When Penelope turned 2, our wonderful pediatrician, Dr. Li, told us that the American Academy of Pediatrics recommended switching to 2% milk. I recall this being delivered in an extremely light-touch way, carefully noting that this was an AAP rec and not a Dr. Li special. We looked into it, and eventually I told her we’d be sticking with whole milk.
Reader, I will be straight with you: a big reason for our decision was because I am a lazy shopper. Jesse and I use whole milk (really, I think Jesse would put heavy cream in his cereal if it were socially acceptable), and the idea of keeping track of multiple milk modalities was too much for me. We considered switching everyone, but this made me sad about my coffee.
But not everyone is so lazy. Or maybe some people like reduced-fat milk. So this raises the question: do you need to switch milks?
While we are here, I’ll cover two other milk questions, about too much and too little.
Do you need to switch your kid to reduced-fat milk?
Generally, the suggestion to switch to reduced-fat milk reflects the overall dietary advice that adults drink reduced-fat milk. Why? Largely due to the lower fat content, which generates correspondingly lower calories. A cup of 1%-fat milk has 103 calories, versus 148 in a cup of whole milk. The share of people in the U.S. who are overweight or obese is high, and much dietary advice focuses on reducing calories. Hence, the advice to have reduced-fat dairy products.
However, it is not at all obvious on its face that this advice makes any sense. For one thing, it’s total calories that matter (as well as physical activity), so if you make up for lower-calorie milk with higher-calorie something else, that’s counterproductive. While it may be true that people who eat a higher-fat diet are, on average, more likely to be overweight, this is by no means a guarantee that these links are causal. I’ve written extensively about problems with drawing causal conclusions about diet (see here and my academic work). Aaron Carroll has a great book on why bad foods aren’t really that bad, if you want to go deep into the issue.
In this particular case, the ambiguity goes beyond the confounding factors. Increasingly, the correlational evidence suggests that kids who drink whole milk are actually less likely to be overweight than those who drink reduced fat. A 2020 meta-analysis of 28 studies found that 10 of them saw no association between milk fat percentage and childhood weight, and the other 18 found that children who drank higher-fat milk had lower weight. Averaging together, the risk of being overweight was reduced by 40% with whole milk.
This evidence has led to what I view as some slightly odd rhetoric. A 2018 update to guidance on toddler nutrition said: Although the American Academy of Pediatrics supports the consideration of reduced-fat milk instead of whole milk in toddlers who are at risk of obesity or cardiovascular disease, early introduction of reduced-fat milk may ultimately increase the risk of obesity and should be avoided in most cases.
This seems to suggest that reduced-fat milk should be used if there is a risk of obesity but also that it ultimately increases the risk of obesity and should be avoided. The main conclusion is that whatever you choose, it’s probably wrong. Or right. Could be both!
The main problem here — the same problem with a huge amount of research on diet — is that it is simply very, very difficult to separate out a single dietary choice from the rest of the diet and from other individual characteristics. Those 28 studies in the meta-analysis were all observational. None were randomized, so all we can really say is that children who drink whole milk are less likely to be overweight, not that the milk causes it. And dietary choices are so deeply wrapped up in all kinds of other features of families.
In the end, I would venture that it is highly unlikely that it matters what kind of milk you give your child. (It probably also doesn’t matter much what kind of milk you drink yourself.) If you like reduced-fat milk, that’s fine. If you like whole milk, that is also fine. Goat milk, expensive but fine. It’s all fine. (On the topic of raw milk, things may be more complicated — you can read more about that here.)
Side note: Flavored milk is a different beast, as it has a lot of sugar. That isn’t obviously a problem, but it’s a diet discussion for another day.
What should I do if my kid hates milk?
Some kids hate milk. My younger child, for example, never really got the taste for it. He will only drink it if we are eating something extremely spicy. What if your kid is like this — is it something to worry about?
Kids get a good deal of calcium from milk. Calcium is important for bone growth. However, calcium is also available in other foods, notably other dairy products — cheese, yogurt, ice cream, etc. But calcium comes in other foods too: soybeans, almonds, various vegetables, beans, some fruit. It’s often added to cereal and bread.
If your kid eats other dairy products, that’s likely to be enough. Even if they do not — say, due to lactose intolerance — it’s not difficult to get enough calcium through other foods.
What if my kid likes milk too much?
This was my other kid, especially as a toddler. She loved milk, even after she was well into solid foods as her main food source. Is this a problem?
Many people got scared, once, by a viral post about “milk anemia” in which a toddler developed severe anemia from subsisting mainly on milk. Underlying this is the observation that milk doesn’t have iron (this isn’t true of formula), so if kids drink milk at the expense of other foods, this can happen. There is also an interaction with iron absorption. If your child is lethargic or showing signs of anemia, they should be seen by a doctor. However, this is not that common, and if your child is eating other foods, it is probably not a significant risk.
Generally, toddlers aren’t supposed to have more than 32 ounces of milk a day. Toddlers and kids should get most of their nutrients through a variety of solid foods, vegetables, carbohydrates, and animal or plant protein. Early childhood is a time to learn about what foods you like and which you do not, to experience new textures and flavors. Too much milk can be a problem if it crowds these out.
I will tell you what we did, thanks to our nanny at the time, Madu, who came up with this. It is simple: we gave the milk at the end of a meal rather than with it. Kids tend to be quite responsive to timing — if they’re hungry and you do veggies first, they eat more of them. By giving a meal first and milk later, we had less crowding out of food.
The bottom line
- Generally toddlers aren’t supposed to have more than 32 ounces of milk a day. Toddlers and kids should get most of their nutrients through a variety of foods. If you’re finding that your child is filling up on milk, try serving it at the end of the meal.
- You do not need to switch your child to reduced-fat milk. Whatever kind of milk your child likes is a perfectly fine choice. The exception is flavored milk, which contains a lot of sugar.
- If your child doesn’t like milk, they’ll usually get enough calcium through other dairy products, including cheese, yogurt, and even (yes) ice cream. Even if they don’t, due to lactose intolerance or otherwise, it’s not difficult to get enough calcium through other foods such as soybeans, almonds, or calcium-fortified cereal.
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This doesn’t seem to take into account that there are some people whose genetics predispose them to higher cholesterol, and requires them to watch their saturated fat intake more….making it sensible to take a more cautionarg approach. Someone can always go back to whole milk as an adult if it turns out they didnt inherit this predisposition from parents, but if that is all they have ever had they might have a harder time getting used to lower fat milk varieties, versus if they are drinking 2% or 1% since childhood.
Has research been done on whole milk v 2% and blood sugar impact? I am under the impression that the fat in whole milk slows down the digestion process, leading to a more gradual release of glucose into the bloodstream.
I find this post a bit weird based on where I live. Here, the norm is 2% fat milk but children (and generally everyone) is recommend to drink non-fat milk. We do use a lot of milk-based products, so I think this article would have benefitted from some contextual perspective: how much milk is consumed per person in the US (versus other countries)? In my context, milk would make up a large percentage of sources of animal fat and that discussion was missing from this text. Is animal fat in general a problem? (at least in my context it is considered one of the main culprits behind cardiovascular diseases)
And I think this post could be supplemented with a discussion comparing cow’s milk to plant-based milks that have become increasingly popular at least in my country (especially oat-based beverages) and which are most more environmentally friendly. Since tastes are formed early, choices of milk in childhood may also affect choices later in life, which has implications for the environment in the future as well.
I think it’s also important to look at the macro nutrients in plant based milks vs animal based milks. Plant based are often much lower in protein, plus some plant based milks, like oat milk, are known for spiking blood sugars.