Transitioning Your Baby From Formula to Cow's Milk

Transitioning from bottles of formula to cups of cow's milk is a major challenge for many families. It can be an overwhelming concept at a challenging time of transition. The following guide is meant to be a road map on some of the ways your family can navigate this change. 

But first you may ask, why do we start serving babies cow's milk when they turn one? The main reason is that by the age of one your baby ideally has moved from a liquid diet to a predominately solid one. By 12 months babies should be eating three full meals a day and getting the majority of their calories and nutrients from whole foods. So, why introduce cow's milk at all? At 12 months your baby's calcium need goes up and is no longer met by infant formula. Cow's milk is an easily accessible source that babies are most likely going to like and consume. Whole cow's milk is also an excellent source of fat, which is critical for brain development at this age. You don't have to introduce cow's milk, these needs can be met by other whole foods (yogurt, cheese, avocado, etc.), but if you're looking to make the change, read more below.

When looking at this transition, there are two major changes, often happening concurrently. The first is the vessel your child drinks from, the bottle or the cup. The second is the content of the vessel, the milk. That one can be a little simpler, so we’re going to start with the vessel.

Types of Vessel

There are three main modes of drinking that your baby (and you or I) are capable of. The first is from an open cup, the second a cup with a straw, and the third is a bottle or sippy cup.

Open Cup

The open cup is the gold standard of drinking in the realm of oral development. If you ask a pediatric feeding specialist, dietician, or even speech language pathologist, they will likely say that your child should be drinking almost exclusively from an open cup. However, that’s just not realistic in day to day life. Babies are incredibly bad at drinking from open cups, it’s a mess and it’s not ideal for on the go. So while it’s very important to have your baby practice with an open cup (maybe outside, on a warm day, in only a diaper), don’t get hung up on meeting the gold standard, good enough is good enough. When looking for an open cup choose one that is sized appropriately for your baby, like this one.

Straw Cup

A straw cup is, realistically, the best thing for your baby to drink from. It promotes good oral posture and development, poses no long term detriment to their teeth, and prevents spills and leaking when out of the house. There are many different types and styles of straw cup. I recommend a soft silicone one to start, so that you can squeeze water through the straw into your baby’s mouth to teach them to drink from it. The Honey Bear cup is very popular for this reason. Once they’ve mastered the straw there are a host of hard plastic and metal options that are less prone to leaking. Dr. Brown's makes one that's very popular and so does Munchkin. Choose one with handles that your baby can hold themselves and a weighted straw so they can drink from any angle as an added ease of use bonus.

Sippy Cups

From an oral function point of view, there is no real difference between a bottle and a sippy cup. I urge parents to steer clear of all sippy cups, they don’t promote oral development and long term can contribute to dental issues, speech problems, and improper swallowing mechanics. Many also have odd or unnatural mechanisms your baby must learn to drink from them (such as the popular Munchkin 360 cup which requires them to bite). It’s best to simply not buy them in the first place. 

Introducing the Cup

You can introduce your baby to a cup as soon as they are able to bring items to their mouth. Before the age of 6 months the cup can be filled with breast milk or formula (depending on your feelings about ‘wasting’ it) or simply presented empty for them to explore. After the age of 6 months water can be introduced in the cup as well. If your baby takes well to it, you can start serving their formula in it too rather than a bottle. However, it's not abnormal for your baby to take some time to learn this skill, or be uninterested in water itself. They've just spent their whole lives drinking only one thing one way! Have some patience and continue to practice regularly and most babies will figure it out.

Switching to Cows Milk

The actual how of how you’re going to switch your child off formula is actually quite simple. For the first 3-7 days instead of serving all formula, mix ¼ of whole cows milk in with ¾ of formula. Then switch to half cows milk, half formula for another 3-7 days, and finally serve ¼ formula and ¾ cows milk for 3-7 days before switching completely over to cows milk. Expect there to be a small amount of gastric upset for your baby (increased gassiness or a change in stool) through each of these transitions. This is fairly normal and generally resolves itself within a few days. If it persists for more than a few days, is getting increasingly worse, or your baby seems to be in pain, return to formula and consult with a medical professional.

Making the Change

Whether you change the vessel or the content first is up to you, but I don’t recommend changing both at once simply because it could be confusing for your baby. Some babies do well on their straw cups and can easily be switched off the bottle even before their first birthday, others take a little longer to come around so it can be worth serving cows milk in their bottle for a time before making the full change to straw cup. It’s important to remember that this process can take time, and you may need to introduce the cows milk in a variety of cups (open, straw, and bottle) for your baby to understand what you're asking of them. You also want to ensure that you’re offering three full meals a day and snacks. The goal of switching to cow's milk is also to cut back on the amount of liquid in your baby’s diet as opposed to whole foods. Cow's milk should not replace your baby's formula intake 1:1, but rather be supplementary to their diet of solids.

Extras!

Dental Health and Hygiene

The predominant cause of tooth decay in babies and toddlers is feeding to sleep or feeding overnight. This is found with formula, cows milk and even breastmilk. Make sure that you’re brushing your baby's teeth after their bottle or milk cup before they go to bed. If your baby needs a drink in the middle of the night, try offering water instead of milk.

Types of Milk

Whole cow’s milk (3.25%) is the number one recommendation because of the high fat content. Babies need this fat for brain development. There is also an increase in need for calcium that cow's milk helps meet. It is possible to meet these needs without cows milk, but it does require a little more monitoring of what they're eating. This also goes for introducing non-dairy milks. If you're choosing a non-dairy milk, be mindful that it doesn't have an excess of additional sugar added. ‘Toddler formula’ or any 12 month and up formula is completely unnecessary for a healthy baby. With this transition the goal is for your baby to be eating all of their necessary calories and nutrients, rather than drinking it. 

Transition Bottles

Transition bottles are a marketing technique to keep you spending money with bottle companies once your baby no longer needs them. They often do nothing more than turn your baby’s bottle into a slightly different kind of sippy cup. Some bottle companies sell straw cup conversion kits (like this Dr. Brown's one), these can be worth the money, but you don’t need to replace the nipple on every bottle you own. Remember, the goal is to have your baby drinking less and eating more. 

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