Dropping Milk Feeds
Current health guidelines suggest one year old children should be consuming three meals of solid food per day, alongside roughly 400mls of milk. However, both Charlotte and I commonly come across parents who are struggling to drop milk feeds and increase solid food intake. We also get many questions asking what to do if children are refusing food and demanding milk instead.
Charlotte has written about milk guidelines and recommendations before, including detailed guidelines on “how much, when” and on “plant based milk alternatives”. If you’re looking for information on these, check these blogs out first.
This blog goes into detail around how to reduce milk feeds for a baby who may be over one and still having a milk heavy diet, affecting their intakes of solid foods.
Current Guidelines (a bit of background)
Exclusively breastfeeding or appropriate formula is recommended for the first six months of life. The introduction of solid foods should start at around six months of age alongside continued responsive breastfeeding or formula. From six months to one year solid food should be gradually increased and by one, a child should be eating three meals a day of solid food, alongside breastfeeding or formula milk. The gradual transition from exclusive breast or formula milk to food between six months and one year is essential – nutritionally, babies need solid foods after six months to maintain healthy growth and development.
Often once a baby reaches one year of age, formula or breast milk is replaced with dairy. However, there are many health benefits to continuing breastfeeding after one; balanced nutrition (if in conjunction with solid foods) boosted immunity, improved health and emotional comfort. Therefore recommendations from the World Health Organisation are to continue to breastfeed up to two and beyond alongside solid foods.
When it comes to milk, national guidelines suggest children over one should be consuming around 400mls (14oz) of dairy per day. This can equate to something similar to – a small cup of whole cow’s milk (100-120mls), a small plain yoghurt (125mls), or 2 tbsp of grated cheese.
These guidelines also recommend a natural reduction in milk consumption as food intake increases, but for some babies this doesn’t happen naturally. If children are still having high consumption of milk and not consuming much in the way of solid foods as they approach one year, it’s useful to look at how much milk is being offered, meal times, routines, food choices and the environment in which food is being offered.
If you are experiencing difficulties cutting down on milk after one
It’s good to look at some of the things going on with your baby/child’s feeding such as;
- When are they eating?
- What are they being offered?
- What are the challenges at mealtimes?
- Who do they eat with?
- What is going well?
- Keeping a food diary can also help.
Some children really take to milk and enjoy breast, or formula milk more than solids. The reason for this is often that:
- It’s familiar and comforting
- It’s easy to consume
- It’s a quick, efficient source of calories and nutrients.
However, it’s not enough or babies alone after 6 months of age. Babies need solids to help:
- Add to nutrition intakes and fill the energy and nutrient gap that milk can’t meet
- To help them learn to self-feed and regulate intakes
- To help them develop feeding skills such as biting, chewing and coping with textures.
There are some common barriers which can hinder the uptake of solid foods;
How to cut down on milk feeds
This is a difficult topic to cover in a blog as it is very individualised to the family and parents. That is why ideally seeing your HV or HCP and getting individual support is best. However, it is important to cut down on breast or bottle feeds gently, to avoid causing distress to your child. Gentle and empathetic parenting approaches are best for long lasting behaviour change.
With any kind of gentle behaviour change, consistency is key. When replacing milk feeds for food, it is recommended this feed is replaced permanently, to avoid sending mixed messages which can be highly confusing,
This can be achieved by;
- Having a routine meals times with milk feeds in-between
- Gradually cutting one feed out at a time and, if over one, you could replace this with a nutritious snack
- Avoid offering milk instead of meals or snacks
If breastfeeding, try cutting down one feed at a time to avoid mastitis and blocked milk duct or expressing instead.
Most health professionals would recommend using the last tin of formula and then offering full fat cow’s milk once a child is one year of age. Formula has very specific guidelines on how to make which should always be followed. If a child is struggling transitioning to dairy milk, then small amounts of dairy can be added to formula after it has been correctly made. See my blog on when to move baby from formula to cow’s milk and how for more information on this. If your child is still having a few bottles in the day then cut down one bottle at a time. Recommendations are to gradually reduce the use of the bottle from one year of age in order to maintain healthy teeth. Read my blog on cups and beakers for babies.
Day vs Night time feeds
Different approaches are taken during the day and at night but communication is key. One-year old children understand much more than most parents think they do, understanding of language comes before speaking! Communicating changes before they are about to happen will prepare a child for the change itself. Plan which milk feeds you are going to take out and then communicate with your child.
Day – if the child is drinking milk and not eating then this feed needs to be replaced with appropriate foods/meals.
As an example:
- “Today you are going to eat lots of solid food and you are only having milk at sleep time”.
- If a child communicates they want milk outside of the time you specified gently remind them, “Today you are only having milk at sleep time” and then offer something else, water or a snack.
- If they become distressed, offer recognition, empathy and choice. “I understand you want milk, I can see this has upset you, however it is important you eat food, just like I do, you are having your milk at sleep time, let’s have something together now, would you like apple or breadsticks”
Emotional parenting and positive boundary setting, such as this, is key as children grow into toddlers. In harder times remember; you are doing this for them, for their health, because you love them.
Night – communication and cuddles, offering cuddles instead of milk but night feeding is often ingrained with sleep. I wrote another blog for Charlotte specifically around night feeding, this will be posted soon.
I hope this blog has alleviated some anxieties around milk after one and how to cut down. If you are struggling with any of the points covered please do not struggle alone. Contact your local health visiting team for support or you can contact me for a consultation firstname.lastname@example.org
Written by Charlie Blyth, Specialist Public Health Nurse (Health Visitor) and founder of The Healthy Child co. You can follow @thehealthychildco for more tips, advice and support or visit www.thehealthychildco.com for health and parenting courses and workshops.