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Transition from Bottle to Cup

Naline Lai, MD and Julie Kardos, MD
00:00
11:20

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Dr. Naline Lai and Dr. Julie Kardos discuss issues that arise when transitioning infants from bottles to cups.

Krista S. -

Would you consider addressing the use of goat milk or goat milk formula in infants? I work in a more rural area in Central Washington state and have patients who use this as alternative to regular formula or breastmilk if they have poor supply. I have cautioned against the use, but have had a hard time finding good information about goat milk formula. In fact I had one patient at his one yr well child who looked very pale and his hct was so low that he had to have a blood transfusion. Mom had been giving him goat milk for several months.

Solomon B., MD -

Krista- thanks for the comment! We asked our Two Peds in a Pod- and here is what they said:

"AAP is very clear for infant nutrition not to give any type of "straight" milk whether cow, goat etc before a year of age.

Recommendation is for formula or breastmilk only. As for a goat milk based formula, we are unclear if there are any benefits or cons, vs soy or milk based formulas - we will have to ask our nutrition friends. However, the FDA has specific requirements for infant formula. Even though they do not approve formulas before they are marketed in the US, the FDA requires that formulas meet federal nutrient requirements. http://www.fda.gov/Food/FoodborneIllnessContaminants/PeopleAtRisk/ucm108079.htm

Bottom line, no "straight" milk of any sort for infants under a year.

Krista is right, not a lot of information about goats milk based formula. The question has now gone out to a different nutritionist who is pooling advice from other nutritionists!

I think it will probably boil down to formulas on the market need to meet federal nutrient guidelines (although I am not sure how they do any quality control since the formulas do not need to be approved prior to hitting the shelves) however, there is not a lot of data on whether goats milk based is any "better" or "worse" than formula based on cow's milk or soy. Plain goats milk, plain cows milk etc. on the other hand, should not be given prior to one year of age. "

So ?more to follow once we hear from the expert nutritionists!

Solomon B., MD -

Krista- more info from Julie Kardos (one of the Two Peds in a Pod) re: goat milk formulas:

"After several emails and a new-found connection, I have an answer from someone at FDA about goat milk formula.

According to Dr. Carrie Assar, PharmD, MS, acting director of the FDA's Infant Formula and Medical Foods Staff,

"All infant formulas sold in the United States, whether produced domestically or outside the US, must meet the requirements of the Infant Formula Act (21 U.S.C. 350(a)) and the associated regulations (21 CFR 106 and 107). These requirements, among other things, include registration and notification of an infant formula with FDA. Selling infant formula that has not been the subject of a notification to FDA (as required by the Infant Formula Act) is identified as a prohibited act in the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 331(s)). The registration and notification process mandated by the Infant Formula Act allows the FDA to conduct regulatory, safety, and nutritional reviews of infant formula products. The purpose of the infant formula requirements is to protect the health of infants by ensuring that the infant formula they consume is safe and provides adequate nutrients."

Additionally,
"To date, there have not been any goat milk-based infant formulas notified to FDA."

I am relieved that the advice I have been giving to parents all along still holds: all infant formula sold in the US are required to meet the same standards of nutrition and safety.

While there are some TODDLER goat milk based formulas sold in the US, they do not qualify as infant formula and, therefore, should not be given to infants.

Who knew?
Infant goat milk formula mystery solved.

Julie"

Rachel F. -

I have parents tell me that their child doesn't like cow's milk or that the parent's themselves do not want to give cow's milk in their home for whatever reason. I have a hard time responding when they ask which alternative milk is better (almond, soy, etc) . I typically discuss nutritive benefits of whole milk and also reiterate that that too much of any type of milk is concern as they most likely aren't eating as much foods that have more nutrients. I also have some parents that say their kids just won't drink milk. Do you have a better response for me? Thanks so much!

Solomon B., MD -

Hi Rachel-
Here is what our Two Peds in a Pod had to say:

"While all milk can provide calcium, vitamin D, and protein, the primary purpose of milk or any liquid is hydration. Kids do not have to drink milk. There isn't much nutritional difference between whole milk, soy milk, almond milk, etc. in terms of nutrition. Kids get their nutrients through food. It is more important to promote healthy habits: avoid "grazing" on milk or juice to protect teeth, and also avoid grazing for comfort with any liquid (even water!).

This article may be helpful for your families in thinking about milk: How to Transition to Milk in a Cup.

Thanks for listening to our Peds Rap!"

Solomon B., MD -

Oops- I dropped the link to the Two Peds in a Pod article...here it is:
http://twopedsinapod.org/2016/10/how-to-transition-to-milk-in-a-cup/

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Transition from Bottle to Cup Full episode audio for MD edition 11:21 min - 5 MB - M4A