Cow's milk

Cow's milk falls short of breast milk or formula in nutrition. It does not supply everything a baby needs to grow. A baby's gut may also handle large amounts of cow's milk protein poorly. So do not give it as a drink before the first birthday. A small amount inside a dish such as oatmeal is fine.

Cow's milk can be tried inside food from 6 months. As a drink, hold off until 12 months. The same rule holds for the milk of other hooved grazing animals such as goats, sheep and buffalo.

Thousands of mammal species nurse their young. People drink the milk of only a few of them. Cow's milk is the most common.

6 to 11 months

Breast milk or formula remains baby's main fluid. Do not give cow's milk as a drink at this age. A small amount may go into meals as long as it does not replace breast milk or formula.

11 to 12 months

Small sips of whole milk, no more than 30 to 60 ml (1 to 2 oz), can be offered in an open cup. The aim is to practice cup drinking and let baby get used to the new taste. Skipping milk at this age and keeping breast milk or formula is also completely fine.

12 months and older

Cap daily milk at 480 ml in total, or 2 servings of dairy. Pick whole milk and full-fat dairy, since healthy growth needs enough fat and calories. A child who still nurses may need less dairy, since breast milk also supplies calcium.

24 months and older

Toddlers can have 2 to 2.5 servings of dairy a day. You may hear advice to move to lower-fat milk. Not every child needs it, so ask your pediatrician.

Milk is low risk when it suits the child's age and development. In theory any food can cause choking. Keep the child seated and stay within arm's reach during the whole meal.

The World Health Organization counts cow's milk among the common allergens. About one in five food allergies in young children is to milk. Dairy from sheep, goats and buffalo can set off similar reactions.

The good news is that milk allergy often fades with time. Most children with cow's milk allergy outgrow it by age 6. Some babies with mild milk protein allergy (one sign can be painless blood in the stool) can restart milk around the first birthday under a pediatrician's guidance. Many children who cannot drink milk yet can handle it when it is baked thoroughly into a muffin or cake.

Milk is one of the usual triggers of a delayed reaction called FPIES. In FPIES, sudden repeated vomiting and diarrhea begin a few hours after eating. Untreated, it can lead to serious fluid loss. When milk is eaten regularly, it may show up as reflux, weight loss and poor growth. Symptoms usually ease once milk is removed. FPIES that starts early usually clears between ages 3 and 5.

Lactose intolerance can be mistaken for allergy, since it causes bloating, gas, diarrhea and nausea. It is rare in babies and young children, becomes more common with age and may affect as many as 70 percent of people worldwide. Lactose-free dairy is available. Ask your pediatrician with any questions.

When a milk allergy is possible for your baby, see an allergist first. Depending on risk factors, the allergist may order tests or have you give the first serving at the clinic with supervision. Where risk is low, starting at home may be advised. For the first servings give a small amount on its own. If there is no reaction, raise the amount slowly. Once common allergens have been introduced, keep them in the diet, twice a week if possible.