA explains it's caused by a lack of the enzyme that digests milk sugar and can cause diarrhoea, vomiting, tummy pain and wind, but it isn't dangerous and doesn't cause rashes or anaphylaxis. For introducing allergy foods in general, see introducing allergens.

When should I get help?

Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) now for any of the severe signs above, or if your child's lips, mouth, tongue or throat suddenly swell, which the NHS food allergy guide lists as a reason to call an ambulance. ASCIA says anaphylaxis to cow's milk is always a medical emergency and needs adrenaline straight away.

See a GP today if your child gets hives or welts, swelling of the face or eyes, or vomiting soon after having milk or dairy and is breathing normally, even if it settles. Stop giving dairy until they've been checked, and ask about an allergy referral and action plan.

Mention it to your GP or child-health nurse if your toddler drinks a lot of milk but eats little, seems pale or tired, has a poor appetite, or you're worried about their growth or iron. If you keep a food and drink log for a few days, include roughly how much milk your toddler drinks — it's often more than parents realise.