Month 22 Worry: When to Switch from Whole to Lower-Fat Milk?

What’s the Issue

You added yogurt and cheese into your child’s diet when she was eight or nine months of age. Then you added whole milk in at her first birthday. The next natural transition would be to skim or low-fat milk. Consistently, parents ask me when this is optimally done. (In other words, “When can I simplify my grocery shopping and give my toddler the same kind of milk I drink?”)

You need to know your milk fat facts: Whole milk is 4 percent milk fat. Two percent and 1 percent milk are self-explanatory, and skimmed milk has minimal fat content. Up to this point, your toddler has been getting whole milk—but right now, he is still just a bit too young for you to pour his milk from the same carton of skim you drink from. And here’s why.

Did you know that the calcium requirements of a 22-month-old are about 500 mg per day? According to the USDA, this is the equivalent of two cups of whole milk or four slices of cheese over the course of a day. Interestingly, nonfat milk has significantly higher calcium content than its whole milk counterpart (316 versus 290 gm per cup). So switching your child to skim milk when he turns 2 will take away the extra fat he doesn’t need and boost the calcium that he does.

What Parents Can Do

You have had your toddler drink whole milk up to this point, mainly for the extra fat. Extra fat is important under the age of two for brain development, body growth, and the absorption of fat-soluble vitamins (especially A and D).

That is why it is best to serve whole milk, whole milk yogurt (Yo Baby, for example), and whole milk cheese until a baby’s second birthday. I advise parents that it is OK to flavor milk with small amounts of syrup or Ovaltine if they are struggling to get the minimum requirements of milk into their sippy cup-toting child. (Read more about maintaining nutrition for picky eaters.)

What the Doc May Do

As usual, your pediatrician will watch your child’s growth curve carefully at each and every well child visit. Unusual instances of “failure to thrive” or very poor weight gain may require higher caloric intake throughout a child’s second year of life (or beyond). These children are placed on an “anti-cardiac” diet, rich in saturated fat and calories—much like the diet you would avoid as an adult—to support proper physical growth and development.

There are other medical conditions which might prompt your pediatrician to recommend a higher-fat diet past age 2, including prematurity with delayed “catch up” growth, significant congenital heart disease, or other severe chronic health conditions.

Pediatricians will almost never recommend a low-fat diet for kids under 2, but with the childhood obesity epidemic we face nationally, it is worth mentioning. Limiting fruit juices, sugared drinks such as sodas, desserts, and candies are critical in this age group. In kids over 2, I feel that the risk of childhood obesity far outweighs the risk of ingestion of small amounts of artificial sweeteners such as aspartame (NutraSweet) or sucralose (Splenda), and I OK them for my patients.

Bear in mind that there are some doctors who recommend continuing a high-fat diet until age 3. Although this was not how I was trained, there is no definitive study which proves that age 2 is an absolute cutoff. So use your good parental judgment, think about your child’s individual needs, and talk to the pediatrician at your toddler’s 2-year visit.

Even the most confident parent has concerns about her child’s health and wellness from time to time. Learn more about which medical issues are most common at each age, here. (If you have any pressing concerns or questions about your child’s health, please check with her healthcare provider.)

Article Posted 6 years Ago

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