Around the one-year mark, babies experience a lot of change. They graduate from infant to toddler, and their nutritional needs evolve. Figuring out the best approach for transitioning your little one to fluids other than formula can be confusing, so we invited Kimberly Dillon, MD, PPG – Pediatrics, to share the basics around introducing new beverages in a healthy way.

What are some of the major feeding takeaways after baby reaches six months?

Under the age of 12 months, babies will still rely on formula or breastmilk as their source of water, and this will also be the primary source of nutrients to round out their diet while they are still learning to eat. After six months, if you’re using bottles, they should be consumed sitting at the table, just like for any meal or snack time. To avoid something called “Baby Bottle Tooth Decay,” never give a child a bottle in a bed to help them get to sleep. This decay can happen even with something that’s healthy for babies, like formula or breastmilk, because the natural sugars (lactose) are reintroduced frequently and left on the teeth. The only other thing that should be placed into a bottle after six months of age is plain (unflavored) water.

What about other types of milk, such as goat’s milk, for baby?

Goat’s milk is lacking in nutrition like folic acid and can lead to unnecessary medical complications. Stick with breastmilk or commercial formula.

Is it safe to make formula from recipes found online?

Those recipes generally stem from the 1960s and before. While they may have been close to the commercially available formulas of the time, that was 60 years ago and the science of nutrition going into commercial formula has changed dramatically since then. I wouldn’t recommend using these.

When should parents consider switching their infant to cow’s milk?

Generally, we recommend switching from formula to cow’s milk around 12 months of age. When you do, introduce it in a cup, and only at meal or snack time while sitting at the table. Preferably, use an open cup (they need to learn how to use one independently by 18 months). If you do use a sippy cup of some variety, when the child gets down from the table at the end of the meal/snack, place the milk back in the refrigerator. Limit the milk to 4 ounces per serving, as opposed to the 6-8 ounces of formula they received in the bottle. Milk is lacking in iron compared to formula, and large amounts of cow’s milk can lead to anemia. Give the child plain water if they are thirsty outside of meal or sit-at-the-table snack times.

I have found that the easiest way to transition between formula and milk once they hit 12 months is to keep them separate. Cow’s milk doesn’t taste or smell like formula, so the child won’t expect milk to come in a bottle. Place the milk in a cup during meals. Give a bottle with formula at the table before bedtime until you run out of the current canister of formula. When the formula then goes away, the bottle naturally goes with it.

What about flavored milk?

Milk flavorings have a lot of sugar in them. We do not recommend using milk flavoring or flavored milk drinks.

Can a toddler have plant-based milks?

Yes! The American Academy of Pediatrics states that soy milk may be used as a safe substitute for cow’s milk once a child turns 12 months of age. However, other types of “milk,” such as almond, cashew, oat, etc. do not have the proper proportion of protein and fat required for growth and brain development in children. 

Do you recommend toddler formula?

Toddler formula is simply a marketing gimmick. It actually contains a large amount of sugar and gives no added benefits. The American Academy of Pediatrics does not recommend toddler formula for this reason.

If a parent is worried about their toddler’s nutrition, should they give them PediaSure®?

In my 20 years of experience in pediatrics, the number of children who have needed these protein shakes has been very few. If you have concerns about your child’s weight or growth, I advise that you speak to your child’s primary care provider before giving them nutritional supplements.

Is it OK to give an infant or toddler juice?

Did you know that apple juice contains 20 calories of sugar per ounce? That is almost double the amount of sugar contained in cola! This high concentration of the sweet stuff makes juice one of the major causes of tooth decay in children. Juice also has almost no nutritional value and certainly not enough to offset the potential health hazards.

If a child doesn’t like the taste of water, can parents add water flavoring?

As human beings, we are wired to drink water. If a child “doesn’t like” water, it’s because they were taught not to like water, either by being introduced to other sweetened options or by picking up on a parent’s bias of disliking the taste of water.

Zero-calorie sweeteners are 100X sweeter than sugar. They can set a child up to crave sweets to an extent that’s harmful to their weight and oral health. I’ve found that sometimes toddlers who are resistant to plain water will take to it if you put a little ice in the sippy cup. Something about the cold or the rattle appeals to them.

In 2019, the American Academy of Pediatrics put out a statement recommending only plain milk and plain water for young children. As a bonus, they also happen to be two of the most economical options.

Keep it simple and enjoy this time of transition for your little one. Introducing new drinks and time at the table can be fun and integral pieces in their development. If you have questions at any time, don’t hesitate to ask your primary care provider.