What should toddlers drink?

Now that Lily’s had a birthday, I’m trying to figure out what the evidence says on what children should drink after age 1.

If you’re just breastfeeding, it’s not that complicated about when to do what. The WHO recommends breastfeeding for at least 2 years, although I can’t even find numbers on how many women actually do that. (Around 1/3 of American babies are at least partly breastfed at 12 months). Their recommendations for non-breastfed children assume that people aren’t continuing formula past 6 months, I guess because most of the world can’t afford formula for a long time.

The American Academy of Pediatrics, on the other hand, says to stick with formula or breastmilk for 12 months and then…it gets kind of vague. Every “how to feed your child” guide handed out at the doctor’s office will tell you that after 12 months, you give them cow’s milk. I imagine most parents take this with a sigh of relief that they can start paying $3/gallon for whole milk instead of $24/gallon for formula.

But something doesn’t make sense here. If the WHO recommends breastfeeding for 2 years, and if formula is intended as artificial breastmilk, why stop formula at 12 months?

(One theory is that the WHO guidelines are meant for people living in countries with poor water sanitation, and breastmilk is recommended partly because it’s cleaner and safer than bottles or cups).

But let’s assume that there’s a nutritional component as well as a sanitation one. There’s hardly anything out there about the use of formula after 12 months. There’s one study (funded by a formula company) saying that formula-fed 3-4 year olds have fewer respiratory infections. There’s this theory that brain differences between breastfed and milk-fed toddlers might be decreased if toddlers got formula instead (but just a theory, no study). You can buy “toddler formula”, and while doctors seem to regard it as ok, I can’t find anyone who feels strongly about it.

I’m surprised at the lack of research here – it seems like it should be easy to find parents who would want to participate in a study where you gave them free formula. And if formula companies would love to point to studies in their favor. Possibly this means that some research was done and quietly discarded if it wasn’t in formula’s favor.

To me, the most obvious difference between formula and cow’s milk is that formula has added DHA. DHA and other long-chain polyunsaturated fatty acids seem to be important for brain development, and are found in breastmilk (particularly if mother is eating fish or fish-oil supplements). Cow’s milk does not have much of it, because cow’s milk is optimized for calves, which need to grow a lot of bulk and not a lot of brain.

They only started adding DHA to American formula in 2002, earlier in Europe. I suspect this is part of the reason that older trials, even ones that controlled for things like socio-economic status, found better cognitive outcomes in breastfed children. But in general supplements seem to work less well than actual food, and Cochrane says DHA supplements for babies don’t help.

So I guess I should keep trying to give Lily salmon, though she’s not keen on it right now.

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2 thoughts on “What should toddlers drink?

  1. detteyoung

    Smoked salmon has been a big hit with Rose, if you haven’t tried that. (I feel like a dreadfully extravagant feeding it to her, but – as with all the meat I feed her – I figure she is getting greater nutritional benefit for a given amount of meat than any bigger person.)

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